RTEP 1: IMAGE PRODUCTION

AND EVALUATION (PT.3)

Prepared by: Leandro O. Dayao Jr., RRT
Radiographic Quality

• Refers to the fidelity with which

the anatomical structures being
examined are imaged on the
radiograph.
• Three main factors:
• Film Factors
• Geometric Factors
• Subject Factors
RADIOGRAPHIC QUALITY
Characteristics of Radiographic Quality

• Resolution - ability to image two

separate objects and visually distinguish
one from the other.
• Spatial Resolution
• Contrast Resolution
• Noise
• Artifacts
Spatial Resolution
• Refers to the ability to image small objects
that have high subject contrast (ex. bone-
soft tissue interface, a breast
microcalcification, or a calcified lung nodule)

• Conventional Radiology has excellent spatial

resolution

• Increases when there is decreased:

• Screen blur
• Motion blur
• Geometric blur
Contrast Resolution
• The ability to distinguish
structures with similar subject
contrast such as liver-spleen,
fat-muscle

• CT and MRI have excellent

contrast resolution
Noise
• is an undesirable fluctuation in
optical density of the image
• Lower noise results in a better
radiographic image because it
improves contrast resolution
• Two major types:
• Film graininess
• uncontrolled by RT
• Quantum mottle
• controlled by RT
Film Graininess
• Refers to the distribution in size and space of
the silver halide crystals in the film emulsion

• Similar to structure mottle that refers to the size

and shape of the phosphors of the radiographic
intensifying screens

• Contribute very little to radiographic noise

• Uncontrolled by RT
Quantum Mottle
• Refers to the random nature by which x-
rays interact with the image receptor

• Principal contributor to radiographic noise

• Image produced with few x-rays will have

higher QM than images produced from
large number of x-rays, use of very fast
intensifying screens also results in
increased QM

• The use of high mAs, low kVp, and slow

image receptors reduces quantum mottle
Speed
• Resolution and noise are
intimately connected with
speed

• While the speed of the

image receptor is not
apparent on the image, it
influences both resolution
and noise.
Radiographic Quality Rules
• Fast IR’s = Low Spatial and Contrast Resolution; High Noise

• Slow IR’s = High Spatial and Contrast Resolution; Low Noise

• Low noise accompanies slow IR’s with high spatial and contrast
resolution
Film Factors of Quality
• Characteristic Curve
• Density
• Contrast
• Latitude

• Processing
• Time
• Temperature
Characteristic Curve
• The graphic
relationship between
OD and radiation
exposure

• Also termed as H & D

curve (Hurter and
Driffield)
Parts of Characteristic Curve
• Toe
• Low exposure level

• Shoulder
• High exposure level

• Straight-line
• Intermediate region in which a
properly exposed radiograph
appears.
• Area where very small changes in
exposure results in large changes in
density
Optical Density
• a measure of the degree of
film darkening
• Formula:
• OD = log10 I o / I t
• I o = level of light incident on a
processed film
• I t = level of light transmitted
through the film
Optical Density Range
• The optical density range is from 0.0 to 4.0
corresponding to clear and absolute black
respectively.
• Useful range in general radiography is from 0.25 to
2.5
• Most radiographs, however show image patterns in
the range of 0.5 - 1.25 OD
Fog Density and Base Density
• Base Density
• Inherent in the base of the film due to the composition of
the base and the tint added to it.
• Approx. 0.1

• Fog Density
• Results from inadvertent exposure of film during storage,
undesirable chemical contamination, improper processing,
a a number of other influences.
• Should not exceed to 0.1
Base plus Fog Density
• Range is from 0.1 to 0.3
• Should be never above 0.3
• Most is 0.21 OD
Controlling Factors - Radiographic Density
mAs can be solved by
The quantity of radiation reaching the ff. equation.
the image receptor has a primary
effect on the amount of mAs= mA x exposure
radiographic density produce. time

Milliamperage and exposure time

(mAs) control the quantity of Important relationship
radiation reaching the image mA and exposure time have
receptor. an inverse relationship when
maintaining the same mAs.
ADJUSTING MILLIAMPERAGE
OR EXPOSURE TIME

100 mA x 0.10s= 10 mAs

To increase the mAs to 20, you

could use:

200 mA x 0.10 s = 20 mAs

100 mA x 0.20 s = 20 mAs
REPEATING RADIOGRAPHS
BECAUSE OF DENSITY ERRORS

Minimum change needed to correct for

a density error is determined by
multiplying or dividing the mAs by 2.

When a greater change in mAs is

needed, the radiographer should
multiply or divide by 4, 8 and so on…
INFLUENCING FACTORS
kVp Generator output
Distance Filtration
OID Compensating
Grids filters
Film-screen Film processing
speed Patient Thickness
Collimation Pathology
Heel effect
Contrast Media
kVp
an increase in kVp does not produce more x-rays to
increase the blackening of film, but an increase in kVp
increases the energy of the x-ray beam.

It is this increase in energy that permits more x-rays to

penetrate the anatomical part which results in increased
blackening on the film.
KILOVOLTAGE AND THE 15%
kVp RULE
 A 15% increase in kilovoltage peak will
have the same effect on radiographic
density as doubling the mAs.

 A 15% decrease in kVp will have the

same effect on radiographic density as
decreasing the mAs by half.
USING THE 15% kVp RULE

To increase density: To decrease density:

 Multiply the kVp by  Multiply the kVp by

1.15 (original kVp + 0.85 (original – 15%)
15%).
80 kVp x 0.85 = 68
80 kVp x 1.15= 92 kVp
kVp
distance
The distance between the source of
radiation to the image receptor can
affect the amount of density produced
on a radiograph.

Due the nature of the beam as a

diverging, the intensity of the beam will
vary at different distances.

The relationship between distance and

x-ray beam intensity is describe by the
inverse square law.
INVERSE SQUARE LAW

It states that the intensity of the x-ray

beam is inversely proportional to the
square of the distance from the source.
As SID increases, the x-ray beam
intensity is spread over a large area.
This decreases the overall intensity of
the x-ray beam reaching the image
receptor.
DIVERGENCE OF X-RAY INTENSITY

Source

1m

2m
INVERSE SQUARE LAW

Formula I1 (D2)2
=
I2 (D1) 2

 Intensity of radiation at an SID of 40

inches is equal to 300mR. What is the
intensity of radiation when the distance
is increased to 75 inches?
ANSWER

300mR (75)2
=
X (40)2

 300mR x 1600 = 5625 X

 480000/5625 = X
 85.3mR = X
SID AND mAs RELATIONSHIP

Increasing the SID requires that mAs

be increased to maintain density
Decreasing the SID requires a
Decrease in mAs to maintain density
SID and mAs are Directly Proportional
to each other.
DIRECT SQUARE LAW/ DENSITY
MAINTENANCE FORMULA
Maintaining consistent densities when the
SID is altered requires that the mAs be
adjusted to compensate.
Density maintenance formula is also known
as mAs/Distance compensation formula.
It provides calculation for adjusting the mAs
when changing the distance.
 mAs1 (SID1)2
mAs2 = (SID2)2

 Optimal density is achieved at

an SID of 40 inches using
20mAs. The SID must be
increased to 50 inches.
 What adjustment in mAs is
needed to maintain
radiographic density?
ANSWER

20mAs (40)2
mAs2 = (50)2

 1600 X = 50000
 50000/1600 = mAs
 31.25 = mAs
 OBJECT-IMAGE RECEPTOR-
DISTANCE
 When distance between the object
radiographed and the image receptor
distance is increased, less density may
result.
 As the exit radiation continues to diverge,
less overall intensity of x-ray beam will
reach the image.
 GRIDS

 Grids absorb scattered radiation,

w/c in turns increases quality of
the radiograph
 Grids also absorb some of the
transmitted radiation exiting the
patient and therefore reduces the
amount of density produced on a
radiograph.
GRID CONVERSION FACTOR
 When a grid is added, the
radiographer must use the correct grid
conversion factor to multiply by the
mAs to compensate for the decreased
density.

 When grid is removed, the correct

conversion grid factor must be divided
into the mAs to compensate for the
increased density.
GCF

 When grid ratio is changed, the ff formula

should be used to adjust the density.

mAs1 GCF1
mAs2 = GCF2
 The new mAs will produce a density
comparable to that of the original exposure
technique.
 Adjusting mAs for changes in
grid
 A quality radiograph is obtained using 2mAs
@ 70 kVp w/out using a grid. What new mAs
is needed when adding a 12:1 grid to
maintain radiographic density?

2 1
=
mAs 5

 2mAs x 5 = 1X
 10mAs = X
GRID CONVERSION CHART

Grid ratios Grid conversion

factor
No grid 1
5:1 2
6:1 3
8:1 4
12:1 5
16:1 6
 Film-Screen Speed
 The combination of the film and
intensifying screen affects the image
receptor’s sensitivity to radiation
exposure.

 The more sensitive the film-screen

system is to radiation, the faster the
speed.
Film-screen system speed and
mAs
 Increasing the film-screen speed
requires a decrease in the mAs to
maintain density.

 Decreasing the film-screen speed

requires an increase in the mAs to
maintain density
Film screen speed conversion
formula
mAs1 RS2
=
mAs2 RS1

 Adjusting mAs for changes in film-

screen system speed.
• A radiograph is obtained by
25mAs @ 85kVp and 100
speed film screen system.

• What new mAs is used to

maintain radiographic
density when changing to a
400 speed film-screen
system?
ANSWER

25 400spd
= 100spd
X
 25mAs x 100 spd = 400 spd
X
 2500/400 = X
 6.25mAs = X
COLLIMATION

 Increasing collimation (smaller

field size) decreases radiographic
density
 Decreasing collimation (wider
field size) increases radiographic
density
ANODE HEEL EFFECT

 As a result of the
angle of the x-ray
tube’s anode, the
intensity along the
longitudinal axis of the
primary beam varies.
Effective use of the anode heel
effect

 Radiographing a foot requires that the anode side

should be at the phalanges while the cathode side
is at the ankle.
 It is because the side of the phalanges requires
less penetration to provide a good density while
on the side of the cathode it requires a higher
intensity to penetrate it and have a good density.
Which of these are properly
used anode heel effect?

Proper use of
anode heel effect
GENERATOR OUTPUT

 Exposure techniques depends on the

type of generator used.

 Generators w/ more efficient output

(3phase units), require lower
technique settings to produce an
image comparable to those of single
phase units.
 From single to 3 phase, 6
pulse
-2/3 of the original mAs
 From single to 3 phase, 12
pulse
-Half the original mAs
FILTRATION

 Filtration reduce patient exposure

dose by eliminating low-energy
photons from the primary beam.
 Removes a portion of the useful
beam.
COMPENSATING FILTERS

 Designed to solve a problem

involving unequal subject
densities
 They are fabricated for many
procedures and therefore come in
various sizes and shapes.
PATHOLOGY

 Additive disease/ conditions

Result in decreased density

 Destructive disease/ conditions

Result in increased density
 ADDITIVE DISEASES
• Abnormal conditions which will
lead to an increase in fluid,
bone, or metal are for
radiographhic purposes
generally considered as Additive
conditions.

• Requires added exposure, or

increased technique factors in
order to be properly
demonstrated.
LUNG CANCER
 DESTRUCTIVE DISEASES

• Abnormal conditions which leads to a

decrease in air or fat, or to a decrease
in normal body fluid or bone, are
radiographically considered as
destructive conditions.

• These require a reduction from typical

exposure techniques
No tissue in
space

Easy to
penetrate
with x-ray
photons

pneumothorax
 ADDITIVE DESTRUCTIVE
PATHOLOGY PATHOLOGY

• 50% increase in • 30% decrease

overall thickness
in mAs or 5%
• kVp altered using
15% rule rather than reduction in
increasing mAs or kVp
• 8% in kVp will be
equivalent to 50%
increase in mAs
Contrast
• The variations in the
OD in the radiograph
• Marked Differences in
OD = High Contrast
radiograph
• OD differences are
small = Low Contrast
radiograph
GEOMETRIC PROPERTIES