Programme Name: BMRIT Semester: 2

Course: Radiographic Image Processing Subject Code: BMRIT 203

Module 4: Radiographic Image

RADIOGRAPHIC IMAGE QUALITY

The quality of the radiographic image may be defined as the ability of the film to
record each point in the object as a point on the film. Image quality can be defined
as the attribute of the image that influences the clinician's certainty to perceive the
appropriate diagnostic features from the image visually. The important components
of the radiographic image quality include contrast, dynamic range, spatial resolution,
noise, and artifacts.
a. Contrast: Radiographic contrast is a fractional difference in the signal or
brightness between the structure of interest and its surroundings. Contrast is
generated by differential attenuation of X-rays by different tissues.
Radiographic contrast is directly proportional to the atomic number, density,
and tissue thickness. For example, X-ray attenuation is least in air and higher
in bone and between in soft tissues. In digital radiography, the contrast can be
adjusted using image post-processing techniques where pixel values are
changed to provide the expected range of contrast depending upon specific
clinical requirements.
b. Spatial resolution: Spatial resolution is the imaging system's ability to
distinguish the adjacent structures separate from each other. A bar pattern
containing alternate radio-dense bars and radiolucent spaces of equal width
can be imaged to get the subjective measurement of spatial resolution in units
of line pairs per millimeter. The modulation transfer function (MTF) is an
objective measurement of the spatial resolution obtained by measuring the
transfer of signal amplitude of various spatial frequencies from object to
image. MTF is the best way to measure spatial resolution.
 c. Noise: The radiographic noise is the random or structured variations within an
image that do not correspond to X-ray attenuation variations of the object. The
noise power spectrum is the best metric of noise that measures the spatial
frequency content of the noise. Quantum noise is primarily responsible for
image noise, and the number of X-ray quanta used to form the image
determines the quantum noise. Controlling exposure factors is the best way to
reduce quantum noise.
d. Sharpness: The ability of the x-ray film or film-screen system to define an
edge. The inability of a film-screen system to record a sharp edge because of
light diffusion in the intensifying screen has been previously discussed.
Sharpness and contrast are closely related in the subjective response they
produce. An unsharp edge can be easily seen if contrast is high, but a sharp
edge may be poorly visible if contrast is low.

Factor influencing radiographic image qualities

Image quality and the amount of detail shown on a radiograph depend on
several factors including:
 Contrast:
Radiographic contrast depends on subject contrast, film contrast, fog and scatter.
Subject contrast-this is the difference caused by different degrees of
attenuation as the x-ray beam is transmitted through different parts of the
patient’s tissues.
It depends upon- differences in tissue thickness, differences in tissue density,
differences in tissue atomic number and quality of the radiation beam.
Film contrast-this is an inherent property of the film itself. It determines how
the film will respond to the different exposures it receives after the x-ray beam
has passed through the patient. Film contrast depends upon four factors- the
characteristic curve of the film, optical density or degree of blackening of the
film, type of film – direct or indirect action and processing.
Fog and scatter- scattered radiation reaching the film either as a result of
background fog, or owing to scatter from within the patient, produces
unwanted film density (blackening), and thus reduces radiographic contrast.
 Image geometry-
The geometric accuracy of an image depends upon the position of the x-ray beam,
object and image receptor (film or digital) satisfying certain basic geometrical
requirements. The object and the image receptor should be in contact or as close
together as possible. The object and the image receptor should be parallel to one
another. The x-ray tube head should be positioned so that the beam meets the object
and the image receptor at right angles.
 Characteristics of the x-ray beam
The ideal x-ray beam used for imaging should be: sufficiently penetrating power to
pass through the patient, and react with the film emulsion to produce good contrast
between the various black, white and grey shadows.
 Image sharpness and resolution
Sharpness is defined as the ability of the x-ray film to define an edge. The main
causes of loss of edge definition include: geometric unsharpness including the
penumbra effect, motion unsharpness, caused by the patient moving during the
exposure, absorption unsharpness – caused by variation in object shape. Screen
unsharpness, caused by the diffusion and spread of the light emitted from
intensifying screens and poor resolution.
Resolution, or resolving power of the film, is a measure of the film’s ability to
differentiate between different structures and record separate images of small objects
placed very close together, and is determined mainly by characteristics of the film
including: – type – direct or indirect action, speed , silver halide emulsion crystal
size. Resolution is measured in line pairs per mm.
Practical factors influencing film-based image quality
The various factors that can influence overall film-captured image quality can be
divided into factors related to: the x-ray equipment, the image receptor – film or
film/screen combination, processing, temperature and humidity, the patient and the
operator and radiographic techniques including patient positioning.
As a result of all these variables, film faults and alterations in image quality are
inevitable. However, since the diagnostic yield from radiography is related directly
to the quality of the image, regular checks and monitoring of these variables are
essential to achieve and maintain good quality radiographs. It is these checks which
form the basis of quality assurance (QA) programmes.
Magnification- Image quality is affected by geometric factors, such as
magnification, distortion and focal spot blur. All radiographic images are magnified
and the magnification (M) is the ratio between the image size and object size. If SID
is the source to image distance and SOD is the source to object distance, then M =
SID/SOD When the object is closer to the source, the magnification is larger. When
the object moves away from the source, magnification decreases. For chest
radiography the SID is about 180 cm, and the magnification is unity. Lesser the
magnification means image blur is less and higher the resolution.
Distortion- It is the result of unequal magnification of different parts of an object. It
may be caused by object thickness, object position and object shape. Thick objects
produce more distortion than thin objects. Patient with irregular anatomy may
contribute to distortion in a radiograph. If the object plane and imaging plane are not
parallel then distortion occurs, due to positioning. The distortion is minimal for
object that is positioned at the centre. Object that is positioned lateral to the center
may have severe distortion. The objects that are lateral may have unequal
magnification than that at the centre. The angle of inclination of the object also
influences the degree of distortion.

Presentation of Radiographs
The radiographic film must have details like full name, date of birth, hospital number
or code, name of hospital, date and time of examination.
Right or left marker. Position of patient or projection, e.g. PA, RAO, ERECT, etc.
Timing of the film in given sequence, e.g. 5 min, 1 h, etc. Number of film in rapid
sequence, e.g. in aortography. Layer height in tomography. Tube angulation used.
Whether mobile or ward radiograph. Stereographs - direction of tube displacement.
Miscellaneous information, e.g. Post micturition, after fatty meal.
Lead markers for radiography are also known by a number of different names
including Pb markers, X-ray markers, anatomical side markers, and radiographic
film identification markers. Lead markers are used to mark X-ray films in hospitals,
clinics, and other healthcare facilities. Most lead markers come color-coded to
denote right and left on X-ray or radiographic images to assist the radiographer or
radiologic technologist on identifying the right and left side of the body. The lead
markers will generally have a letter R for the right and the letter L for the left as well
as the radiologic technologist (R.T.s) initials. X-ray markers commonly consist of
Lead or Lead-free characters, an Aluminium or Plastic backing and epoxy part to
cover the letters. With that said, the only radiopaque material in the markers are the
lead or lead-free characters. Once X-ray marker is exposed to radiation, the
characters cast a shadow, which is displayed on the final image. Characters can be
letters, numbers, lead balls (for position markers), or lead arrows (to point the part
of interest on images). Traditionally all X-ray markers were made of lead characters,
but over the years due to the hazarders nature and harmful potential effects of
lead, and some other suppliers have started offering lead-free alternatives. The lead-
free characters are made of other dense metals such as Bismuth, which serve the
same purpose without the potential risks of lead. Lead characters have been around
for a long time and their variety is far larger than lead-free options. Lead-free
characters are only available in flat face style, while lead characters come in flat
face, industrial, hairline, condensed deep block and sharp face.

Identification of dental films:

Dental film is embossed with a raised dot in one corner.
The convex side of the film indicates front side of the film.
The dot is used to identify right from left.
The convexity of the dot is placed at the occlusal edge and toward the x-ray tube.
The concavity of the dot is placed toward the tongue or palate.
To determine whether a film is on the right or left side, imagine where the convex
dot is located, and identify the progression of teeth from incisors to molars.
Characteristics of Image display television
 Dark Level The minimum luminance (dark level) must first be properly set by
changing the B brightness setting. Ideally, monochrome CRT monitors can be
set between 0.2 and 0.5 cd/m2 .
 Monochrome LCD monitors can usually be set at about 1.0 cd/m2 .
 The lower the dark level the better, but at the same time, the monitor must be
able to provide a maximum luminance adequate for the particular application
(e.g., 170 cd/m2 for most images displayed on colour monitors, and 350 cd/m2
for most images displayed on monochrome monitors).
 Maximum Luminance The maximum luminance should be set by changing
the B contrast setting.
 The optimal value for this setting will depend on several factors. If there is a
high level of ambient lighting in the room, then a higher maximum luminance
will be required to give the same image quality that is required in a darker
area. If the maximum luminance, however, is set too high for a particular
monitor, it will significantly shorten its useful life span.
 The ambient lighting should therefore be minimized if at all possible. For new
monochrome monitors, the optimal scenario to prolong their useful life span
would be to drive the monitor at 50% of its capable maximum luminance to
achieve 300Y350 cd/m2 .
 New colour monitors should be driven at about 70% of their capable
maximum luminance (about 250 cd/m2 ) to achieve about 170 cd/m2 .
DICOM 14 Grayscale Standard Display Function
To ensure that as much information as possible can be seen by the human eye,
display systems should be set to the Digital Imaging and Communications in
Medicine (DICOM) 14 Grayscale Standard Display Function (GSDF) this is
necessary because the response of the human eye to light is not linear.
 This step is achieved by mapping bit values representing different gray levels
to specific luminance values. The mapping is stored in look-up tables (LUT)
on the graphics card or in the monitors.
 Visual Checks: There are several geometric patterns and patterns of varying
luminosity that can be helpful. One that is often used is the Society of Motion
Picture and Television Engineers (SMPTE) pattern. This pattern can be used
to detect areas that are unfocused (horizontal and vertical thin lines that should
be discernible) and to determine the proper contrast (especially the 0 to 5%
luminance difference and the 95 to 100% luminance difference).
 The SMPTE pattern can also be used to align the window vertically and
horizontally and to determine if there is skewing or bowing (pincushion
effect). Other parameters to check include ghosting (i.e., when previous
images linger), burn-in on CRT. DICOM 14 Grayscale Standard Display
Function (GSDF). The Just Noticeable Difference (JND) index is the
minimum amount that the luminance can be changed for the human eye to
perceive a difference.
 Image quality assurance of soft copy display systems 281 monitors, pixel
dropout in LCD monitors, and non-uniformity of luminance. Uniformity of
 luminance can be measured by placing the photometer on different quadrants
of the monitor.
 Luminance non uniformity is usually not a problem with LCD monitors, but
can be a problem with CRT monitors. This can occur if the CRT phosphor
coating is not applied evenly, if the phosphor on the edges of the screen gets
less light than in the middle of screen due to the distorted electron beam, or if
there is a misalignment in the CRT components.
 Non uniformity is also prevalent in CRT monitors that are within a magnetic
field. Monitor Calibration Pilot Study A variety of clinical and radiological
Picture Archiving and Communication Systems (PACS) workstations from a
multisite teaching hospital were identified for use in a pilot study for the
protocol. The purpose of the pilot study was to determine the value of a
monitor quality control program through an assessment of their current state
and noting any improvements after application of the protocol, to validate and
if necessary, to modify the protocol, and to determine the resource
requirements to perform the quality control program.
 Sixteen PACS workstations (11 dual-monitor systems and 5 single-monitor
systems) were calibrated during the study. Three of the workstations were
intentionally included for the pilot due to complaints of poor image quality,
whereas the other workstations were randomly chosen out of approximately
1,000 workstations that are used for viewing medical images. They were
selected from radiology reading rooms and clinics to represent a range of
monitor types.
Laser Lights
A laser is a device that emits light (electromagnetic radiation) through a process
called stimulated emission. The term laser is an acronym for light
amplification by stimulated emission of radiation. Laser light is usually spatially
coherent, which means that the light either is emitted in a narrow, low-divergence
beam, or can be converted into one with the help of optical components such as
lenses. Typically, lasers are thought of as emitting light with a narrow wavelength
spectrum ("monochromatic" light). This is not true of all lasers, however: some
emit light with a broad spectrum, while others emit light at multiple distinct
wavelengths simultaneously. The coherence of typical laser emission is
distinctive. Most other light sources emit incoherent light, which has a phase that
varies randomly with time and position.
Laser Imagers:
A silver-halide type dry laser imager that provides high-quality diagnostic images
with a compact body.
Imaging Plate:
The imaging plate (IP) is a new and flexible X-ray sensor for the CR system
which uses the conventional medical X-ray imaging system and can be employed
as a substitute for the screen/film system. The IP is made by densely applying
particles of inorganic crystals called photostimulable phosphor onto a polyester
film. The phosphor layer has the function of recording an X-ray image. The
photostimulable phosphor is a special luminescent material which stores X-ray
energy and emits light proportional to the stored X-ray energy when stimulation
energy such as visible light is irradiated to it. After radiation, the enhanced
phosphor material absorbs and stores x-ray energy in gaps of the crystal structure,
building a latent image. Usually, the storage phosphors are stimulated with a low-
energy laser to release visible light at each point of x-ray absorption. To read-out
the image, the plate is inserted into a computed radiography scanner. The
scanning laser beam causes the electrons to relax to
lower energy levels, emitting light that is captured by a photo-multiplier tube and
converted into an electrical signal. The electronic signal is then converted
to digital data and can be displayed on laser-printed films, workstations,
transmitted to remote systems, and stored digitally. The X-ray image is stored to
be read out at a later time. The CR units automatically erase the image plate after
the complete scan. Phosphor imaging plates, like film, are stored
in cassette format and can be re-used very often if they are handled carefully.
Existing conventional x-ray equipment, from generators to x-ray tubes and
examination systems, can be used with imaging plates.
Dry Cameras:
Dry imaging cameras are important hard copy devices in radiology. Termed as
dry imaging devices, laser imagers, laser printers, direct digital imagers or hard-
copy cameras, they create multiformat images of digital radiology modalities.
Fundamentally, hard copy devices are classified based on laser and non-laser
technology [Figure 1].[2] The laser based devices are a) wet, b) dry, and c) laser
induced thermal technologies.[3] The non-laser based devices are divided into a)
monitor based, b) thermal print head and c) ink jet technologies. Thermal print
head technologies are either direct or dye sublimation technologies. In practice,
dry imaging camera are widely accepted, especially the direct thermal imaging
and laser optic technologies. Dry imaging cameras were introduced in 1984 by
3M, followed by the launch of “dry” laser imager technology in Abstract Dry
imaging cameras are important hard copy devices in radiology. Using dry
imaging camera, multiformat images of digital modalities in radiology are
created from a sealed unit of unexposed films. The functioning of a modern dry
camera, involves a blend of concurrent processes, in areas of diverse sciences
like computers, mechanics, thermal, optics, electricity and radiography. Broadly,
hard copy devices are classified as laser and non-laser based technology. When
compared with the working knowledge and technical awareness of different
modalities in radiology, the understanding of a dry imaging camera is often
superficial and neglected. To fill this void, this article outlines the key features of
a modern dry camera and its important issues that impact radiology workflow.
The functioning of a dry camera involves concurrent processes digital,
mechanical, thermal, optic, electrical and radiographic processes.