Radiation Biology Chapter 7

Patient Immobilization:
Reasons for immobilization
Blurring of radiograph if there is motion
Reduction of radiation exposure due to reduction of repeat films
Infant or small children will not hold still
Combative adults (Alzheimer’s, mental illness, intoxication)
Types of motion on film
Voluntary – on a non combative patient, good communication should limit this
Involuntary – image unsharpness due unavoidable motion of anatomy (cardiac
contraction/relaxation, peristolsis). Try to reduce exposure times to limit
motion.

Beam Restriction / Collimation:

You MUST collimate. Effects of collimation include lower tissue dose, less
scatter radiation, and improvement of image quality.

Two factors affecting the amount of scatter: kV and material irradiated.

kV: As kV increases, fewer atoms interact with the tissue, and more pass through to end
up on the film. If kV increases and mAs stays the same, scatter will increase. But if kV
increases and mAs is lowered to maintain the same density, scatter will decrease.

Irradiated Material: Scatter increases as volume and atomic number of irradiated material
increases. When using larger film, you will have more scatter radiation (volume of
irradiated material increases). Use collimation to limit amount of scatter.

Beam Limiting Devices: help reduce absorbed and scattered radiation by the patient

Aperture diaphragms: flat plate of lead that attaches to collimating device – usually used
in special procedures.

Cones: circular attachments to the tube housing of varying and sometimes adjustable
lengths that can be flared or straight. Typically used with skull or dental work.

Collimator: variable aperture collimator…adjustable set of apertures within the tube

housing, accompanied by a lamp and mirror projecting the exposed field. Can have
automatic collimation to film size in the bucky. Should be accurate within 2% of the SID

Filtration: filters assist in reduction of patient exposure by eliminating low energy

photons. This improves beam quality and increases the average energy of the beam
(beam hardness).

Inherent filtration: Glass housing around xray tube and cooling oil surrounding the
housing.
Added filtration: any filtration added on the outside of the film housing (compensating
filter)

Total filtration = inherent filtration + added filtration.

Minimum filtration requirements for fixed radiographic equipment are:
Below 50kV = 0.5mm Al
50 – 70kV = 1.5mm Al
above 70kV = 2.5mm Al
Minimum requirements for mobile xray equipment or C-arm is 2.5mm Al equivalency

HVL – Thickness of material that will reduce the xray beam’s intensity to have of its
original value. Measures beam quality.

Shielding:
Gonadal – to be used when gonads are within 5cm of primary beam on anyone of
reproductive age. Shaped contact gonadal shielding is the best type to use during sterile
procedures– worn by males inside a support around the gonads. Other types include flat
contact shields… flat rubberized lead strips, shadow shields – usually used in surgery...
radiopaque material draped over a portion of the tube housing.

Reduction of Radiation Exposure:

kV: an increase in kV will increase patient exposure, unless it is accompanied by a

reduction in mAs. Law of reciprocity – to maintain the same density on film

mAs: an increase in mAs will increase patient exposure. Inversely related to kV when
maintaining radiographic density. The use of high kV and low mAs will result in less
patient exposure. When determining proper technique for your radiographs, films must
display adequate part penetration, acceptable density, and proper contrast.

Film/Screen combination: a higher screen speed will reduce patient exposure. Approx.
95% of film exposure is from visible light emitted from the intensifying screen. Also, as
kV increases, the speed at which the screen converts xray to light increases.

Patient positioning: especially when phototiming, part of interest over photocell. This
will reduce amount of repeat radiographs.

Grids: Placed between the patient and the image receptor. They absorb primary and
scatter radiation. You need an increase in exposure factors while using grids, and there
will be an increase in patient exposure. The result will be less scatter radiation and better
film quality. The lower the grid ratio, the lower the patient dose will be.

Pregnant patient: 10 day rule – xray exams should be postponed on women of child-
bearing age until 10 days after the onset of menstruation. Ultimately up to the physician
ordering the exam. Always ask if pregnant, if unknown, ask date of last menstruation. If
pregnant, use shielding and collimation. Some facilities have a pregnancy consent form
for the patient to fill out.

Repeat radiographs: Most common reason for repeat radiographs is operator error.
Operator errors include improper exposure techniques, poor positioning, failing to align
beam to bucky, multiple exposures on film. Other factors include dirty screens,
incorrectly loaded cassettes, light leaks, chemical fog, processor artifacts, and grid errors.

Image intensification fluoroscopy: Conversion of live xray to visible light. Conventional

fluoroscopy required adjustment of the eyes to the dark, and image was faint. Now it is
easily visible through intensified fluoro as image brightness increases.

Intermittent fluoroscopy: Radiologist should periodically activate flouro instead of

standing on the pedal… you’ll notice this happens with surgeons. This also prolongs
tube life.

Reduction of field size: Collimating shutters should be utilized to include only the area
of interest.

Cumulative timing device: Records fluoroscopic time and sounds an audible alarm every
5 minutes. Due to strict radiation dose guidelines, California requires the technologist to
inform the physician every 5 minutes of fluoro used. Federal regulations state exposure
rate at tabletop must be no greater than 10R/min for intensified fluoroscopic units and no
greater than 5R/min without intensified fluoro.

Minimum source to tabletop distance for stationary fluoro equipment must be at least 15
inches, and 12 inches for mobile fluoroscopic equipment.