Radiographic Exposure Factors

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al dierence between lm and anode ng power) of the x-ray beam is controlled by the voltage adjustment. This control usually is labelled in keV (thousand electron volts) and some mes the level is referred to as kVp (kilovoltage poten al). Do not be confused by the dierent terminology, just remember there is a control by which the dierence in poten al between the cathode and anode can be controlled. The higher the voltage se ng, the more energe c will be the beam of x-ray. A more penetra ng beam will result in a lower contrast radiograph than one made with an x-ray beam having less penetra ng power. It is probably obvious that the more energe c the beam, the less eect dierent levels of ssue density will have in a enua ng that beam. The generator waveform if is not constant poten al (medium frequency etc) will aect the eec ve Kv. mA Tube Current The second control of the output of the x-ray tube is called the mA (milliamperage) control. This control determines how much current is allowed to ow through the lament which is the cathode side of the tube. If more current (and therefore more hea ng) is allowed to pass through the lament, more electrons will be available in the "space charge" for accelera on to the target and this will result in a greater ux of photons when the high voltage circuit is energized. The eect of the mA circuit is quite linear. If you want to double the number of "x" photons produced by the tube, you can do that by simply doubling the mA. Changing the number of photons produced will aect the blackness of the lm but will not aect the lm contrast. S Time The third control of the x-ray tube which is used for medical imaging is the exposure mer. This is usually denoted as an "S" (exposure me in seconds) and is combined with the mA control. The combined func on is usually referred to as mAs or milliampere seconds so, if you wanted to give an exposure using 10 milliampere seconds you could use a 10 mA current with a 1.0 second exposure or a 20 mA current for a 0.5 second exposure or any combina on of the two which would result in the number 10. Both of these factors and their combina on aect the lm in a linear way. That is, if you want to double lm blackness you could just double the mAs. The X-Ray beam The x-ray beam has two main proper es you need to understand. 1) Beam QUALITY is the ability of the beam to penetrate an object, its all about the penetra ng power of the x-ray photons, this is controlled by the KV control. 2) Beam INTENSITY this is the number of x-ray photons in the beam and is principally controlled by the mAS

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But note as you increase the KV not only does the QUALITY harden (more penetra ng) but you do actually get more photons so INTENSITY increases too. Pu ng it all together the exposure Any radiographic subject has a minimum Kv required for the x-ray photons penetrate the most dense part of the subject, the most radiographicaly dense part of the subject will depend upon what the part is chemicaly composed of (Atomic number) and its thickness (remember linear a enua on coecients and HVL!?) The thicker the subject the more absorp on of x-rays so the thicker the part the more mAS you require. In theory the more Kv you use the less the contrast of the image will have However in prac ce lm screen / processing condi ons aect contrast much more In prac ce it is not as simple as this as sca er is produced which is not image forming but adds density to the lm and needs to be controlled, if you remember all those complex diagrams about interac ons of x-rays with ma er you will realise the amount and direc on of sca er depends on the Kv and the material absorbing the x-rays.

Image 1 The Kv is too low the femoral condyle is under pentrated you cannot see the bone trabecualr pa erns. the contrast is too high to demonstrate all the so ssues.

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Image 2 Much be er the all the subject is penetrated and all the so ssues are visible

A well exposed abdomen image demonstra ng all the so ssue structures.

A good chest image the medias num is pentrated the image is exposed well demonstra ng the bones and so ssues.

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Radiographic Exposure Factors

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Under penetrated

OK

Under penetrated

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Radiographic Exposure Factors

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Too much mAS

Too Li le mAS

A few myths Changing the Kv by 2 or 3 makes almost no perceptable image change! Adding 10 Kv does not double the image density Exposure factors are an exact science ! (the image you produce must sa sfy the radiologist who interprets the image - not all radiologists like the same penetra on / density / contrast for the same body part) Image Contrast Here, we need to spend a li le more me discussing the issue of radiographic contrast. This is an important concept because image contrast plays a cri cal part in the interpreter's ability to detect abnormali es which are only slightly dierent from the density of the surrounding material. It is not possible to say what is the op mal contrast (or the op mal radiographic technique) for all situa ons. Dierent body parts have dierent inherent ssue contrast. This can be illustrated by using the extreme examples of the chest and the breast. In the chest, there is good inherent ssue contrast with densi es ranging all the way from

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Radiographic Exposure Factors

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bone at the high end to air at the low end. On the other hand, the breast is inherently very low in ssue contrast only containing structures which are water density (glandular material or tumor) or fat density. For the moment, we will disregard small calcica ons which are really not normal structures. Because of this dierence in inherent ssue contrast, we would be likely to use a very low contrast radiographic technique for the chest because we have good ssue contrast. Conversely we would be likely to use a very high contrast technique for the breast because the breast has minimal, inherent ssue contrast. Remember, image contrast is controlled by the energy of the "x" photon beam. Therefore, high kV techniques result in low contrast images (the assump on is always made that the image will have approximately the same average lm density so if kV is increased, there must be a compensa on in mAs to keep lm density constant). To increase image contrast in situa ons where there is low ssue contrast, a low kV, high mAs technique should be used. This is obvious for mammography but you should also remember this possibility for other special situa ons such as looking for low-density foreign bodies embedded in so ssue. To improve lm contrast for mammograms we would need to use a very low energy x-ray beam. Mammograms are frequently done with beams in the 25 keV range. For the chest x-ray, we would like to use a low contrast technique which requires a rela vely high-energy beam. Chest x-rays are frequently done with beam energies above 100 keV. You should understand that for similar lm densi es, the high KV technique usually results in lower pa ent radia on exposure. Think about this long enough to clearly understand why less radia on is absorbed in the pa ent when a high-energy beam is used. Grids One of the problems in ge ng a sharply dened image in clinical radiology is the presence of sca ered or secondary radia on. These photons are created in the body of the pa ent or closely surrounding objects by the interac on of that material and the primary "x" photons coming from the x-ray tube. Several possible interac ons occur in the diagnos c energy range. At rela vely low energies, the photoelectric eect is probable. The photoelectric eect is actually the desirable, photon/ ssue interac on because there is complete absorp on of the photon with no produc on of a secondary photon. The more common ssue interac on at the photon energies used for the majority of clinical procedures is called the Compton eect or coherent sca ering. In this interac on, a secondary photon is produced at the site of interac on. The secondary photon will always have lower energy than the primary photon and will be going in an altered direc on. These secondary photons, if allowed to reach the lm, will actually produce erroneous informa on by recording gray tone varia on (and therefore indica ng rela ve ssue densi es) at some distance from the site at which the photon/ ssue interac on actually occurred. The net result of allowing a signicant number of secondary photons to reach the lm is a reduc on in image sharpness. There will always be a loss of spa al resolu on. Several methods have been devised to reduce the problem of sca ered radia on. The simplest and most direct is to simply limit the eld of exposure. If a small image area is adequate to make the clinical diagnosis, the image area should be "coned down" to that small size. For instance, if you want to image the gallbladder, you will get a much sharper picture if you bring the shu ers down to include an area only the size of the gallbladder instead of including the en re upper abdomen on the image. Just remember that the smaller the area of the x-ray beam the fewer sca ered photons you will produce.
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Radiographic Exposure Factors

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In the typical clinical imaging situa on, the most common method of reducing sca er is to use a radiographic grid. The grid looks like a at metallic plate the size of the x-ray lm if you look at it directly. However, it is more complicated than that. It actually is composed of alterna ng radiopaque (lead) and radiolucent (aluminum) strips. These are arranged on edge, sort of like looking at the strips of a vene an blind which is arranged to let light come between the strips. The edge of these strips is turned towards the source of x-rays and in the most commonly used grid, the focused grid, the anglula on of the strips is arranged to match the divergence of the x-ray beam. This arrangement of the radiographic grid will give the highest probability for primary "x" photons passing between the lead grid strips and reaching the lm, while the o-focus or secondary photons are likely to interact in the lead strips and never reach the lm. The use of this radiographic grid will greatly improve image sharpness when a rela vely thick body part is being imaged. Unfortunately, there is always a trade o. Since the grid does stop some of the photons which would contribute to lm blackening, if you just add a radiographic grid without changing the tube se ngs, the lm will be greatly underexposed. If you decide to use a grid, you will have to increase the number of photons produced by the x-ray tube in order to get the correct lm exposure. This will result in giving the pa ent increased radia on exposure. Remember, the posi on of the grid is between the pa ent and the lm. The third method of reducing sca er or at least reducing the probability that sca ered photons will reach the lm is to use an air gap. This is infrequently used in clinical radiography but can s ll, some mes be used to an advantage par cularly when magnica on of the image might be helpful. Ordinarily we would have the lm posi oned as close to the pa ent's body as possible for the radiography of any body part. With an air gap technique, the lm is moved several inches away from the pa ent's body. That separa on, (because secondary photons are likely to be lower energy and moving at a greater angle than primary photons) will result in a decreased probability of the secondary photon hi ng the lm. From the diagram below, you will be able to understand that crea ng the air gap will also result in magnifying the radiographic image. Remember the x-ray beam is produced from almost a point source and it diverges as it goes towards the pa ent. Useful Link h p://www.med.sc.edu:1000/2prod&useab.htm

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