AAPM

T utorial Stephen Balter, PhD

Contrast and Scatter in X-ray Imaging1

Gary T. Barnes, PhD

The effect of scattered radiation on x-ray image contrast is reviewed. With-

out scatter control, the information content of x-ray images is severely com-
promised. Typical grid performance in general radiography and mammogra-
phy and grid selection considerations are presented. Contrast can be signifi-
cantly improved and patient dose reduced if more efficient methods of
scatter control can be developed. This can be accomplished in chest radiog-
raphy with scanning slit and improved grid techniques, in mammography
with multiple scanning slit techniques, and in abdominal radiography with
scanning grid techniques.

INTRODUCTION
The deleterious effects of scattered radiation on image quality in x-ray imaging
have long been realized and led to the invention of the grid by Bucky in 1 9 1 3 (1)
and the development of a practical grid assembly by Potter a few years later (2).
However, although the scatter problem is well known, the magnitude of its effect
is not generally appreciated. Figure 1 shows lumbosacral spine radiographs made
for the physics section of the American College of Radiology Teaching File to
demonstrate this effect. One radiograph was obtained without a grid (Fig la) and
the second with a highly efficient prototype grid (3) (Fig ib) The same x-ray .

tube potential and incident beam quality were employed for both; thus, the only
difference between the two images is due to scatter. The nongrid image provides
virtually no information and is useless for diagnostic purposes. The grid image is
markedly improved, and spondylolisthesis is evident.
Figure 1 demonstrates that when scatter is controlled, image contrast is im-
proved. The degree of improvement depends on the amount of scatter present and
the efficiency with which it is controlled. However, controlling scatter also me-
sults in increases in x-ray tube load and patient dose. The reasons for this are two-
fold. First, the scatter reaching the imaging receptor is significantly less when a

Abbreviations: CIF contrast improvement factor, SDF scatter degradation factor, S/P ratio of scattered radia-
tion to primary radiation

Index terms: Breast radiography, technology, 00. 11 Images,

#{149} quality Radiography,
#{149} technology Screens
#{149} and
films

RadioGraphics 1991; 1 1:307-323

I From the Department of Radiology, University of Alabama Hospitals and Clinics, University of Alabama at Birming.
ham, 619 S 19th St, Birmingham, AL 35233. Received December 6, 1990; revision requested December 18; revision
receivedjanuary 8, 1991; acceptedJanuary 10. Address reprint requests to the author.
RSNA,
#{163} 1991

307
 grid is employed. Second, a grid also absorbs approximately 40% of the primary ma-
diation emerging from the patient. The absorption of scatter radiation, as well as
the absorption of primary radiation, makes it necessary to increase the radiation
incident on the patient to achieve the desired image receptor exposure level and
film density. For example, in Figure 1 the patient’s, entrance skin exposure was
increased by a factor of seven when the grid was used compared with when it was
not. Thus, scatter control improves image quality at the penalty of increased pa-
tient dose. The objective of x-ray equipment manufacturers and the medical phys-
ics community is to control scatter efficiently, that is, to maximize improvement
in image contrast and minimize the associated dose penalty. This article reviews
the degree of success that has been achieved in this regard and the potential for fu-
tune improvements.

a. b.
Figure 1. Comparison of lumbosacra! spine radiographs obtained at 1 00 kVp (34
[three phase]) with a 23 X 43-cm radiation field. (a) Nongrid radiograph acquired with
use of 100 mA at 0. 1 2 second, 102-cm source-to-image receptor distance, 0.33-R (0.09.
mC/kg) entrance skin exposure, and 1 .2-mm effective focal size. (b) Scanning grid ra-
diograph obtained with use of 200 mA at 0.8 second, 1 22-cm source-to-image receptor
distance, 2.2-R (0.57-mC/kg) entrance skin exposure, and 1 .2-mm effective focal spot
size. Both exposures were made in the same cassette with use of DuPont (Wilmington,
Del) HiP!us screens combined with Eastman-Kodak (Rochester, NY) X-L film. The radio-
graphs were developed within minutes of each other in the same processor, and the half-
value layers were matched.

308 U RadioGrapbics U Barnes Volume 11 Number 2

 The formation of a radiographic image is conceptually depicted in Figure 2 Pho-
. IMAGE
tons from the x-ray source pass through the patient. Variations in tissue composi- FORMATION
tion give rise to differences in attenuation, which in turn give rise to spatial varia- AND
tions in x-ray intensity (the x-ray image) The exiting x rays are then captured
. by CONTRAST
an intensifying screen or, for digital systems, an imaging plate. Spatial variations in
x-ray energy absorbed in the intensifying screen give rise to differences in screen Subject,
response and light output. These in turn give rise to differences in display signal Display,
(the radiographic image) . Image contrast is the difference in display signal (eg, and Image
film density) between the object of interest and its surround and is a product of Contrast
two components:

image contrast display contrast X subject contrast. (1)

Subject contrast is commonly defined as follows:

subject contrast = loge(12/Il) , (2)

where ‘2 the transmitted x-ray intensity associated with the object of interest
and I is the transmitted intensity of its adjacent surroundings. Display contrast is a
function of the display and, for digital images, postprocessing. In conventional
screen-film systems, the display is film, and display contrast is synonymous with

Figure 2. Diagrams illustrate formation of

::iiiIIIIIIIIII:IIIIIIIIiii:: Patient
the radiographic
graphic images,
film density,
tion.
I
image (x-ray

=
assuming
x-ray intensity,
and radio-
no scatter)
x
D
posi-
.

X-Ray Image

x -

Image Receptor

t
D
Radiographic Image

x -#{248}

March 1991 Barnes U RadioGrapbics U 309

 film contrast. That is, as illustrated in Figure 3 , spatial variations in x-ray intensity
are converted to density variations by the exposure (sensitometnic) response of
the screen-film combination, which is a property of the film, film processing, and
the screen-film exposure level. If the screen-film system is underpenetrated or un-
derexposed, the x-ray exposure levels associated with the anatomy of interest lie
in the toe region of the sensitometmic curve. There is little or no film contrast and,
therefore, little or no image contrast. Likewise, if the screen-film system is over-
penetrated or overexposed, the x-ray exposure levels associated with the anatomy
of interest lie in the shoulder region, where film and image contrast are similarly
compromised. An advantage of digital techniques is that after an exposure, the
mean pixel value of the image can be shifted so that it corresponds to the middle
(or desired) range of gray-scale display values. This is commonly referred to as
“leveling.” Similarly, “windowing” adjusts the display contrast so that the anato-
my of interest spans the desired video-monitor gray-scale range or, on hard copy,
the desired range of film densities. In modern digital systems, windowing and 1ev-
cling are automated, and the desired range of display gray-scale values is obtained
with little or no operator intervention.
Subject contrast depends on the spatial variations in x-ray interactions-photo-
electric absorption, coherent scattering, and inherent scattering-that occur with-
in the patient. These variations depend on x-ray tube potential, beam filtration,
object size, patient thickness and tissue composition, and the differences in densi-
ty and atomic number between the object of interest and its surround. If scatter is
neglected, the (primary beam) subject contrast can alternatively be expressed as
follows:

subject contrast = loge(12/Il) (2)

= loge(1 + EP/P) (3)

L&P/P (when ISP/P < 0 1) . , (4)

where .P is the difference in primary intensity between the object and it surround
and P is the intensity of the surround. That is, I P, ‘2 P + iSP, and subject
-

contrast is the fractional variation in primary x-ray intensity emerging from the pa-
tient.

Figure 3. Dia-
grams illustrate
x-ray to radio-
graphic image
conversion and
screen-film expo- t
sure response.
D film density, x -0.

I = x-ray intensi- 3
ty,x=position.

Log Relative Exposure

310 U RadioGrapbics U Barnes Volume 11 Number 2

 Primary x rays are by definition x rays that travel in a straight line from the source Scatter
assembly to the image receptor. X rays that bounce off an atom or electron (ie, un- and Subject
dergo a coherent or Compton scattering interaction) are deflected, do not travel in Contrast
a straight path, and give rise to scattered or secondary radiation. In soft tissue, a
28-keY x-ray photon has an equal probability of either undergoing Compton scat-
tering or being photoelectrically absorbed. Below 28 keY, a photon is more likely
to be photoelectrically absorbed, and above 28 keV, it is more likely to undergo
Compton scattering. (The probability of a coherent scattering interaction is much
smaller than the probability of a photoelectric or Compton interaction.) General
radiographic x-ray spectrums have a significant percentage of x-ray photons above
28 keV, and at the higher x-ray tube potentials, the majority of x-ray photons are
above 28 keV. Thus, Compton scattering is an important, and in many instances
the dominant, interaction that occurs in patients.
As illustrated in Figure 1 , scattering degrades subject (and image) contrast. Scat-
tem acts as a slowly varying (ie, constant) background or out-of-focus radiation 1ev-
el superimposed on the image (Fig 4) When the effects
. of scatter are taken into
account, Ii P + 5, ‘2
- P + LP + 5, and Equation (2) becomes

subject contrast = loge(I2/I1) (2)

= log41 + AP/(P+ .S)J (5)

(&P/P)/(1 + S/P) (6)
(P/P)SDF, (7)

where S = scatter, S/P = ratio of scattered radiation to primary radiation and SDF =

(1 + S/P) 1 The latter is known as the scatter degradation factor and is the frac-
tion of primary beam (possible) contrast that is imaged due to the presence of

ii:ii Patient
Figure

image).
ty, x
4.
the radiographic
D =

position.
Diagrams

film
image
illustrate

density,
(primary
I
formation
and scatter
x-ray intensi-
of

t
X-Ray Image

Image Receptor

t
D
Radiographic Image

March 1991 Barnes U Ra4ioGrapbics U 311

 scatter. Numerically, the factor takes on values from one (no scatter) to zero (infi-
nite scatter) . The dependence of subject contrast on S/P is plotted in Figure 5.
Small amounts of scatter significantly degrade contrast.
The amount of scatter emerging from a patient depends primarily on the volume
of tissue irradiated (ie, patient thickness and field size) (Fig 6) Scatter also in- .

creases as the tube potential is increased over the diagnostic range. The data pre-
sented in Figure 6 indicate that the scatter emerging from the patient is less when
the radiation field size is reduced (ie, proper collimation is employed) and when
patient thickness is reduced (ie, compression is employed).
Because of the differences in patient thickness, field size, and anatomic attenua-
tion, as well as in x-ray tube potential, the relative intensity of scatter emerging
from patients varies greatly in clinical practice. Typical ranges for common exami-
nations are listed in Table 1 . Also listed are the corresponding SDFs, which mdi-
cate that for many routine examinations, the fraction of possible contrast imaged
is quite small if scatter is not controlled. Radiography of the chest, abdomen, and
spine is associated with extremely high S/Ps. As illustrated in Figure 7, these high
values result from the greater attenuation of the spine and mediastinum, which me-
sults in reduced primary radiation levels compared with the levels in adjacent me-

LI.
0
Cl)

Scatter/Primary nw si#{149}
(cm)

5- 6.
Figures 5, 6. (5) Plot of the fraction of possible or primary-beam (SDF) contrast that is
imaged versus the S/P. (6) As seen in the plot of S/P and field size, the relative intensity
of scatter (ie, S/P) increases with patient thickness and field size (based on 1 05-kVp sin-
gle-phase data from reference 4).

312 U RadioGraphics U Barnes Volume 11 Number 2

 gions. The scatter in these regions arises from neighboring areas in which the pni-
mary radiation and production of scatter are more intense. The combination of
these two effects gives rise to high S/Ps in the spine and mediastinum.
In mammography, due
to the low x-ray tube potentials and the small volume of
tissue irradiated, prior 1 975 scatter
to was thought to have a negligible effect on
mammography image contrast. The error in this line of reasoning was pointed out
qualitatively by Friedrich (5) and quantitatively by Barnes and Brezovich (6,7).
Depending on breast thickness and, to a lesser degree, field size, S/P in mammog-
raphy ranges from 0.4 to 1 .5 and results in a significant contrast degradation un-
less scatter is controlled.

Table 1
Ranges of Patient S/P for Selected
focal spot Examinations and Associated SDFs

Examination S/P SDF

collimator
Radiography
Abdomen/lum-
banspine 4-20 0.20-0.05
Chest 1-15 0.30-0.06
Mammography 0.4-1.5 0.71-0.40

primary
radiation

scattered
radiation

U)
C
0
C
)1
0

position
Figure 7. Diagram shows the effect of
variations of primary beam intensity on im-
aged S/P. High S/Ps occur under the spine
because of its greater attenuation and be-
cause of the presence of x rays scattered
from the more intense primary fields in the
adjacent soft-tissue regions.

March 1991 Barnes U Ra4ioGrapbics U 313

 SCATfER There are two common methods of controlling scatter in medical radiography-
CONTROL aim gap and grid. An aim gap between the patient and image receptor is employed
AND GRID when direct magnification is desired. The aim gap reduces the percentage of scat-
PERFORMANCE tered photons that are incident on the image receptor, and the efficiency of this
technique is greater with large aim gaps than with smaller field sizes. In general,
Conventional magnification is not desired, and the standard technique is to employ a grid. A
Grid Design typical grid, illustrated in Figure 8, consists of an array of radiopaque foil strips
(usually lead) separated by strips of radiolucent spacing (or interspace) material
(usually aluminum or fiber) The grid is positioned
. between the patient and im-
age receptor (Fig 9) so that the image-forming x rays from the x-ray tube focal
spot “see” (project) only the edges ofthe lead foil strips, and most pass through
the radiolucent spacers. However, a significant portion (typically, 30%-45%) of
the image-forming or primary x rays are attenuated by the lead strips and inter-
space material. Scattered
x rays directed toward the image receptor do not have a
straight-line path throughthe radiolucent spacers and “see” a much larger area of
lead. Typically, 80%-95% of the scattered radiation is absorbed. Typical grids
have top and bottom covers, consisting of aluminum or, more recently, carbon fi-
ber, that provide support and protect the easily damaged lead foil strips. Typical
grid design parameters are given in Table 2 A lead foil strip thickness
. of 50 &m is
common, and the thickness of interspace material varies from 1 25 to 250 m de-
pending on the number of grid strips (lines) per centimeter.
The ratio of the height of the lead strips to the interspace material thickness is
the grid ratio and is of fundamental importance. Typical grid ratios vary from 4:1
to 1 6: 1 For a given number
. of grid lines per centimeter, as one increases the
height of lead strips or grid ratio, the scatter transmitted by the grid decreases.
However, two factors limit this in practice-increased attenuation of the primary
x-ray beam by the interspace material (usually fiber or aluminum) and the in-
creased difficulty in aligning and maintaining alignment of high-ratio grids.

RADIOPAQUE INTERSPACE
STRIPS MATERIAL
focal spot

collimator
h

primary radiation

D
Figure 8. Conventional grid. b height of
grid, d = thickness of radlopaque strips, D
= thickness of radiolucent interspace mate-
mial.

scatt#{149}rsd
radiation

- grid
imagi
rceptor

Figure 9. Bucky grid assembly. Black lines

represent radiopaque strips that make up
the grid. Arrow at lower right indicates the
common practice of moving the grid a short
( 1 -2 cm) distance during an exposure to
blur out shadows cast by the lead strips.

314 U RadioGraphics U Barnes Volume 11 Number 2

 When the lead strips are parallel, as shown in Figure 8, the grid is referred to as
a parallel grid. More commonly, the lead strips are focused. As illustrated in Fig-
ure 1 0 , the focus of a linear-focused grid is a line . When the x-ray tube focal spot
is located along the grid focal line (ie, when the x-ray beam and grid are properly
aligned), x rays across the field “see” the lead strips on edge and the primary
transmission of the grid is optimized. This fact permits one to obtain angled views
and to perform linear tomography without creating alignment problems as long as
the x-ray tube focal spot moves along the focal line of the grid. If the focal spot
lies above or below the grid focal line (ie, off-focus decentering) , cutoff occurs
and there is a loss of primary radiation and an increase in the relative intensity of
scatter at the edges of the field. Other types of decentering are off-level and later-
al Both of these
. result in a uniform loss of primary radiation and an increase in the
relative intensity of scatter imaged. For all three types of decentering or grid mis-
alignment, the loss of primary radiation is directly proportional to the grid ratio,
and it is therefore essential that high-ratio grids be properly aligned. Such is not al-
ways the case in clinical practice, and grid alignment, as well as grid uniformity,
should always be checked on new equipment.
During an exposure, grids are usually moved through 20 or more grid line inter-
vals (ie, 20 times the distance of a strip and interspace thickness) to blur out the
grid lines. An additional advantage of such movement is that grid artifacts are also
blurred and suppressed. In certain examinations, such as those performed with
portable equipment, grid movement is not practical and grids with high strip den-
sity are preferred, even though they are less efficient. On grids with an ultrahigh
strip density (60 lines per centimeter or greater) , grid lines are not visually per-
ceived on general-purpose screen-film images, and it is not necessary to move the
grid.

Table 2
Typical Grid Design Parameters
Thickness of
Thickness of Radiolucent
Grid Lead Interspace
Interspace Height Strips Material Strip Density
Ratio Material (mm) (zm) (sm) (lines/cm)

8:1 Aluminum 1.6 50 195 41

12:1 Aluminum 2.3 50 195 41
12:1 Fiber 3.2 50 265 32

Figure 10. Focused linear grid, with the

lead strips progressively tilted with increas-
ing distance from the center of the grid.

March 1991 Barnes U RadioGraphics U 315

 Grid The performance of a grid depends on the improvement in contrast that results
Performance when it is employed and the factor by which patient dose is increased to achieve
Indexes this improvement. The contrast improvement factor (CIF) of a grid is defined as
follows:

CIF = subject contrastw/grid/subject contrast,0 grid. (8)

If one substitutes Equation (7) in Equation (8) (and notes that the primary beam
contrast P/P is not greatly affected by the grid) , one obtains the equation

CIF SDFw/id/SDFw/o grid. (9)

The CIF of a grid depends on its scatter and primary transmission (T5 and T) and
also on the amount of scatter that is present. As illustrated in Figure 5 the greater ,
the scatter level, the smaller the fraction of possible contrast that is imaged and
the greater the room for improvement. In addition, the CIF of a grid will also de-
pend on the penetrating quality of the scatter and primary radiation emerging
from the patient.
The dose penalty or Bucky factor of a grid is the factor by which the milliampeme
second product has to be increased (at a given tube potential) when a grid is em-
ployed to achieve the same film density that was achieved without the grid. That
is,

Bucky factor fllASw/grid/fllASw/o grid. (10)

Grid The performance results for three common grids are given in Table 3 In compar- .

Performance ing the 8: 1 and 1 2: 1 aluminum interspace grids, as one would expect, the 12:1
in General grid achieves greater contrast improvement and has a higher dose penalty. The
Radiography 1 2 : 1 fiber interspace grid achieves better contrast improvement with a lower

Table 3
Typical Grid Performance at 80 and 100 kVp (34)

Tube S/P
Gnid/ Potential T T, Without With Bucky
Interspace (kVp) (%) (%) Grid Grid CIF Factor

8:laluminum 80 57 10.0 6.6 1.16 3.52 6.2

12:laluminum 80 49 5.5 6.6 0.74 4.37 8.9
12:lfiben 80 59 5.5 6.6 0.62 4.69 8.0

8:laluminum 100 61 12.7 7.2 1.50 3.28 5.4

12:la!uminum 100 54 8.0 7.2 1.07 3.96 7.3
12:lfiber 100 61 6.4 7.2 0.76 4.66 7.6

Source-Unpublished data, Barnes and Moreland.

Note-Measured for a 30 X 30 X 18-cm-thick Lucite phantom.

316 U RadioGraphics U Barnes Volume 11 Number 2

 Bucky factor (lower dose) than the 1 2 : 1 aluminum interspace grid. Artifacts were
not quantified, but aluminum interspace grids typically result in fewer artifacts
than the fiber interspace grids.
Table 4 lists the CIFs and Bucky factors associated
with the 8: 1 and 1 2 : 1 aluminum interspace grids as a function of the S/P. At low
S/P, the contrast improvement obtained with the 1 2 : 1 grid is only slightly better
than that obtained with the 8: 1 grid. This modest difference, along with the great-
em Bucky factor of the 1 2 : 1 grid, is the reason why lower-ratio grids are generally
employed in low-scatter situations (ie, S/P of 4 or less) In high-scatter
. situations
(ie, S/P of 5 or greater) ,
the contrast improvement obtained with the 1 2 : 1 grid is
markedly better than that obtained with the 8: 1 grid and is the reason why high-ma-
tio grids are preferred when thick body parts are imaged.

Table 4
CIF and BuCky Factor of Aluminum-Interspace 8:1 and 12:1 Grids as a
Function of S/P

CIF Bucky Factor

S/P 8:lGnid 12:lGnid 8:lGnid 12:lGnid

0 1.0 1.0 1.8 2.0

2 2.2 2.5 3.9 5.0
4 2.9 3.5 5.2 7.0
6 3.4 4.2 6.0 8.5
8 3.7 4.7 6.6 9.7
10 4.0 5.2 7.0 10.6

Note-Calculated from 80-kVp (34) T, and 1’, values listed in Table 3.

March 1991 Barnes U RadioGrapbics U 317

 Grid In mammography, moving Bucky grids are routinely employed to control scatter.
Performance In Carbon fiber cover construction and wood or fiber interspace material are com-
Mammography mon. Typical strip densities are 30-50 lines per centimeter. Typical grid ratios are
4 : 1 or 5 : 1 The measured
. performance of a 4 : 1 , 46-lines-per-centimeter mammog-
raphy grid is given in Table 5 Even for the . small scatter intensities in mammogma-
phy, a significant improvement in contrast is realized when scatter is controlled.
This is demonstrated qualitatively in Figure 1 1 , where nongmid and grid images of
the Memorial breast phantom are compared. (This phantom is not commercially
available but has been well described in the literature [9].) As breast thickness in-
creases, the relative intensity of scatter emerging from the breast is greater, and,
correspondingly, the contrast improvement is greater. The penalty for this im-
provement is a twofold increase in dose.

Table 5
Mammography Grid Performance
Phantom S/P Bucky
Thickness (cm) Without Grid With Grid C!F Factor

4 0.62 0.19 1.36 1.97

6 0.91 0.26 1.51 2.14

Source -Reference 8.
Note-Measured for a 1 6 X 8-cm BR- 1 2 breast phantom at 30 kVp on a Mam-CP
mammography unit (Transwon!d X-ray, Charlotte, NC).

a. b.
Figure 11. Images of Memorial breast phantom (6 cm) obtained without (a) and with
(b) a grid on the same mammography unit at 30 kVp (30) with the same cassette and
with Eastman-Kodak Min-R screen combined with DuPont Microvision film. The films
were developed within minutes of each other in the same processor. The techniques and
associated average glandular doses were 49 mAs and 73 mrad (730 Gy) for a and 117
mAs and 1 74 mrad (1 ,740 tGy) for b.

318 U RadioGraphics U Barnes Volume 11 Number 2

 It is of interest to compare performances of commonly used grids with that of an FUTURE
ideal grid (T 1 00%, T5 0%). A plot of CIF as a function of S/P for a conven- POTENTIAL
tional 1 2 : 1 fiber interspace grid and an ideal grid demonstrates that there is sub-
stantial room for improvement in contrast at high scatter levels (Fig 1 2) . A clinical Limitations of
example of the improvement that is possible is shown in Figure 1 3 , which com- Conventional
pares lateral sacral spine radiographs obtained with a 1 2 : 1 grid and a prototype Grids
scanning slit device (1 0) Use of the prototype . yields a marked improvement in
contrast. Of clinical relevance is that the patient had prostate cancer metastatic to
the sacrum. Although the presence of metastases was suggested on the convention-

Figure 13 Lateral sacral spine radiographs obtained at 1 16 kVp (3q5) with a 33-cm
subject thickness and 20 X 30-cm radiation field. (a) Radiograph obtained with a 12:1
grid with 40.6 lines per centimeter at 300 mA and 0.07 second. The source-to-image ne-
ceptor distance was 1 02 cm and the entrance exposure, skin
5 20 mR (0 1 34 mC/kg). .

(b) Radiograph obtained on a scanning multiple slit device at 600 mA and ‘/ second.
The source-to-image receptor distance was 1 22 cm and the entrance skin exposure, 760
mR (0. 1 96 mC/kg). Both exposures employed a nominal 1 .2-mm focal spot with the
same cassette, Eastman-Kodak Lanex screens, and Eastman-Kodak Ortho-G film. The
films were developed within minutes of each other in the same processor. The same gen-
erator was employed for both films, and the half-value layers of the two source assem-
blies used were matched.

Figure 12. Plot of CIFs obtained with a

conventional 1 2 : 1 grid and an ideal grid
(T 100%, T, 0.0%) as a function of S/P.
If The T, and T, data employed to calculate
C the 1 2 : 1 CIF were for a fiber interspace grid
0
at 1 00 kVp (30), that is, the conventional
0.
grid with the best performance (Table 3).
E
U,
U,
C

Scatter/Primary Emerging From Patient

March 1991 Barnes U Ra4ioGrapbics U 319

 al image, it is readily apparent on the scanning slit image, and the diagnosis was
made with a high level of confidence.
The realization of the limitations of conventional grids and the potential for im-
proved contrast has resulted in the recent development of a number of novel scat-
ter control devices. These developments can be categorized in four groups: single
scanning slit devices, multiple scanning slit devices, scanning grids, and improved
conventional grids.

Scanning Slit The use of a single pair of moving slits to suppress scatter was suggested at the
Radiography turn of the century (1 1) . Such a device is illustrated in Figure 1 4 and consists of a
beam-defining fore slit between the x-ray tube and the patient and a similar scat-
ten-limiting aft slit between the patient and image receptor. The two slits move
synchronously and scan the area of interest during an exposure. The principle of
scanning slit radiography is that the small radiation field defined by the fore slit
produces little scatter in the primary field and the x rays scattered out of the irma-

Table 6
Comparison of Performance of Conventional and Ideal Mammography Grids

Scatter Control S/P Dose Penalty

Technique Without Grid With Grid CIF Factor

Conventional 4 : 1 grid 0.9 1 0.26 1 .5 1 2.14

Idealgnid 0.91 0.0 1.91 1.91

Note-Measured for a 16 X 8-cm BR-i 2 bre ast phantom at 30 kVp.

Focal Spot

Coll,mator/ Shutters

Figure 14. Diagram illustrates the

principle of scanning slit radiography.
Beam Defining Fore Slit

Primary
Scattered Radiation

Patient

Table . Eliminating
Cassette I Aft Slit

320 U RadioGrapbics U Barnes Volume 11 Number 2

 diated volume are not imaged because of the aft slit. However, because small slits
and excessive tube loads are necessary for efficient scatter control, the employ-
ment of a single pair of scanning fore and aft slits has not proved practical for gen-
era! medical radiography. In chest radiography, tube loads are less demanding,
and such a configuration has been incorporated along with a discrete linear detec-
tom array in the design of a prototype digital chest unit by Picker International
(Highland Heights, Ohio) (12).
The increased tube load associated
with a single pair of scanning slits can be me-
duced by employing a multiplicity of such slits (1 0, 1 3- 1 6). Such a device was
used to obtain Figure 1 3b. The comparison in Figure 1 3 demonstrates that a multi-
plc scanning slit device can control scatter more efficiently than a conventional
high-ratio grid. A problem with the multiple scanning slit device is the difficulty
of maintaining alignment while obtaining angled views. This limitation has pre-
cluded its commercial development for abdominal radiography. However, the
technology has potential in the fixed x-ray imaging geometries commonly em-
ployed in chest radiography and mammography. Such devices have been con-
structed for mammography (1 7, 1 8), and more
recent designs have been able to
accommodate the necessary patient
requirements position
(1 . The performance 9)

of multiple scanning slit devices In mammography approaches that of an ideal

grid. Table 6 compares the performances of the two and reveals that greater image
contrast is possible with a lower patient dose with an efficient multiple slit de-
vice.

An alternative way of Improving scatter control is to employ more efficient grids. Novel Grid
Two techniques that have clinical potential have been described in the scientific Techniques
literature. One is a scanning grid that consists of radlopaque slats situated between
the patient and film (Fig 1 5) (3,20). However, unlike a conventional grid, there is
no interspace material, and, during an exposure, the assembly scans across the ra-
diation field and the grid slats articulate so that they remain focused at the x-ray
source. The scanning motion is synchronized with the exposure time so

pivot point

Figure 15. Dia-

gram of scanning
grid.
upper grid slat spacer

grid slats

receptor

grid slat spacer

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 that the film receives a uniform radiation exposure. Focusing is realized by mak-
ing the lower slat spacing equal to the geometric projection of the upper slat spac-
ing. The upper and lower spacers are connected to a linkage arm that maintains fo-
cus and alignment as the slats articulate during scanning. The design permits one
to construct high grid ratios (ie, greater than 20: 1) with respectable primary trans-
mission values (ie, T, greater than 70%) . A 1 5 : 1 prototype scanning grid was em-
ployed to obtain Figure lb. The scanning grid principle is compatible with angled
views and linear tomography because the pivot axis is maintained at the focal spot
when the x-ray tube is moved.
A different approach has been used by Sorenson and colleagues (2 1 ,22) Their .

improved grid design uses tantalum grid strips or lamellae, a lowem-than-conven-

tional strip density, and air interspace. Their grids were constructed by gluing the
tantalum strips into grooved, 1-mm-thick carbon fiber support plates. To achieve
efficient scatter control, they employed two orthogonal 1 1 : 1 grids. Their primary
interest was in the chest, where the geometry is fixed and where the inability of
the cross grids to accommodate angled views is not a problem.

Comparison of In Table 7, cross-tantalum air-interspace grids, a scanning multiple slit assembly,

Conventional and the scanning grid are compared with conventional 8: 1 and 1 2 : 1 grids and the
and Novel Picker prototype scanning slit digital chest unit. Although the latter has by far the
Scatter Control best scatter control performance, its excessive tube load limits its use to chest ra-
Techniques diogmaphy. Likewise, the tube loads are high on the scanning multiple slit unit.
Such is not the case with the scanning grid and cross-tantalum air-interspace grids,
and these techniques offer great promise.

CONCLUSIONS Scatter control plays an important role in diagnostic x-ray imaging. Without scatter
control, image quality is severely compromised. In many instances, conventional
techniques yield acceptable results, especially if attention is paid to detail-colli-
mating to the area of interest and, when feasible, compression. However, in imag-
ing thick body parts, the capability of conventional grids is limited. Novel scan-
ning grids and low-strip-density air-interspace tantalum grids offer considerable
promise, and it is highly likely that these techniques could virtually eliminate

Table 7
Comparison of Conventiona 1 and Novel Scatt em Co ntrol
TeChniques at 100 kVp

Tp Ts Relative
Technique (%) (%) S/P CIF Dose

Nongrid reference 100 100 9.0 1 .0 1.0

Conventional grid
8:1,aluminuminterspace’ 67 11.2 1.50 4.0 6.0
12:1,aluminuminterspace 62 8.5 1.23 4.5 7.2
Crossed 1 1 : 1 air-interspace
tantalumgnid(20) 66 3.3 0.45 6.9 10.4
Scanninggrid(1) 67 3.7 0.50 6.7 10.0
Scanning multiple slit
device(12) 84 3.1 0.33 7.5 8.9
Picker digital chest
unit(22) 90 0.4 0.04 9.6 10.7
Idealgrid 100 0.0 0.0 10.0 10.0

322 U Ra4ioGrapbks U Barnes Volume 11 Number 2

 scatter in abdominal radiography. As shown in Figure 1 2 and demonstrated in Fig-
ure 1 3 , a marked improvement in image contrast would be realized. In view of
this, it is highly likely that these techniques will be commercialized in the near fu-
ture. Likewise, in mammography, conventional techniques are not dose efficient,
and scanning multiple slit techniques have the potential of simultaneously im-
proving image contrast and reducing patient dose.

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