 Exposure Factors influence and determine

the quantity and quality of the x-radiation

to which the patient is exposed.
 Radiation quantity refers to the radiation
intensity referred to as mR or mR/ mAs.
 Radiation Quality refers to the beam
penetrability and measured in HVL.

Chapter 18 Radiographic
Exposure
 The radiographic exposure factors are
under the control of the operator except
for those fixed by the design of the x-ray
machine.
 There are two choices for focal spot.
 With the exception of compensating
filters, added filtration is fixed.
 The type of high voltage power is also
fixed.

Radiographic Exposure
 kVp
 mA times Exposure Time = mAs
 Determines the quality and quantity of the
exposure
 SID, Focal Spot and Filtration are
secondary factors

Exposure Factors Controlled by

the Operator
 As we have discussed in the laboratory,
kVp controls radiographic contrast.
 kVp determines the ability for the beam to
penetrate the tissue.
 kVp has more effect than any other
factor on image receptor exposure
because it affects beam quality.

kVp
 To a lesser extent it also influences the
beam quantity.
 As we increase kVp, more of the beam
penetrates the tissue with higher energy
so they interact more by the Compton
effect.
 This produces more scatter radiation
which increases image noise and reduces
contrast.

kVp
 50 kV 79% is photoelectric, 21%
Compton, < 1% no interaction
 80 kVp 46% is photoelectric, 52%
Compton 2% no interaction
 110 kVp 23% photoelectric, 70%
Compton, 7% no interaction
 As no interaction increases, less exposure
is needed to produce the image so patient
exposure is decreased.

kVp
 1 Ampere = 1 C/s = 6.3 x 1018 electrons/
second.
 The mA selected for the exposure
determines the number of x-rays
produced.
 The number of x-rays are directly
proportional to the mA assuming a fixed
exposure time.
 100 mA produced half the x-ray that 200
mA would produce.

mA
 Patient dose is also directly proportional
to the mA with a fixed exposure time.
 A change in mA does not affect kinetic
energy of the electrons therefore only the
quantity is changed.

mA
 Many x-ray machines are identified by the
maximum mA or mAs available.
 A MP 500 has a maximum mAs of 500
mAs.
 A Universal 325 has a maximum mA of
300 and maximum kVp of 125

mA
 More expensive three phase machines will
have a higher maximum mA.
 A General Electric MST 1050 would have
1000 mA and 150 kVp.

mA
 The exposure time is generally always
kept as short as possible.
 This is not to reduce patient exposure but
to minimize motion blur resulting from
patient movement.
 This is a much greater problem with
weight bearing radiography.

Exposure Time
 Older machine express time as a fraction.
 Newer machines express exposure time
as milliseconds (ms)
 It is easy to identify the type of high
voltage generation by looking at the
shortest exposure time.

Exposure Time
 Single phase half wave rectified fasted
exposure time is 1/60 second 17 ms.
 Single phase full wave rectified fastest
exposure time is 1/120 second or 8 ms
 Three phase and high frequency can
provide exposure time down to 1 ms.

Exposure Time
 mA and exposure time is usually
combined and used as one factor
expressed as mAs.
 mAs controls radiation quantity, optical
density and patient dose.
 mAs determine the number of x-rays in
the beam and therefore radiation
quantity.
 mAs does not influence radiation quality.

mAs
 Any combination of mA and time that will
give the same mAs should provide the
same optical density on the film. This is
referred to as the reciprocity law.
 As noted earlier for screen film
radiography, 1 ms exposure and exposure
longer than 1 seconds do not follow this
rule.

mAs
 On many modern machines, only mAs can
be selected. The machine automatically
gives the operator the highest mA and
shortest exposure time.
 The operator may be able to select mA by
what is referred to as Power level.

mAs
 mAs is one way to measure electrostatic
charge. It determines the total number of
electrons.
 Only the quantity of the photons are
affected by changes in the mAs.
 Patient dose is therefore a function of
mAs.

mAs
 If we know the mR/mAs, multiply that
figure times the mAs. or
 If we know the mR for a given exposure
at a given kVp, we can divide the
exposure by the mAs to get the mR/
mAs.
 To compute exposure we need to know
what the mR/mAs is for the kVp used and
the SID.

mAs
 Distance affects the exposure of the
image receptor according to the inverse
square law.
 Distance affects the intensity of the x-ray
beam at the film but has no effect on
radiation quality.

Distance
 ◦ mAs (second exposure) SID2 1st exposure
exposure
◦ ----------------------------= ----------------------
---
◦ mAs (first exposure) SID2 2nd exposure

Inverse Square Law

 The most common source to image
distances are 40” (100 cm) and 72”(182
cm)
 Since SID does not impact the quality of
the beam, adjustments to the technical
factors are made with the mAs.
 To go from 40” to 72” increase the mAs
3.5 time.

Distance
 Increasing the distance will impact the
geometric properties of the beam.
 Increased SID reduces magnification
distortion and focal spot blur.
 With the need to increase the mAs 3.5
times for the 72” SID, tube loading
becomes a concern.

Distance
 72” SID is used for Chest radiography and
the lateral cervical spine to reduce
magnification.
 72” SID used for the full spine to get a
36” beam.

Distance
 Operator has limited control.
 The following will impact the technical
factors based upon the type of machine.
◦ Focal Spot Size
◦ Filtration
◦ High-voltage Generation

Imaging System Characteristics

 Most machines limited to two focal spot
sizes.
 Common office focal spots are 1.0 mm
for the small and 2.0 mm for large.
 Highly detailed radiography such as
mammography use micro-focus tubes
with 0.1 mm and 0.3 mm focal spot sizes.

Focal Spot Size

 The focal spot size limits the tube’s
capacity to produce x-rays. The electrons
and resulting heat are placed on a smaller
portion of the x-ray tube.
 The mA is therefore limited for the small
focal spot. This results in longer exposure
times with greater chance of patient
movement.

Focal Spot Size

 For single phase machines, the small focal
spot use is limited to extremities and the
cervical spine.
 With high frequency, most views can be
done on the small focal spot except for
larger patient and ones that cannot hold
still.
 My limit is exposure times less than 1/2 s.

Focal Spot Size

 If the mA is properly calibrated, the focal
spot will have no impact on the quantity
or quality of the beam.

Focal Spot Size

 All x-ray beams are affected by the
filtration of the tube. The tube housing
provides about 0.5 mm of filtration.
 Additional filtration is added in the
collimator to meet the 2.5 mm of
aluminum minimum filtration required by
law.
 2.5 mm is required for 70 kVp.

Filtration
 3.0 mm is required for at 100 kVp.
 3.2 mm is required for operations at 120
kVp.
 Most machines now are capable of over
100 kVp operation.
 We have no control on these filters.

Filtration
 Chiropractic radiography is a leader in the
use of compensating filters. We have total
control over compensating filtration.
 In areas of the body with high subject
contrast or wide differences in density,
compensating films improve image quality
and reduce patient exposure.

Filtration
 You will determine the type of high-
voltage generation when you purchase
your x-ray machine.
 The type of generator will determine the
efficiency of the generator or the amount
of ripple in the wave form.
 Single phase has 100% ripple.

High-voltage Generation
 Three phase has a 14% so it is significant
improvement in efficiency increasing both
quality and quantity of the beam.
 More x-rays per mAs with higher energy.
 Cost to provide 3 phase power is very
high so not practical in office.

Three Phase Generation

 Virtually no ripple ( less than 1%.)
 Inexpensive and can use normal incoming
power.
 Provides significant reduction is mAs or
kVp compared to single phase. Reduction
of mAs by 50% compared to single phase
techniques.

High Frequency Generation

 Radiographic Quality refers to the fidelity
with which the anatomic structures being
examined are images on the film.
 Three main factors:
◦ Film Factors
◦ Geometric Factors
◦ Subject Factors

Chapter 19 Radiographic Quality

 Characteristic of radiographic quality:
◦ Spatial Resolution (Recorded Detail)
◦ Contrast Resolution (Visibility of Detail)
◦ Noise (Visibility of Detail)
◦ Artifacts

Radiographic Quality
 Spatial Resolution is the ability to image
small structures that have high subject
contrast such as bone-soft tissue
interface.
 When all of the factors are correct,
conventional radiography has excellent
spatial resolution.

Spatial Resolution
 Contrast resolution is the ability to
distinguish structures with similar subject
contrast such as liver-spleen, fat-muscle.
 Computed tomography and MRI have
excellent contrast resolution. Convention
radiology is fair to poor.

Contrast Resolution
 Noise is an undesirable fluctuation in
optical density of the image. Two major
types:
◦ Film Graininess- no control over
◦ Quantum Mottle- some control over

Noise
 Film graininess refers to the distribution in
size and space of the silver halide grains
in the film emulsion.
 Similar to photographic film. 400 ASA film
is more graininess than 100 ASA film.
 Similar to structure mottle that refers to
the size and shape of the phosphors in
the intensifying screens.

Film Graininess
 Resolution and noise are intimately
connected with speed.
 While the speed of the images receptor is
not apparent on the image, it influences
both resolution and noise.

Speed
 Fast Image receptors have high noise and
low spatial and contrast resolution.
 High spatial and contrast resolution
require low noise and slow image
receptors.
 Low noise accompanies slow image
receptors with high spatial and contrast
resolution.

Radiographic Quality Rules

 Characteristic curve
◦ Density
◦ Contrast
◦ Latitude
 Processing
◦ Time
◦ Temperature

Film Factors of Quality

 Sensitometry is the study of the
relationship between the intensity of
exposure of the film and the blackness
after the film is processed.
 Unexposed film is clear with a blue tint
after processing.
 Exposed film is black after processing.

Sensitometry
 Two principles involved.
◦ Exposure of the film
◦ Amount of light transmitted through the
processed film of optical density.
 Used to describe the relationship of
radiation exposure and blackness or
density on the film.

Sensitometry
Characteristic Curve
 This relationship is
called the
characteristic curve
or H & D curve of
the film.
 H & D stands for
Hurter and
Driffield.
Parts of the Characteristic Curve
 Toe and shoulder
where large
changes in
exposure results in
small changes in
OD.
 Very high and very
low variations of
exposure make
very small changes
in density.
Parts of the Characteristic Curve
 The straight line or
intermediate area
is where very small
changes in
exposure results in
large changes in
density.
 This is the
important part of
the curve in
radiography.
Log Relative Exposure (LRE)
 X-ray films
responds to a wide
range of exposure
from 1 mR to 1000
mR.
 Exposure is
represented on
logarithmic
manner.
Optical Density Range
 The optical density
range is from 0.0
for no density to
4.0 for absolute
black.
 Useful range in
general
radiography is
from 0.5 to 2.25.
 Image range is 0.5
to 1.25 OD
Base fog or base density
 The tint of the
base of the film
and the
inadvertent
exposure of the
during processing.
 Range is from 0.1
to 0.3. Should be
never above 0.30
most is .21 OD
 Film storage
 Film exposure to wrong spectrum of light
or light intensity.
 Chemical contamination.
 Improper processing.
 High Base fog levels reduce contrast.

Items that Impact Base Fog

 Radiographic Contrast is the combined
result of image receptor contrast and
subject contrast.
 Image receptor contrast refers to the
contrast inherent in the film and
influenced by the processing of the film.

Contrast
 Subject contrast is determined by the
size, shape and x-ray attenuating
characteristics of the subject being
examined and the energy (kVp) of the x-
ray beam.

Contrast
 Inherent to the film and screen
combination but is influenced by:
◦ Range of Optical Density
◦ Film Processing Technique
 Film type is determined by the type of
intensifying screens used but many
dealers sell off brands of film.

Image Receptor Contrast

Image Receptor Contrast
 The slope of the
straight line portion
of the H & D curve is
the receptor
contrast.
 The average
gradient is a straight
line drawn between
the densities of 0.25
and 2.00 + base
fog.
Average Gradient
 The average
gradient is a
straight line drawn
between 0.25 OD
and 2.0 OD above
base plus fog.
 This is the normal
range of density in
a radiograph
Speed
 Speed is the ability
of the receptor to
respond to low x-
ray exposure.
 The H & D curse is
useful in
comparing speed
when selecting film
or screens.
 A relative number of 100 given to Par
Speed Calcium Tungstate Screens.
 High Speed Calcium Tungstate has a
speed of 200. Half of the exposure is
needed to produce the same image.
 Rare earth screen film combinations range
is speed from 80 to 1600.

Speed
 By knowing the Speed, sometimes
referred to as the Relative Speed Value, it
is easy to convert the technical factors for
one speed to another speed.

Speed
LATITUDE
 Latitude can be
observed on the H
& D curve.
 Latitude refers to
the range of
exposure that will
produce a
diagnostic range
OD.
Latitude
 Latitude and
Contrast are
inversely
proportional.
 Wide latitude has a
wide gray scale or
low contrast. (B)
 Narrow latitude
has a short scale
or high contrast.
(A)
 Latitude is designed into some screen and
film combinations. With wide latitude, the
error factor in technique is wider.
 Latitude can also be impacted by the
technical factors.

Latitude
Film Processing
 Radiographic
Quality is impacted
by film processing
parameters.
 The developer
must be at the
proper
concentration and
at the correct
temperature.
Film Processing
 The film must also
spend the correct
amount of time in
the developer.
 This is the time
& temperature
relationship.
 Speed and base fog increase with the
temperature.
 Contrast will increase to a point and then
drop with the base fog increase.
 Manufactures set processing parameters
to optimize speed, contrast and low base
fog.

Processing
 In 9th Quarter we will discuss processor
quality control in detail.

Processing