FIAPA  Common indication includes detection of fractures

chest pathology also foreign body localization.

Lesson 1: The Radiographic Film
Characteristics of a Good Radiograph
Working in the Philippines
 Adequate exposure factors are used.
 The Philippines is one of the world's third world
 Adequate x-ray penetration is evident on the part of
countries and is currently developing, with many
interest.
citizens that lack access to healthcare and higher
 Sufficiently geographic density and contrast are
education.
present.
 Although some of its hospitals utilize CR or DR imaging
 Field size selection is appropriate.
systems, many are still using the analog counterpart.
 Motion is absent during exposure.
 Do to its low commercial price and cheap
 Anatomic part being examined is properly positioned.
maintenance, the FS imaging system is more
 Proper accessories have been utilized.
appealing to the Philippine hospital market.
RADIOGRAPHIC FILM
Advantages of Film-Screen
Image Receptor
 Radiography is a vital tool of a hospital due to its ease
to produce readily available diagnosis of the patient's  A medium that converts X-ray into a visible image,
condition, especially for trauma and VA patients. either by processing or digital manipulation. Examples
 With film screening, the technologists will not used in radiography include:
worry about problems related to auto-processor  Radiographic Film
or electronic errors in digital post-processing.  Solid State
 However, the technologist must be skillful  Fluoroscopic Image Intensifier
enough to avoid repeat examinations.  Television Monitor

RADIOGRAPHY Radiographic Film

Art of Radiography  A media that makes a permanent record of the image.

 Create a recorded image caused by retaining the areas
 Radiography: the use of ionizing radiation (x-rays) to
exposed to X-ray photons.
produce a recorded image on a photosensitive
 The most common image receptor.
material.
 Parts: Base, Adhesive Layer, Emulsion, Protective
 Radiograph: an image produced using x-radiation
coating.
recorded on a photon sensitive material.
 Thickness: 175 – 300 (whole)
 Radiographer: the professional trained to use X
rays to produce a radiograph. Brief History of the Radiographic Film

Technical Competencies of a Radiographer  1895: Photographic Glass Plate

 The first to be used as imaging base, applied during
 Operation of the control panel.
the World War I for diagnosing injured soldiers.
 Selection of appropriate exposure factors.
 Coated with a single coat of photographic
 Selection of appropriate accessories.
emulsion.
 Utilization of terminologies in radiograph evaluation.
 Expensive, fragile, heavy, and of limited supply.
 Utilization of measurements.
 1904: Double Emulsion Glass Plate
 Evaluation of results (poor, fair, good)
 Charles Leonard demonstrated double-emulsion
Radiography radiography, still on glass plates.
 Exposure time must halved and the image was
 Provides the cheapest and simplest examination. enhanced, due to a decrease of blurring associated
 Uses x-radiation to create a 2D image of the body in with long exposure times.
the form of shades of grayscale.
  Provide a rigid structure onto which the emulsion can
 1918: Cellulose Nitrate Film Base be coated and maintain the integrity of the image.
 Cellulose Nitrate: a film base that was found out to
Requirements of the Base
be a better and cheaper alternative to glass plates.
 Is highly flammable and easily torn.  The radiographic base is composed of polyester
 Responsible for numerous fire incidents in hospital plastic.
basements during the 1920s – 30s.  Polyester = Ethylene Glycol + Dimethyl
 1918: Double Emulsion Film Terephthalate
 Commercial availability of duplitized (Double-  Must have a strong build, clear of impurities and
Emulsion) films of medical use. consistent thickness.
 1920s: Cellulose Triacetate Film Base  Tinted with pale blue or blue-gray dye.
 Also flammable, and not as bad as those c. nitrate
 Considered “safety film base” because of its Properties of the Base
somewhat less flammability than its predecessors.  Physical Stability: flexible and sturdy, prevents
 Emulsion cracks and peels away from base when damage during handling and processing.
processing chemicals are too hot.  Dimensional Stability: the ability to maintain size and
 1924: Cellulose Acetate Film Base shape during use and processing to avoid image
 An alternative for its triacetate counterpart. distortion.
 1933: Tinted Film Base  Uniform lucency: near transparency to light to avoid
 Early radiologists interpret numerous amount of unwanted shading or patterns in the image.
images every day, thus, very much susceptible to  Slight tint of blue dye: manufactured to have 0.14 OD
eye strain and fatigue. to reduce print-through effect and eye-strain.
 The introduction of tint in the film base reduced
this effect and made interpretation less fatigue to Why Polyester: Qualities of Polyester
the eyes.
 Superior dimensional stability
 1936: Direct Exposure Film
 Stable optical clarity
 1940: Film Suitable for Both Direct/Indirect Exposure
 Waterproof
 1958: Fast Light-Sensitive Film  High tensile strength and flexibility
 1960s: Films Suitable for Rapid Processing  Chemical memory
 1960s: Polyester Film Base  Inert to processing chemicals (chemically inactive)
 Polyester was introduced as the superior material
in the production of film-based radio graphic Polyester Vs. Triacetate as Film base
images.
 Polyester is less susceptible to high temperature.
CROSS SECTION  Polyester is much stronger than triacetate, in terms of
same thickness.
Parts of the Film  Polyester is more resistant to warping due to age.
 Polyester permit easier transport in automatic
 Film Base: provides flexible support for the emulsion.
processors.
 Adhesive Layer: maintain contact of emulsion to the
base. Film Base: Specifications
 Emulsion: consists of Silver Halide crystal as recording
 Thickness: 150 m – 300 m
medium and gelatin as structural support.  Composition: Polyester plastic
 Protective Coating: protects the emulsion from  Ethylene glycol + Dimethyl terephthalate
outside elements.  Base Density = 0.14 OD
 Result of blue or blue-gray dye.
The Radiographic Film Base
The Adhesive Layer (Substratum)
 Provides flexible, but not elastic, support for the
radiographic emulsion.  Allows the emulsion and base to maintain proper
 Serve as the foundation of radiographic film. contact and integrity during use.
  Transport: within the cassette.  Pressure created from picking up the film.
 Handling: loading/unloading from the cassette.  Scratches were made while processing.
 Processing: moving from different chemistries.  AKA Overcoat, Supercoat, Topcoat
 Coated on the base before the emulsion is added
during manufacture. FILM EMULSION
The Active Layer of the Film
The Emulsion Layer
 Known as the active (heart) layer of the film because it
 The heart of the x-ray film. performs the actual purpose of the radio graphic film.
 The material that interacts with the (1) X-ray from the  Primarily a controlled mixture of gelatin and silver
tube or (2) photons from the intensifying screen and halide crystals, contains the image during pre- and
keep that information. post- processing.
 Photographically active, activated by light and  The silver halides hold and make the image.
radiation to create an image.  The gelatin holds the silver halides in place.

Composition of the Emulsion Characteristics of the Gelatin

 A homogenous mixture of Gelatin and Silver Halide  Must be clear to transmit the light emitted by the
(Fluorine, Chlorine, Bromine, Iodine) crystals. screens directly to the crystals.
 Most are made of AgBr (98%) and Agl (2%).  Should be porous to allow processing chemicals to
 Arranged in lattices, creates the images easily reach and act upon the crystals.
depending on how the photons collided the  Functions as a support medium to hold and maintain
structure. the crystals uniformly dispersed.
 Spectral Response: the absorption of visible light
Why Collagen (Colloid) as Ideal Gelatin Material?
emitted by the phosphors.
 Maintains every suspension of crystals.
Characteristics of Emulsion Layer  Ability to swell, shrink, and harden.
 Consists of a gelatin containing the film crystals.  Increases the sensitivity of the crystals.
 Can be on one side or both sides of the base. More on Gelatin
 Can have different thickness, quantity, and size of
crystals.  In manufacturing, the colloid instructed from cattle
 Consider the active layer of the film, due to its reaction hooves and hide are rendered into a pure
to electromagnetic energy (visible light, x-rays) that uncontaminated state.
the other layers do not possess.  The gelatin swells while immersed in processing
solution which allows easy penetration of
Types of Film Emulsions chemicals.
 Standard Contrast emulsion  Able to re-harden in the drying stage of
 Serves as the baseline of the other types. processing.
 B + F density = 0.18 Manufacturing Process of the Gelatin
 Average Gradient = 2.16
 D-Max = 3.5 – 4.0  Mixing of gelatin
 Speed = logarithm of 1.53  Emulsification
 Half – Speed emulsion  Physical ripening (coalescence, Ostwald)
 Latitude (L) emulsion  Cooling
 Contrast (C) emulsion  Shredding and Sieving
 High Speed emulsion  Washing
 Holographic emulsion  Chemical Ripening
 Doctoring for additive (
The Protective Coat Layer sensitizer, hardener, fungicide, wetting, plasticizer)
 Is cellulose layer that serve as protection to outside Silver Halide Crystals
environments that might damage the emulsion, such
as:  Serves as the recording medium of the image, the
 Moving the film across the screen/cassette. active ingredient of the emulsion.
  Manufactured to have specific characteristics Grain Shape of Crystals
(e.g., speed, contrast, resolution).
 Manufactured to be sensitive to specific colors of  During manufacture, the silver halide crystals are
light (spectral matching). harvested and mixed with emulsion gelatin.
 Mixture is made with precision and care to ensure
Characteristics of the Crystals the uniform distribution of crystals in the emulsion.
 The crystals can be processed into two grain
 Consist of 98% AgBr (S. bromide) and 2% Agl (S. shapes, globular and tabular grains.
iodide).
 Commonly manufactured tabular in shape, 0.1 m in Globular Grains
size, and used mostly in general radiography.
 Approx. 1-1.5 m thick for screen-film exposure.  Appearance: Compact spherical shape
 Crystals are made in cubic structure.  Advantage:
 Crystal Lattice containing ions.  Processed to be a high volume to increase
absorption efficiency without producing
Manufacturing Process of the Crystals excessive unsharpness, in relation to film speed.
 Metallic silver (Ag) is dissolved in nitric acid (HNO3) Tabular Grains (T-Grain)
and forms silver nitrate (AgNO3).
 Silver nitrate is mixed with potassium bromide (KBr).  Exclusive to sensitized emulsions, appearing flatter
 Due to the strong ionic attraction between and tabular versions of the crystals, reduces light
silver and bromide, silver separates with nitrate scatter and increases resolution.
and bromide separates from potassium.  T-mat (Kodak 1963): allows reduced patient dose.
 Silver and bromide form silver bromide (AgBr) and  Structures twins Emulsion (Agfa): allows quality
the other pair becomes potassium nitrate (KNO3). images with high film speed.
 Since Silver bromide is solid, it precipitates.
Potassium nitrate is soluble, therefore, is wash  Advantage:
away.  Increased image resolution, due to decrease in
 Silver bromide is then harvested and is processed crossover effect.
according to its designated radiographic  Reduced silver coating weights, crystals are
specification. designed thinner and flatter.
 Suitable for 45-second processing systems.
Lesson 2: Radiographic Film: Characteristics
 Disadvantage:
The Film is Composed of Layers  Increased graininess caused by increase quantum
 Film Base: provides flexible support for the mottle, due to decreased prevalence of
emulsion. crossover.
 Adhesive Layer: maintain contact of emulsion to the  Lower silver recovery.
base. FILM EMULSION
 Emulsion: consists of Silver Halide crystal as
recording medium and gelatin as structural support. The Film Emulsion
 Protective Coating: protects the emulsion from  The emulsion is considered as the active layer of the
outside elements. film and serves as its recording medium.
 Is primarily a mixture of gelatin and silver halides.
The Sensitive Emulsion  Dictates the specification of how it records the
 The heart of the x-ray film. image like quality, speed, and dose required to
 The material that stores the latent image, produced create an acceptable radiograph.
by exposure from visible light and X-rays. Types of Film According to Emulsion Coat
 Photographically active, activated by light and
 The efficiency of image formation and dose
radiation to create an image.
requirement can be affected by how emulsion was
 A homogenous mixture of Gelatin and Silver Halide
coated on the film.
(Fluorine, Chlorine, Bromine, Iodine) crystals.
 How the coating was made also have their own
CRYSTAL GRAINS advantage and disadvantage.
 Emulsion can be applied to the film as: Crossover Control Layer
 Single Coat
 Double coat  Crossover Control Layer: found within the film base
that functions to reduce effect near zero.
Single Emulsion Coat  Absorbs most of the crossover light.
 Remains as a separate layer and does not
 Advantage: better image detail than double-coat diffuse in the emulsion.
films.  Is removed completely during processing.
 Disadvantages:
 Halation: the emulsion is double exposed by FILM CHARACTERISTICS
screen (if exposed on a double screen cassette).
 Increase patient dose (due to lower speed Variations According to Purpose
compared to duplitized films).  Radiographic films are designed to meet the need of
 Compensatory Layers: the Radiology department, intended to be used
 Anti-Halation Layer: absorbs light that passes depending on its purpose.
through the film base and into the opposing  When high quality images are needed, high
coating. resolution films and high contrast films can be
 Anti-Curl Backing: another layer of gelatin that used.
ensures the film stays flat.  If patient dose is the primary concern, high
Double (Duplitized) Emulsion Coat speed films and duplitized films are available.

 Advantage: More on Film Specs

 Less patient dose required to create an image.  The service the x-ray film can perform is dependent
 Higher film speed, compared to single coat. on how it was designed during manufacture. Film
 Disadvantage: characteristics include:
 Results to crossover effect during exposure.  Film Speed
 Less image detail, due to the prevalence of  Spectral Matching
penumbra.  Film Contrast
Image Penumbra in Duplitized Films  Exposure Latitude
 Abidance to Reciprocity Law
 Penumbra: occurs as the blurred edges of an image
caused by two same images superimposing each Speed Point (Film Speed)
other.  The degree of sensitivity of the film to x-rays and
 Overlaying images registered on both film light.
emulsions blur the edges of protected  Determined by the number and size of the
structures. crystals.
 Inherent in images in double-emulsion coat  Film Speed Expressed as Arbitrary Numbers
films.  Fast: values greater than 200
Crossover Effect  Average: values around 100.
 Slow: values ranging 50-90.
 AKA Parallax, Print-Through, Cross-stalk.
 An image is created on both emulsions, then Relation of Emulsion & Speed
superimpose each other resulting to a slight blurring  Duplitized films are faster than single-emulsion films.
of the image.  Single coat: maximum of 150 speed values.
 Exposure of an emulsion caused by light from  Double coat: around 200 values
the opposite intensifying screen.
Factors that Decrease Crossover
Relation of Exposure Factors & Speed
 Film base is dyed with blue.
 Silver halides crystals in the emulsion are  Film Speed = Sensitivity = exposure factors
manufactured in tabular grains. necessary to produce specific density
 Intensifying screens used emit short wavelengths.
 Film used has Crossover Control Layer.
 Relation of the Screen & Film Speed  High Contrast: film emulsion contains smaller
crystals with uniform grain sizes.
 The films’ speed value must match the intensification  Low Contrast: film emulsion contains larger
factors of the screen to achieve quality images. crystals with (random changes in grain sizes.
 Speed Value: the exact value of speed of the film.
 Intensification factor: measure of screen speed, Exposure Latitude
should match that of the film speed.
 Screen Speed: AKA light emission; the amount of  The ability of the film to achieve a diagnostically
light the screen produces. acceptable image even though it was overexposed or
underexposed.
Relevance of Film Speed  The “margin of error” of the film, takes into
consideration the chance of errors that may
 Speed = Sensitivity = Dose = Contrast occur during exposure.
 Fast films usually contain large crystals resulting  Capability of the film to produce optical density.
to high sensitivity, this results to reduced
contrast. Relation of Exposure Latitude & Contrast
 Slow films require more radiation due to their low
sensitivity, however, has superior contrast.  In Low Contrast Emulsions
 Film speed if the choice if patient dose Is the  Contains larger grains, having variety in grain
size differences; grants more sensitivity.
primary consideration.
 Has 3x Wider exposure latitude.
Spectral Matching  Grants more range of exposure factors to create
an acceptable image.
 A principle stating that the spectral response of the  Typical duplitized films having twice the speed.
film must match the light spectrum emitted by the
intensifying screen.  In High Contrast Emulsions
 Spectral Response: the sensitivity of the film to  Contains smaller grains with relatively uniform
various light colors. sizes.
 Higher frequency colors have a higher tendency  Has narrow exposure latitude.
to overexpose the film if exposure is done  Requires an exact (or nearly exact) exposure
incorrectly. factor to achieve its high contrast.
Films & Their Spectral Response Abidance to the Reciprocity Law
 Monochromatic Film: sensitive to higher frequency  Reciprocity Law: states that any combination of mA
colors; matched with blue light emitting screens. and time that produces the same mAs value will
 Orthochromatic film: sensitive to a wider portion of produce the same density.
the spectrum; matched with green light emitting  Formula: Exposure = Intensity x Time = Constant OD
screens.  Applicable only in film-screen radiography.
 Panchromatic: sensitive to all visible light colors.
According to Spectral Sensitivity
Additional Notes
 Monochromatic
 Monochromatic (mono = single) films are sensitive to  Orthochromatic
the single blue color emitted by the CaWO3 screen  Panchromatic
and ignores ROY color emitted by the Wratten 6B
filter. According to Number of Emulsion Coat
 Orthochromatic (ortho = correct) films are sensitive
to a wider range of color emitted by the rare earth  Single-Coat Film
screen & are only suitable to the GBX2 filter.  Double-Coat (Duplitized) film
According to Manner of Exposure

Film Contrast  Direct Exposure Film

 No screen is involved; purely x-rays from the
 The quality of film contrast id inherited to the film image.
and is designed during manufacture.  High exposure factor; results to high patient
dose.
  Thich emulsion; single coated.  Done by exposing a side of the film under a
 High resolution; produces high density and positioned anatomy, then another on the other
contrast. side.
 More crystals in the emulsion.  The side of the film not being exposed should be
covered by a blocker.
 Indirect Exposure Film
 Screen is involved; x-rays are converted into According to Use
visible light by the IS and absorbed by the film.  Radiology offers a wide range of services and utilize
 Low exposure factor; results to low patient imaging films depending on a given specialty and
dose. workload. These include:
 Thin emulsion; double/duplitized coated.  Specialty film
Screen-type Vs. Direct Exposure Films  Localization film
 Video film
 Screen-type film  Laser film
 A: patient dose, speed
 D: resolution Mammographic Film
 Direct Exposure Film  Use in mammography, imaging of female breasts.
 A: resolution, D-max, contrast  Commonly a single emulsion contains fine grains and
 D: patient dose, speed produces greater detail.
According to Film Size Therapy Localization Film
 Principle of Use: all portions of the part of interent  Used as a reference image to locate the part of
should be included in the image, positioned interest.
properly, done in minimal expense of film.  Provide acceptable radiographic detail under a wide
 Common film sizes found in hospitals and clinics range of exposure to X-rays and gamma rays.
include:
 14 x 17in, 14 x 14in, 11 x 14in, 10 x 12in, 8 x 10in Dental Radiographic Film
 Must be exposed in a matching cassette size.  Used to image the patient’s teeth which the dentist
Common Film Size Application utilizes to diagnose oral health.
 Intra-oral: AKA periapical, bitewing,
 14 x 17in: on abdomen, chest (male), lower interproximal occlusal film; place inside the
extremity mouth.
 14 x 14in: on chest (female or adolescents)  Extra-oral: AKA panoramic film; placed outside
 11 x14in: on chest (pedia), lower extremities (2p) the mouth.
 10 x 12in: used mainly on skull, foot, babygram.
 8 x 10in: used mainly on hand, chest (infant) Video Film

Use of 14 x 17in Film  A single emulsion film to be exposed in a device called

multi-format (laser) camera.
 The 14 x 17in film covers the largest area and is
usable for imaging large body parts. Photofluorographic Film
 Chest (male, adult)  Used in photography of the image on the fluorescent
 Abdomen screen by a camera for mass chest X-ray examination.
 T/L Spine (2P)
 Thigh/Leg (2P) Cine Film
 Single emulsion films with sprocket holes.
Film exposure with Multiple Projections Copying (Duplicating) Film
 A common practice when imaging portions of the  A single emulsion film designed to be exposed under
patients’ extremities, POI is demonstrated in different ultraviolet light through an existing radiograph to
positions in a single film. produce a copy using BLB UV fluorescent lamp.
 Automatic Serial Changer Film  Films should be stored in a clean dry place with
temperature ranging from 50 to 70 °F and humidity of
 Used in serial imaging radiography (e.g., angiography); 30 to 60%.
has special protective coating.
Nearly Radiation Sources
Dosimeter Film
 Films should be stored away from nearby radiation
 AKA Personnel Monitoring Film, placed inside a sources; this will fog.
dosimeter.  Chemical solutions should not be stored near films for
 Dosimeter: a device used to measure the dosage the emit of (although fairly weak) radiation in the form
received by the professional being monitored. of potassium-40.
 Film emulsion has varying grain sizes, affecting its Shelf Life
sensitivity to radiation.
 Measure rad (radiation absorbed dose).  Films are supplied in boxes with an expiration date.
 Always take note of the manufacturer’s
Industrial Film expiration date.
 Expired films lose their speed in contrast and
 Use for high-energy non-medical radiography.
increase their tendency of fogging.
Polaroid Radiographic Film  Films should be stored in upright orientation not in
stacks.
 Paper-based film for radiography.
Packaging
Laser Film
 Most films are supplied in boxes of 100 sheets.
 Imprints the images via laser printers; commonly used  14 x 36 inch size films are supplied in 25-sheet boxes
for printing images of CT and MRI scans. with each sheet interleaved with paper.

FILM CARE & HANDLING Usage

General Precautions  The oldest films in stock should always be used first.
 Stocking should be practiced to ensure there is always
 Improper handling of radiographic films will result in films to be used.
poor image quality due to artifacts.
 Hands must be clean and dry when handling
films.
 Hands should not be applied with lotions or
creams; chemicals might cause reactions to the
film emulsion.
 Film should be opened only in the processing room
using the recommended safelight system.
 Film should not be:
 Bent, buckled, or pinched while handling.
 Laid on cabinets or benches for too long.
 Drop or slide through a surface.
Storage Considerations for Radiographic Films
 Radiographic films are delicate and very sensitive to:
 Heat and humidity
 Radiation sources
 Shelf life and packaging
 Usage
Heat & Humidity
 Films are sensitive to heat and humidity throughout,
from its manufacture until it was viewed.