MIDTERM-RDT 104

MIDTERM-RDT 104
Radiographic Contrast Part 2
● RADIOGRAPHIC CONTRAST
- the image quality factors holds a significant contribution regarding the visibility of anatomy
- how a part is distinguishable from another anatomical structure
- arises from the areas of light, dark and shades of gray
- density differences
- much more of a complex attribute than density
● Is it possible to have a density on a radiograph without the presence of contrast?
- Yes. If the entire film has been exposed to a uniform (homologous) amount of radiation from the intensifying
screen, the result will be a radiograph that has the same density level over the entire surface of the film.
- density exist even without contrast

- A radiograph with density however has no variation in the density level.

- if we apply this in a clinical set up, we cannot determine what we should see in the image.
● Is it possible to have a contrast present on a radiograph without the presence of density?
- No. Contrast on a radiograph depends on the presence of density.

- A radiograph with multiple levels of density, producing contrast.

- Contrast is responsible for the visibility of the outline or border of an anatomical part or structure.
- Radiographic contrast results from differences of attenuating capability or feature as the x-ray passes through
various tissues in the body.

● ATTENUATION
- a process where radiation is reduced when passing through the medium, either partially scatter (Compton) or
completely absorbed (Photoelectric effect).
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 - X-rays that reach the IR will be converted into black metallic silver processing.
- Transmission is not included in attenuation but it is only a simultaneous outcome of photoelectric effect and
Compton scattering.
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The chest x-ray image, bone-to-soft tissue interface exhibits high contrast (best example). Density variations is from
black to white and few apparent steps
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Abdomen x-ray, a lot of organs. There’s little difference exist between adjacent soft tissues. This is an example of low-
contrast appearance since there has been a lot of shades of gray that we can determine.
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- Obtaining adequate image contrast requires that the anatomical part is adequately penetrated.
- Therefore, penetration becomes the key in understanding image contrast.
- The penetrability of the x-ray beam is controlled by kVp.
- As x-ray energy is increased, the relative number of x-ray that undergo Compton scattering also increases—
which means to say that kV is one of the factors that affect the level of scatter radiation.
- As scatter radiation increases by the time that you are exposing the patient, the radiographic image is losing
contrast which makes it appear from gray to dull.
- All radiographs should be taken at the lowest reasonable kVp because this technique would result in minimum
scatter, which would result in higher image contrast.
- Unfortunately, it is not that simple. When it comes to penetration, no matter how much of an mAs that you would
adjust, there will be no effect at all when it comes to the capability of our x-ray beam in regards to its energy of
how much of it will reach to expose our IR.
- kVp is our main factor when it comes to the penetrating capability of our x-ray beam.

- mAs is not a substitute for beam penetration. It cannot make up for a lack of energy in the x-ray beam.
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 - Fewer x-rays reach the IR at lower kVp.
- disadvantage— higher patient radiation dose
- increasing the mAs usually generates enough x-rays to provide a satisfactory image. However, the same
outcome is an unacceptably high patient radiation dose.
- Smaller increase in kVp provides sufficient x-rays at a much lower patient dose. Unfortunately, when you
increase the kVp, scatter radiation will also increase leading to reduced contrast.

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In this table, during an exposure, it is simultaneous that apart from transmission we have interactions from photoelectric
and compton effect.

- At low energy, most x-ray interaction with tissue is photoelectric or absorbed mostly.
- At higher energy, compton scattering relatively increases.
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- As the dimension increases, the intensity of scatter radiation also increases.

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 - Scatter radiation is the “blanket of fog” (unwanted exposure) on radiographs. It contributes no useful
information to the overall density on the radiograph but decreases contrast.
- In IR: scatter radiation is an additional information
- Compton scatter x-rays will create an image noise (generates a generalized gray or dull quality)
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pelvis x-ray image

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- Radiographic film images are typically described by their scale of contrast or the range of visible densities.
- grayscale of contrast— refers to the range of optical densities from whitest to the pitch black
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 - low kVp, high mAs to not compromise the image quality. But also mind the PATIENT DOSE!!!!!
- cause of repeat in mobile x-ray: underpenetrated (left pic)
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GENERAL GUIDELINES FOR DESIRED CONTRAST

PROCEDURE SUBJECT C+ EXPOSURE
FACTOR (kVp)

Skeletal Radiography (Bone) High Low

Soft Tissue Radiography Low (Fat & Low

(Breast) Muscle)

Chest Radiography High High

Abdominal Radiography Low Low

- Contrast is a complex attribute.

- a psychovisual perception, it is in the eye of the beholder, according to your preference.
- Level of Radiographic Contrast desired
- anatomic tissue
- amount of information needed to visualize the tissue for accurate diagnosis
- Good contrast = High Contrast
- not desirable
- should be avoided
- Low Contrast
- most desirable as it provides more information as long as when measured in the densitometer it is
within the visible range of useful ODs

Radiographic Contrast
Influencing factors affect Radiographic Contrast by controlling the amount of Scatter Radiation that reaches the Image
Receptor
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 ● RADIOGRAPHIC CONTRAST
- the degree of difference between adjacent densities
- the total amount of contrast present acquired from both the anatomical part and the film
○ CONTRAST
- one of the two photographic properties that comprise visibility of detail
○ VISIBILITY OF DETAIL
- refers to the fact that the radiographic image is visible to the human eye only because sufficient
contrast and density exists to permit structural details to be perceived

- It is combined result of two categories:

- Film (Image Receptor)
- Subject Contrast
● TWO CATEGORIES
○ FILM (IMAGE RECEPTOR) CONTRAST
- is a result of the inherent properties manufactured into the type of film and how it is radiographed
(direct exposure or with I.S), along with processing conditions
- Example:
1. Film Type
2. Direct Exposure
3. Intensifying Screen
○ SUBJECT CONTRAST
- is a result of the absorption characteristics of the anatomic tissue radiographed and the level of
kilovoltage used.
- Example:
1. Kilovoltage
2. tissue Composition
3. Contrast Medium
- It is the range of differences in the intensity of the x-ray beam after it had been attenuated by the
subject.
- It is dependent on kilovoltage and the amount and type of irradiated material.
● KILOVOLTAGE
- as long as the kVp is adequate to penetrate the part being examined, low kVp will produce high subject contrast
- When kVp is too low, most of the photons do not reach the film because they are absorbed by the patient.
- Low kVp produces higher subject contrast because most of these low energy photons are absorbed by the
thicker parts while more penetrate the thin part.
- With high kVp, subject contrast is decreased because more uniform penetration occurs between thick and thin
part.
- In addition to kVp, radiation fog has a significant effect on contrast. It is the result of x—interaction with matter,
primarily Compton scatter.
- As kVp increases, the percentage of Compton interaction increases. As a result of this increase in the amount
of scatter reaching the film, contrast in decreased.

● ANATOMIC PART
- Tissues that have A higher atomic number absorb more radiation than those with a lower atomic number.
- As thickness of a given type of anatomic tissue increases, the amount of scatter radiation also increases and
radiographic contrast decreases.
- Knowledge About Absorption Characteristics of Anatomic Tissues and The Effect of kVp Helps the Radtech
Produce A Desired Level of Contrast
- The CHEST is an anatomic area of HIGH SUBJECT CONTRAST because there is a great variation in tissue
composition.
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 ● CHEST EXAMINATIONS
- High kVp results in a wide range of radiographic densities that fall within the visible range of densities.
- It visualizes air-filled lungs, soft tissues, and the bony structure. No structure appears underexposed or
overexposed.

Good Contrast— pulmonary vessels visualized behind the bones

● ASSESSMENT OF LUNG FIELD

- Pulmonary vessels can be easily traced at the lung fields

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 ● RIB EXAMINATION (TBC):
- Low kVp are used to enhance differences between the air-filled lungs and the overlying bony structures.
- The air-filled lungs demonstrate increased radiographic density, while the bony structures demonstrate
decreased radiographic density compared to the CXR film.

● PART THICKNESS AND RADIOGRAPHIC CONTRAST

○ Increasing part thickness Lowers radiographic Contrast because of More Scatter radiation reaching the Image
Receptor

● AMOUNT OF IRRADIATED MATERIAL

- As body thickness increases, x-ray absorption increases. This results in a decrease in subject contrast.
- When the difference between adjacent thickness of various body parts is great, subject contrast is
increased. When little difference exists in the thickness of adjacent body parts, subject contrast is decreased.
- The ABDOMEN is an anatomic area of LOW SUBJECT CONTRAST because it is made up of similar tissue
types.

● TYPE OF IRRADIATED MATERIAL

- This type of irradiated material is influenced by the atomic number of the material and its density.
- Both these factors influence subject contrast, the greater the atomic number, the higher the contrast.
● KILOVOLTAGE AS CONTROLLING FACTOR
○ Kilovoltage— is considered the controlling factor for radiographic contrast.
- The quality or penetrating power of the x-ray beam has the most direct effect on controlling the desired level of
contrast.

● SCALE OF CONTRAST
- is the number of useful visible densities or shades of gray.

○ HIGH CONTRAST (Short-scale)

- when the differences between adjacent densities that comprise contrasta re great which results to

fewer densities of gray

- low voltage:
- low penetrating power of the x-ray beam, results in:
- high absorption
- low transmission
- high density differences in the anatomic tissues
- High contrast “good contrast”
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 - Contrast is psychovisual perception
- It depends on the person’s visual abilities and experience
- Therefore, it can only be termed as contrast sensitivity.
○ LOW CONTRAST (Long Scale)
- when the differences between adjacent densities are minimal.
- high kilovoltage
- high penetrating power of the x-ray beam, results in:
- low absorption
- high transmission
- low density differences in the anatomic tissues
- Low contrast provides more information
- Low contrast provides more densities even though the difference between densities is less as long as
the differences remain within the visible range of densities.
- Low contrast provides more diagnostic information
- More information because more densities are present, thus, forming more contrast differences.

● KILOVOLTAGE AND RADIOGRAPHIC CONTRAST

- High kilovoltage creates more densities but with fewer differences, resulting in a low-contrast (long-scale)
image.
- Low kilovoltage creates fewer densities but with greater differences, resulting in a high contrast (short-scale)
image.

● KILOVOLTAGE, SCATTER RADIATION, AND RADIOGRAPHIC CONTRAST

- At higher kilovoltage, a greater proportion of Compton scattering will occur compared to x-ray absorption
(photoelectric effect) and decreases radiographic contrast.
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