Imaging with X-Rays
By Nipun Gupta
IMAGE QUALITY
WHAT IS IMAGE QUALITY?
Image quality describes the overall appearance of the image
and its fitness for purpose.
There is always a playoff between image quality and patient
dose.
So we always need images that are of diagnostic value and fit
for purpose not the visually appealing pictures.
IMAGE QUALITY
The main factors to consider are:
Contrast
Spatial Resolution
Noise
Distortion
Blur
CONTRAST
Contrast, or more precisely contrast resolution,
is the ability to distinguish between adjacent
areas of the image.
So, better contrast means better appreciation of details.
The amount of contrast between tissues is intrinsically
linked to their properties and the imaging modality
being used.
CONTRAST
Radiograp
hic
contrast:
Film
contrast
Subject
contrast
SUBJECT CONTRAST
A structure in the patient is demonstrated by two things:
Resolution, sharpness, or lack of blurring of the
image of its boundary.
Contrast between it and adjacent tissues caused by
differences in the transmission of X-rays (or attenuation
of X-Rays).
FACTORS AFFECTING SUBJECT
CONTRAST
Subject contrast C depends on:
The thickness t of the structure.
The difference in linear attenuation coefficients "1-2"
of the tissues involved which is dependent on their
densities and atomic no.
Thus
C (1 2) t
FACTORS AFFECTING SUBJECT
CONTRAST
As attenuation depends on tissue density and atomic
number:
The more the two tissues differ in these respects the
greater the contrast.
The higher the kV the smaller the attenuation
coefficients the less is the contrast
FACTORS AFFECTING SUBJECT
CONTRAST
Radiation quality : Penetrating ability or kV. More the kV,
more is the penetrating power, less is the contrast.
Properties of radiographic object
affecting the contrast:
Density
Atomic
number
Thickne
ss
Radiolucency : Degree of transmission of radiation.
Radio-opacity: Degree of attenuation of radiation in
tissue,
BALANCING CONTRAST AND
PATIENT DOSE
A major consideration in X-Ray imaging is to restrict the dose
of the patient as much as possible despite able to produce a
satisfactory image.
Penetration, Contrast and Patient Dose depend upon X-Ray
beam spectrum, the best spectrum provides adequate
Penetration and Contrast while keeping the Patient Dose at
lowest possible
The spectrum produced is dependent upon the target material,
inherent or added filtration and kilo-voltage.
BALANCING CONTRAST AND
PATIENT DOSE
Low Energy (kV) = Low Penetration = High Contrast =
High Patient Dose
High Energy (kV) = High Penetration = Low Contrast =
Low Patient Dose
Optimum Situation : kV that gives adequate contrast for
an acceptable patient dose.
PATIENT DOSE
This is about 3 Gy for film screen radiography and
between about 0.2 and 0.5 Gy s-1 for fluoroscopy.
This is the exit dose emerging from the patient.
The entrance surface dose has to be much higher
because of high attenuation of X-Rays by the patient.
FILM CONTRAST
Factors affecting film contrast:
Films vary in inherent contrast depending on Emulsion characteristics.
Development process.
Time-temperature used in processing.
Under exposed
Over exposed film
Max.contrast
CONTRAST MEDIA
One way of increasing the contrast is to use a lower kV;
another is to use a contrast medium.
A contrast media is a radio-opaque media with high
atomic no.
The high atomic no. of the contrast maximizes the
photoelectric absorption of the X-Rays.
CONTRAST MEDIA
The two common contrast agents are Iodine (Z-53) and
Barium (Z-56).
Air can also be used as contrast media but now used
only in double contrast barium enema studies.
CONRAST AND SCATTER
Primary radiation carries the information to be imaged.
Scatter obscures it as it carries no information about
where it came from.
The amount of scatter (S) may be several time the
amount of primary (P) in the same position.
CONRAST AND SCATTER
The S/P Ratio depends on the thickness of the patient.
For typical PA Chest it is 4:1 (20% of photons carry useful information)
For typical lateral pelvis it is 9:1 (Only 10% of photons carry useful
information)
Scatter is generally quite uniform across the image.
Scatter reduces contrast that would otherwise be produced by
the primary by a factor of upto 10 times.
CONTRAST AND SCATTER
SCATTER RADIATION
result in FOGGING of
image.
SPATIAL RESOLUTION
SPATIAL RESOLUTION is the ability to detect fine
detail within an image.
Fine detail is most clearly seen when the
contrast between the feature and its background
is high.
SPATIAL RESOLUTION
Spatial resolution can be quantified as the highest
occurring frequency of lines that can be resolved in a
high contrast bar pattern.
The object used to measure the spatial resolution is
known as LINE PAIR TEST TOOL.
SPATIAL RESOLUTION LINE PAIR
TEST TOOL
It uses bars of lead with
width of bar equal to the
space between them.
A bar and space makes up
the line pair and spatial
frequency of the pattern is
given as line pair per mm.
The smallest visible detail is
approximately half of the
inverse of the resolution
expressed in this way
NOISE
NOISE refers to the variations in the levels of grey in the
image that are distributed over its area but unrelated to
the structures being imaged.
The most significant source of noise in radiological
imaging is quantum noise or mottle.
NOISE
Noise reduces the visibility of low contrast regions
within the image, particularly if they are small in area,
thus reducing the visibility of finer detail in the image.
The lower the no. of photons detected, the greater will
be the noise.
Quantum mottle
Audible or visible disturbance that hampers the
information.
Normal
Quantum
mottle
QUANTUM MOTTLE
Lesser for slow screen film than fast
screen film.
Increases with high contrast film as
density differences are exaggerated
Increases with increase of KV .
ATTENUATION OF X-RAYS BY THE
PATIENT
In conventional projection radiography, a fairly
uniform, featureless beam of X-radiation falls on the
patient it is differentially absorbed by the tissues of
the body the X-ray beam emerging from the patient
carries a pattern of intensity which is dependent on the
thickness and composition of the organs in the body.
ATTENUATION OF X-RAYS BY THE
PATIENT
The X-rays emerging from the patient are captured on a
large flat phosphor screen this converts the invisible Xray image into a visible image of light, which then is
either:
Recorded as a negative image on film, to be viewed on
a light box (film screen radiography);
Recorded electronically prior to printing (computed or
direct digital radiography)
Displayed as a positive image on a video monitor
(fluoroscopy).
DISTORTION
Distortion
Size
Shape
Size - Magnification
Shorter the distance between object and the source of
light, greater is the magnification.
Source of light
Source of
light
object
object
shadow
Law of magnification states that
width of the image is to the width of
the object, as the distance of image
from the light source is to distance
of the object from the light source
Image width
-----------------Object width
Image distance
----------------------Object distance
Linear magnification of image:
Magnification factor:
image width
---------------------object width.
%Magnification: image width - object width
--------------------------------object width
Shape distortion:
It is misalignment of
central ray, the anatomic
part and the film.
To Summarize.
Greater distortion means poor
recorded detail
Shape distortion is due to
improper alignment
Size distortion: magnification is due to
divergence of beam.
Shorter the OID and Longer the SID less is the
distortion.
Macroradiography
Preservation of recorded
detail while achieving
magnification.
Fractional focal
spot/microfocus tubes are
used with small focal
spot (.3mm)
Principle of radiographic
magnification
F
Ideal point
source
SO
D
Image
SID
Magnification : 2 times
Object is placed in between F and film
Magnification factor
SID
SOD
Intensifying screens are used and
are more efficient when the same
information in an enlarged image is
spread over a larger area.
Air gap :
It is used to clean up scattered radiation.
More is the gap between object and the film, less will be
the scatter radiation.
Air gap
Blur
Geometric
blur
Motion blur
Object blur
Screen
blur
Geometric Blur (Penumbra)
Arrangement of X-Ray, anatomical part and film in
space.
Depends on:
Effective focal spot size
Source to image receptor distance
Object to image receptor distance
Focal spot is larger than object
Finite
focal spot
object
Blur
Effective focal spot size
Focal
spot
Focal spot
Focal spot
blur
A
blu
Br
Effective focal spot
Normal size of focal spot understates the effective or
projected size of the spot by significant margin.
Ex: 0.3 mm focal spot may be as large as .45mm
Source to image receptor distance
Object image receptor distance
Motion blur
Any motion while taking a radiograph can hamper the
image.
It can be minimised by:
Immobilization
of the part by
sandbags or
compression
bands
Suspension
of
respiration
Using short
exposure
Screen blur
Cardboard holders provide better recorded
detail than screen as immobilization is
present
In uncontrolled motion: fast exposure
with screens is used.
Extremely short exposure using high
speed screen can hamper recorded detail.
Film screen
combination:
Its a combination of film and
intensifying screen.
Recorded details is better in fast
speed and medium speed screen
combination
Recorded detail is never sharp with
intensifying screen because
Crystal
size
Active
layer
thicknes
s
Film
screen
contact
Quantum Mottle
Audible or visible disturbance that hampers information.
Normal
Quantum
mottle
Object blur
Effect of object blur is greater than appreciated.
Objects having round border introduce blur factor.
Object Blur
To Summarize.
Blur decreases with decrease in focal spot size, OID,
increase in SID
Motion blur decreased by immobilization or short
exposure
Cardboard holders decrease screen blur
Rounded objects increase blur.
Quantum mottle: visible disturbance in x ray
Less in slow screen receptors, more in fast screen receptors.
DENSITY
Darkening of a X-Ray film or certain area.
Carries information
Silver halide
Metallic silver
Appears black
Radiographic density depends on:
Amount of radiation reaching a particular area of the
film
The resulting mass of metallic silver deposited per unit
area
Measurement
Measured by an instrument called DENSITOMETER.
Density = log incident light intensity
transmitted light intensity
Clear film: has a density of 0.06-0.2
Diagnostic radiograph: 0.4 in lightest area and 3 in darkest
Factors Affecting Exposure and
Density
KV :
KV-
exposure rate- density
Milli ampere: increases exposure rate
Time: increase in exposure time- increases no. of photons
emitted by target.
mA.s: measure of charge transferred from cathode to anode
during an exposure.
EFFECT OF
DISTANCE :
X-ray photons arise from various
point of focal spot.
Assume photons spread in form of
cone from focal spot after leaving
tube.
Radiographic exposure rate decreases
as focus film distance increases.
Inverse square law of
Radiation:
Intensity or exposure rate of radiation at a given distance from a point
source is inversely proportional to square of distance.
I2/I1=d12 /d22
I2:exposure at d2
d2:distance of 2 nd film
I1:exposure at d1
d1:distance of 1 st film
Radiographic object
Thicker and denser
anatomical parts
more absorption of x
ray.
less exit of radiation onto film
Order of tissue density
Denta
l
enam
el
Bone
Tissu
e
Fat
gas
To summarize.
Density is darkening of x ray film due to deposition of
silver.
Depends on- kv, mA, exposure time, distance, object
density.
As the distance of film from source increases, exposure
decreases.
DEVICES FOR
IMPROVING
RADIOGRAPHIC
QUALITY
By:
Dr. Nipun Gupta
SCATTERED
RADIATION
As the primary beam pass through the patient,
some of the radiation is absorbed, while the rest
is scattered in many directions
This multidirectional scattered radiation is a
noise factor.
In a radiograph of good
quality, less than one-fourth
the density should result
from scattered radiation.
RATIO OF SCATTERED TO PRIMARY RADIATION
It increases with:
increase in the area of the radiation field
and the thickness of the part.
increase in tube potential.
increase in the density of the tissues.
Chest
80%scattered
Abdomen - 90%scattered
20%primary
10%primary
Methods to control scatter radiation :
GRID
AIR GAP
APERTURE DIAPHRAGMS
COLLIMATORS
CONES
THE ANODE HEEL EFFECT
COMPENSATION FILTERS
RADIOGRAPHIC GRID
Developed by Gustav Bucky in 1913
It is a device placed between the patient and
the cassette for the purpose of reducing
the amount of scattered radiation reaching the
film and improving radiographic contrast.
Gustav Buckys original gird
Cross hatch type.
Modern stationary grid consists of thin , closely
spaced lead strip measuring about 0.05mm in
width
Radiolucent material, plastic or aluminium
separate them which is 0.33mm wide.
Aluminum is preferred for improved durability of
the grid
ADVANTAGE
DISADVANT
AGE
Cast shadows
on the
radiograph as
thin white lines
Absorb 90%
scattered
radiation
Require
Increased
exposure
EFFICIENCY OF RADIOGRAPHIC GRIDS
Depends on
Physical factors
Functional factors
PHYSICAL FACTORS
1. Grid ratio :- r = d/w
(d-depth of the interspace channel,
w-width of this channel)
2. Grid Frequency :- number of lead
strips per cm or per inch.
3. Lead content
FUNCTIONAL FACTORS
Depends on:
1.
Selectivity
2.
Contrast improvement factors
grid cutoff
Primary radiation transmitted /
Selectivity scattered radiation transmitted
Contrast
Improvemen
t Factor
k = Radiographic contrast with grid/
Radiographic contrast with out grid
THUMB RULE
If Object > 11 Cm Thick Grid is to be used
Grid is to be always used With Intensifying
Screen
GRID
Stationary grid
Moving grid
STATIONARY
GRID
Thin wafer grids
Taped to the front of cassette.
Used with intensifying screen.
CROSSED GRID is used in Cerebral angiography
Stationary Grid
Non focused
focused
PARALLEL OR NON FOCUSED GRID
Distance decentering
Used in fluoroscopy
PARALLEL OR NON FOCUSED GRID
Angulation decentering
FOCUSED GRID
More frequently used type
Comprise of parallel strips.
Slant more towards lateral edges around a CONVERGENCE LINE
Used in Standing Abdomen Scan, Lateral Cervical
Spine, Swimmers View, Portable
MOVING GRID
Developed by Dr. Hollis Potter - 1920
To eliminate the grid lines
produced in radiograph.
Known as potter Bucky diaphragm
Lead strips are parallel to the long axis of
the table.
It is of focused type
Lead strips are thicker
PRECAUTONS IN THE USE OF FOCUSED GRIDS
1. SOURCE
IMAGE RECEPTOR
DISTANCE
This should be kept more for a clearer
image to minimise the scattered radiation
and also the blurring.
2. ANGULATION
OF THE BEAM
In Focused grid there uniform decrease in density
of radiograph
In Nonfocused grid there is decentering of beam
3. CENTERING OF
THE TUBE
Tube centering is done with center of the grid to
avoid peripheral cut off
PRACTICAL APPLICATION OF RADIOGRAPHIC GRIDS
BUCKY OR GRID FACTOR OF 12 :1 IS PREFERRED BECAUSE:1) Its efficiency in cleaning up scattered radiation.
2) Centering is less critical.
3) Less exposure to the patient.
4) Lead strips are thicker there by absorbing more
efficiently.
REMOVAL OF SCATTERED RADIATION
BY AN AIR GAP :-
Space between the patient and the
image receptor is known as air gap.
Increasing the air gap allows more of the scattered
photons to move laterally outside the film area.
Due to Inverse Square Law, there is only small reduction in primary
intensity which can be compensated by increasing the ma.
This also result in magnification of image.
There is no absorption of scattered radiation in
the air gap.
It require increase in exposure factors to
keep radiographic density unchanged.
This technique has a place in chest radiograph,
magnification radiograph and in cerebral and
renal angiography.
Reduction Of Scattered Radiation By Limitation
Of The Primary Beam
Aperture Diaphragms
Cones
Collimators
APERTURE DIAPHRAGM
CONES
FLARED CONE
CYLINDER CONE
COLLIMATORS
ANODE HEEL EFFECT ANODE CUT OFF
Depends on the angle the rays make with the face
of the target
The variation in exposure rate according to the
angle of emission of the radiation at the focal spot
is called anode cutoff or anode heel effect
Smallest exposure rate occurs at the anode
Useful in radiographing a region with wide range
of thickness .
Thickest part is towards the cathode end of the beam
Thinnest part is towards the anode.
COMPENSATION FILTERS
Made up of aluminium or barium plastic
Wide application in general radiography such as aortic
arch angiography, Anteropost. projections of foot.
These filters help to record body parts that differ
greatly in thickness or density into more uniform
density on a single film.
THANK YOU
