IMAGING WITH X-

RAYS
By Dr. Prajwal Lakkol
Under the guidance of
Dr. B.P Venkatesh
 IMAGING QUALITY
Is the term used to describe overall appearance
of the image and its fitness for purpose. There
are two basic description,
1. Contrast is the ability to distinguish between
adjacent area in the image.
2. Spatial resolution is the ability to detect fine
details.
 CONTRAST
• The information content of the invisible x-ray image is
“decoded” by the x-ray film in to a pattern of variation
optical density, known as “radiographic contrast.”
• It is the density difference between image area in the
radiograph.
• It is depends on subject contrast and film contrast.
• Subject contrast depends on the differential attenuation of
x-ray beam as it passes through the patient.
• Subject contrast was seen to be affected by the thickness,
density, atomic differences of the subject, radiation energy ,
contrast material and scatter radiation.
• The information content of the x-
ray image is the pattern of varying
intensity of the x-ray beam caused
by differential attenuation of x-ray
by subject.
• Film contrast depends on,
1.characteristic curve of the film
2. film density
3. screen or direct x-ray exposure
4. film processing.
 SHAPE OF THE CHARECTERISTC CURVE

• It tells us how much change in film density will occur

as film exposure changes. The slope of the curve is
measured expressed numerically . One such
measurement is called film gamma.
• The gamma of film is defined as the maximum slope of
the characteristic curve and described by,
• Gamma = (D2-D1)/(Log E2- Log E1)
• Where D1 and D2 are the densities on the steepest
part of the curve resulting from log relative exposures
E2 and E1.
 AVERAGE GRADIENT

• It is the slope of a straight line joining two

points of specified density on the
characteristic curve.
• It is usually calculated between 0.25 and 2.0
• If the average gradient of the film used is
greater than 1, the film will exaggerate subject
contrast.
 FILM DENSITY

• The slope of the characteristic curve changes

with density. This is especially true in the toe and
shoulder regions .
• Let us emphasize that the ratio of the difference
in log relative exposure is determined by the kVp
selected. If the kVp remains constant, this ratio
will remains constant for any one examination
despite change in exposure time, milliamperes or
 SCREEN OR DIRECT X-RAY EXPOSURE
• If a film designed for exposure by light from intensifying screens is
exposed to x-rays directly , its characteristic curve has a considerably
different shape than the curve obtained exposure with screen.
• Considerably more exposure (mAs) is required if no screen are used,
because intensification factor of screen ranges from 15 to 50 or more.
• At the same density , contrast is always lower for film exposed to x-
rays only than for same film exposed by light from intensifying screens.
• Intensifying screens are relatively more sensitive than film to higher
energy x-rays and less sensitive to the lower energy of the scatter
radiation
• X-ray film , because it is more sensitive to lower kVp X-ray films ,may
record the scatter radiation better than the higher energy , in the
formation containing primary beam.
 FILM PROCESSING
• Increasing the time or temperature of development will, up to a
point, increase the average gradient of a film. If the development
time is only 40% of normal, the gradient will be reduced to about
60% of maximum.
• Fog will also increased development time or temperature, and
fog decreases contrast.
• To summarize , increasing the time or temperature of
development will,
1.Increase average gradient
2. increase film speed
3. increase fog
 SPATIAL RESOLUTION

• It is ability to display separate image of two objects

placed close together.

• Spatial resolution measurement are determined by

using test objects of high contrast . Spatial
resolution is expressed in terms of the size of the
smallest visible details.
• A test object used to determine spatial resolution
consists of number of equally spaced bars, the space
between the bars being the same width of a bar.
 NOISE
• It is one of the limiting factor to contrast. It refers to the
variation in the levels of grey in the image that are distributed
over its area but unrelated to the structures being imaged.
• Most significant source of noise in radiological imaging is
quantum noise or mottle. This is generated because of very
low signal level being generated.
• Random pattern of photon is called noise or quantum mottle.
• The detection of a photon is randomly occuring event, and
lower number of photons detected greater will be the
variation of signal.
 ATTENUATION OF X-RAYS BY PATIENT

• In projection imaging, a fairly uniform, featureless

beam of x-radiation falls on the patient and is
differentially absorbed by the tissue of the body.
Emerging from the patient, the x-ray beam carries a
pattern of intensity that is dependent on thickness
and composition of organ in the body.
• In general, the x-rays emerging from the patient
are captured on large phosphor screen. This
converts invisible x-ray image into a visible image
of light, which is then either;
1. recorded as a negative image on film, to be
viewed on light box ( film – screen radiography),
2. recorded electronically prior to printing on a
hard-copy device or display on a monitor screen(
computed or direct digital radiography).
3. displayed as a positive image on a TV monitor
( fluoroscopy).
 THICKNESS DIFFERENCE
• If an x-ray beam is directed at two different
thickness of the same material, the number of x-
ray transmitted through thin part will be greater
than the number transmitted through thick part.
• If Is is the intensity of the x-ray beam (I)
transmitted through the thin segment and I L is the
intensity transmitted through the thick segment ,
subject contrast may be defined as
• Subject contrast = Is \ IL
 DENSITY DIFFERENCE
• The greater the density of a tissue ,the greater
is its ability to attenuate x-rays.
 ATOMIC NUMBER DIFFERENCE
• Subject contrast depends on the relative difference in attenuation of the x-ray
beam by different tissue in the body. In diagnostic radiology attenuation of the
x-ray beam by the photoelectric effect makes the most important contribution
to subject contrast.
• Photoelectric absorption is increased in substance with high atomic numbers,
especially when low kVp x-rays are used. The effective atomic number of bone ,
muscle and fat are,
• Bone 13.8
• Muscle 7.4
• Fat 5.9
• Bone will attenuate many more x-rays than muscle or fat ,assuming equal
thickness. Subject contrast between bone and muscle is high . Muscle and fat,
with little difference in atomic number , shows little difference in their ability to
attenuate x-ray by photoelectric absorption process and less difference by
compton reaction.
 RADIATION QUALITY
• The ability of an x-ray photon to penetrate tissue
depends on its energy. High kVp x-rays have greater
energy . Selecting the proper kVp is one of the most
important matters to consider in choosing the
proper exposure technique. If the kVp is too low,
almost all the x-rays are attenuated in the patient
and never reach the film.
• The kV selected has a great effect on subject
contrast . Low kVp will produce high subject
contrast.
 PATIENT DOSE
• The film-screen or any other imaging system used to convert the x-
ray pattern into an image requires a specific or minimum dose to
produce satisfactory image quality; about 3µGy for film
radiography and between about 0.2 and 0.5µGy/s for fluoroscopy.
• This is the exist dose emerging from the patient and any
intervening materials between the patient and the imaging device.
• Entrance surface dose, that is the dose to the skin proximal to the
tube , has to be much higher because of the high attenuation of x-
ray by the patient.
• ESD might be roughly 10 times greater than the exist dose of PA
chest x-ray, 100 times for an x-ray of skull, 1000 times for an AP
pelvis, and 5000 times for a lateral view of lumbar spine
 EFFECT OF TUBE KILOVOLTAGE ON
PATIENT DOSE
• Using a higher kV makes the beam more
penetrating and increases the proportion of
high energy photons that reach film screen. As
a result, a lower entrance dose needed for
same exist dose. Increasing the kV therefore
reduces the skin dose incurred in producing
satisfactory image and to a lesser extent the
dose deeper to tissues.
 EFFECT OF FOCUS – FILM DISTANCE ON
PATIENT DOSE
• Increasing the focus-film distance reduces
the dose to the patient. In delivering a
specific dose to film-screen , a sufficient
number of photons need to enter through
the skin .
• At the shorter FFD , with the focal spot at
S, they are concentrated on to a surface
area defined by the point C and D. At the
longer FFD, with the focal spot at S, the
same number of photons is required at the
film to provide a satisfactory image . when
they enter through the skin they are spread
over large surface area represented by CD
and they result in lower skin dose.
• Thus while increasing the FFD necessitates
increasing mAs needed to produce desired
number of photons at the film screen.
 Effect of scatter radiation
• The primary radiation carries the information to be imaged
, while the scatter radiation obscures it. This is similar to
the way in which ambient light in a room affects the image
seen on a monitor screen.
• The amount( S) of scattered radiation reaching a point on
the imaging device may be several times the amount of
primary radiation ( P) at the same position.
• The ratio s/p depends on the thickness of patient body the
area of beam. The ratio is typically 4:1 for a PA chest and
9:1 for a lateral pelvis.
 SCATTER REDUCTION AND CONTRAST
IMPROVEMENT
• The amount of scatter produced in patient may be decreased by decreasing
the volume of tissue irradiated. This may brought about by;
1. reducing the field area by the use of collimation
2. compression of the patient to move overlying tissue to the side.
3. Kilovoltage, as kV is reduced, the scatter produced is less in the forward
direction towards the film and relatively more on the side.
4. A grid an antiscatter grid, seen cross section ,consists of thin strips of heavy
metal sandwiched between thicker strips of low attenuation interspace
materials. The scattered photons that hit the grid obliquely are absorbed by
the lead strips, while a high proportion of the primary rays pass through the
gaps and reach the film.
5. an air gap, if the film screen moved some 20-30 cm away from the patient ,
much of the obliquely travelling scatter radiation misses it and the contrast
improves. Because of inverse square law.
ANTISCATTERED GRID
• SCATTER RADIATION-PRODUCED WITHIN THE
PATIENT THROUGH _______INTERATION
CAMPTON
 SCATTER

SCATTER
 GRID CONSTRUCTION
• The grid is constructed using lead strips usually
about 0.05-0.07mm wide. The number of strips
per cm, the line density, is generally in range of
30-80, with 40 strips per cm being typical. In a
grid of this specification repetition interval is
0.25mm, with gap between strips being 0.19mm
with 0.06 mm wide lead strips. The gap is filled
with inter space material that may be aluminium
but is preferably a lower attenuation material
such as carbon fibers.
GRID CONSTRUCTION
 GRID RATIO
• Is the ratio of depth of the inter space channel divided
by its width and is typically 8:1 .
• Larger the grid ratio the smaller is the angle of
acceptance and the more efficient is the grid at
absorbing scattered radiation, thus the greater is the
contrast in the image.
• With very large fields, especially at high kV , more
scatter is produced and a high ratio grid is preferable.
• A grid is generally not used with thin parts of the body
such as extremities or children, because less scatter is
generated.
GRIDS:
GRIDS
GRIDS
GRIDS
P-B DIAPHRAGM
• Grid cut off:
• Within certain tolerance ,the focused grid
must be used at a specified distance from
anode, the tube must be accurately centered
over grid, and grid must not be tilted about an
axis parallel to the lead strips. Otherwise , cut-
off of primary rays will occur.
• The tolerance reduce with higher grid ratio.
GRID ERRORS
 MOVING GRID
• It was invented by Dr. Hollis E. Potter in 1920 .
• Grids are moved to blur out the shadows cast
by lead strips.
• They are advantageous because they
eliminate grid line from film.
• Disadvantages are costly, subject to failure
may vibrate x-ray table and increases patients
radiation dose.
 MAGNIFICATION AND DISTORTION
MAGNIFICATION is reduced by using a longer FFD ‘F’ or by
decreasing the object film distance ‘h’. when positioning
the patient, the film is therefore usually placed close to
the structure of interest. If the tissues were compressed
, this would also reduce patient dose.
DISTORTION this refers to a difference between the shape
of a structure in the image and in the subject. It may
caused by foreshortening of the shadow of tilted object.
It may also caused by differential magnification of the
parts of structure nearer to and further away from the
imaging device. It can be reduce by using a longer FFD.
 HEAT RATING
• The heat loading of an x-ray tube is calculated in
joules and is equal to kV × mAs for a constant
potential or three phase generator. For single phase
generators, the heat loading is 0.7 × kVp × mAs.
• Single radiographic exposure;
In order to freeze and display a moving structure
individual exposure should be as short as possible
and is limited by the heating of x-ray tube. A
combination of kV , mA and exposure time used
should be such that, at the end of the exposure, the
temperature of anode does not exceeds its safe
value.
 HEAT UNIT
• Is the original unit of energy input to target. It
was defined in the days when single-phase
generators were standard.
• The number of heat unit is simply kVp × mAs.
 COLLIMATION
• X-ray set have a collimator system
so that the beam can be adjusted to
the required size by the operator. In
radiographic equipment, this
Collimators
comprises two sets of parallel
blades made of high attenuation
material that can be driven in to the
beam to define required area. The
collimator incorporates a light
source to the side of the x-ray beam
and mirror in the beam.
COLLIMATORS

Collimator in SPS Top view open View along beam End view
Carbon-carbon jaw
ring installed collimator path assembled jaw
 PERFORMANCE TEST ON THE X-RAY
TUBE AND GENERATOR
• LIGHT BEAM DIAPHARAGM AND BUCKY
CENTERING;
Regular checks should be made to ensure that
the beam and x-ray beam match and that the
centre of the field lies at the centre of the film
when the cassette is positioned in the bucky
assembly behind the patient. Any misalignment
would lead to repeat examination or use of
unnecessarily large field x-ray
• KILOVOLTAGE AND OUTPUT;
The kV is generally measured indirectly using a penetrameter.
The instrument usually has two radiation detectors placed
behind metal filters of different thickness.
The output of the tube can be measured using a dosimeter,
often an ionization chamber.
STEP WEDGE;
A simple alternative to the use of a kV meter and ionization
chamber is to use a step wedge. This is a block material,
generally aluminium, which is machined so as to have
successive steps of differing thickness.
Penetrameter
 SUMMARY
• Contrast in the image depends on thickness, density and
atomic number of structure with in the body.
• Contrast media use high atomic number materials with suitable
k-edge.
• For a particular imaging device, patient dose is affected by kV ,
FFD and filtration
• Scattered radiation reduces image contrast.
• The grid is generally focused to minimize cut off and moved
during exposure to blur out the grid lines.
• Heat rating of an x-ray tube indicates the maximum allowable
mA for the specified kV and exposure time and the maximum
sustainable continuous mA without damage to tube.
• X-Ray Film