Imaging with X-Rays

By Nipun Gupta

IMAGE QUALITY
WHAT IS IMAGE QUALITY?
Image quality describes the overall appearance of the image
and its fitness for purpose.
There is always a playoff between image quality and patient
dose.
So we always need images that are of diagnostic value and fit
for purpose not the visually appealing pictures.

IMAGE QUALITY
The main factors to consider are:
Contrast
Spatial Resolution
Noise
Distortion
Blur

CONTRAST
Contrast, or more precisely contrast resolution,
is the ability to distinguish between adjacent
areas of the image.
So, better contrast means better appreciation of details.
The amount of contrast between tissues is intrinsically
linked to their properties and the imaging modality
being used.

CONTRAST

Radiograp
hic
contrast:
Film
contrast

Subject
contrast

SUBJECT CONTRAST
A structure in the patient is demonstrated by two things:
Resolution, sharpness, or lack of blurring of the
image of its boundary.
Contrast between it and adjacent tissues caused by
differences in the transmission of X-rays (or attenuation
of X-Rays).

FACTORS AFFECTING SUBJECT

CONTRAST
Subject contrast C depends on:
The thickness t of the structure.
The difference in linear attenuation coefficients "1-2"
of the tissues involved which is dependent on their
densities and atomic no.
Thus
C (1 2) t

FACTORS AFFECTING SUBJECT

CONTRAST
As attenuation depends on tissue density and atomic
number:
The more the two tissues differ in these respects the
greater the contrast.
The higher the kV the smaller the attenuation
coefficients the less is the contrast

FACTORS AFFECTING SUBJECT

CONTRAST
Radiation quality : Penetrating ability or kV. More the kV,
more is the penetrating power, less is the contrast.

Properties of radiographic object

affecting the contrast:

Density
Atomic
number

Thickne
ss

 Radiolucency : Degree of transmission of radiation.

Radio-opacity: Degree of attenuation of radiation in
tissue,

BALANCING CONTRAST AND

PATIENT DOSE
A major consideration in X-Ray imaging is to restrict the dose
of the patient as much as possible despite able to produce a
satisfactory image.
Penetration, Contrast and Patient Dose depend upon X-Ray
beam spectrum, the best spectrum provides adequate
Penetration and Contrast while keeping the Patient Dose at
lowest possible
The spectrum produced is dependent upon the target material,
inherent or added filtration and kilo-voltage.

BALANCING CONTRAST AND

PATIENT DOSE
Low Energy (kV) = Low Penetration = High Contrast =
High Patient Dose
High Energy (kV) = High Penetration = Low Contrast =
Low Patient Dose
Optimum Situation : kV that gives adequate contrast for
an acceptable patient dose.

PATIENT DOSE
This is about 3 Gy for film screen radiography and
between about 0.2 and 0.5 Gy s-1 for fluoroscopy.
This is the exit dose emerging from the patient.
The entrance surface dose has to be much higher
because of high attenuation of X-Rays by the patient.

FILM CONTRAST
Factors affecting film contrast:
Films vary in inherent contrast depending on Emulsion characteristics.
Development process.
Time-temperature used in processing.

Under exposed
Over exposed film

Max.contrast

CONTRAST MEDIA
One way of increasing the contrast is to use a lower kV;
another is to use a contrast medium.
A contrast media is a radio-opaque media with high
atomic no.
The high atomic no. of the contrast maximizes the
photoelectric absorption of the X-Rays.

CONTRAST MEDIA
The two common contrast agents are Iodine (Z-53) and
Barium (Z-56).
Air can also be used as contrast media but now used
only in double contrast barium enema studies.

CONRAST AND SCATTER

Primary radiation carries the information to be imaged.
Scatter obscures it as it carries no information about
where it came from.
The amount of scatter (S) may be several time the
amount of primary (P) in the same position.

CONRAST AND SCATTER

The S/P Ratio depends on the thickness of the patient.
For typical PA Chest it is 4:1 (20% of photons carry useful information)
For typical lateral pelvis it is 9:1 (Only 10% of photons carry useful
information)

Scatter is generally quite uniform across the image.

Scatter reduces contrast that would otherwise be produced by
the primary by a factor of upto 10 times.

CONTRAST AND SCATTER

SCATTER RADIATION
result in FOGGING of
image.

SPATIAL RESOLUTION
SPATIAL RESOLUTION is the ability to detect fine
detail within an image.
Fine detail is most clearly seen when the
contrast between the feature and its background
is high.

SPATIAL RESOLUTION
Spatial resolution can be quantified as the highest
occurring frequency of lines that can be resolved in a
high contrast bar pattern.
The object used to measure the spatial resolution is
known as LINE PAIR TEST TOOL.

SPATIAL RESOLUTION LINE PAIR

TEST TOOL
It uses bars of lead with
width of bar equal to the
space between them.
A bar and space makes up
the line pair and spatial
frequency of the pattern is
given as line pair per mm.
The smallest visible detail is
approximately half of the
inverse of the resolution
expressed in this way

NOISE
NOISE refers to the variations in the levels of grey in the
image that are distributed over its area but unrelated to
the structures being imaged.
The most significant source of noise in radiological
imaging is quantum noise or mottle.

NOISE
Noise reduces the visibility of low contrast regions
within the image, particularly if they are small in area,
thus reducing the visibility of finer detail in the image.
The lower the no. of photons detected, the greater will
be the noise.

Quantum mottle
Audible or visible disturbance that hampers the
information.

Normal

Quantum
mottle

QUANTUM MOTTLE
Lesser for slow screen film than fast
screen film.
Increases with high contrast film as
density differences are exaggerated
Increases with increase of KV .

ATTENUATION OF X-RAYS BY THE

PATIENT
In conventional projection radiography, a fairly
uniform, featureless beam of X-radiation falls on the
patient it is differentially absorbed by the tissues of
the body the X-ray beam emerging from the patient
carries a pattern of intensity which is dependent on the
thickness and composition of the organs in the body.

ATTENUATION OF X-RAYS BY THE

PATIENT
The X-rays emerging from the patient are captured on a
large flat phosphor screen this converts the invisible Xray image into a visible image of light, which then is
either:
Recorded as a negative image on film, to be viewed on
a light box (film screen radiography);
Recorded electronically prior to printing (computed or
direct digital radiography)
Displayed as a positive image on a video monitor
(fluoroscopy).

DISTORTION

Distortion

Size

Shape

Size - Magnification
Shorter the distance between object and the source of
light, greater is the magnification.
Source of light
Source of
light
object

object
shadow

Law of magnification states that

width of the image is to the width of
the object, as the distance of image
from the light source is to distance
of the object from the light source

Image width
-----------------Object width

Image distance
----------------------Object distance

Linear magnification of image:

Magnification factor:

image width
---------------------object width.

%Magnification: image width - object width

--------------------------------object width

Shape distortion:

It is misalignment of
central ray, the anatomic
part and the film.

To Summarize.
Greater distortion means poor
recorded detail
Shape distortion is due to
improper alignment
Size distortion: magnification is due to
divergence of beam.
Shorter the OID and Longer the SID less is the
distortion.

Macroradiography
Preservation of recorded
detail while achieving
magnification.
Fractional focal
spot/microfocus tubes are
used with small focal
spot (.3mm)

Principle of radiographic
magnification
F

Ideal point
source

SO
D

Image

SID

 Magnification : 2 times
Object is placed in between F and film
Magnification factor

SID

SOD
Intensifying screens are used and
are more efficient when the same
information in an enlarged image is
spread over a larger area.

 Air gap :
It is used to clean up scattered radiation.
More is the gap between object and the film, less will be
the scatter radiation.

Air gap

Blur
Geometric
blur
Motion blur
Object blur
Screen
blur

Geometric Blur (Penumbra)

Arrangement of X-Ray, anatomical part and film in
space.
Depends on:
Effective focal spot size
Source to image receptor distance
Object to image receptor distance

Focal spot is larger than object

Finite
focal spot

object

Blur

Effective focal spot size

Focal
spot

Focal spot

Focal spot

blur
A

blu
Br

Effective focal spot

Normal size of focal spot understates the effective or
projected size of the spot by significant margin.
Ex: 0.3 mm focal spot may be as large as .45mm

Source to image receptor distance

Object image receptor distance

Motion blur
Any motion while taking a radiograph can hamper the
image.

It can be minimised by:

Immobilization
of the part by
sandbags or
compression
bands

Suspension
of
respiration

Using short
exposure

Screen blur
Cardboard holders provide better recorded
detail than screen as immobilization is
present
In uncontrolled motion: fast exposure
with screens is used.
Extremely short exposure using high
speed screen can hamper recorded detail.

Film screen
combination:

Its a combination of film and

intensifying screen.
Recorded details is better in fast
speed and medium speed screen
combination

Recorded detail is never sharp with

intensifying screen because

Crystal
size

Active
layer
thicknes
s

Film
screen
contact

Quantum Mottle
Audible or visible disturbance that hampers information.

Normal

Quantum
mottle

Object blur
Effect of object blur is greater than appreciated.
Objects having round border introduce blur factor.

Object Blur

To Summarize.
Blur decreases with decrease in focal spot size, OID,
increase in SID
Motion blur decreased by immobilization or short
exposure
Cardboard holders decrease screen blur
Rounded objects increase blur.
Quantum mottle: visible disturbance in x ray
Less in slow screen receptors, more in fast screen receptors.

DENSITY
Darkening of a X-Ray film or certain area.
Carries information

Silver halide
Metallic silver
Appears black

Radiographic density depends on:

Amount of radiation reaching a particular area of the
film
The resulting mass of metallic silver deposited per unit
area

Measurement
Measured by an instrument called DENSITOMETER.
Density = log incident light intensity
transmitted light intensity
Clear film: has a density of 0.06-0.2
Diagnostic radiograph: 0.4 in lightest area and 3 in darkest

Factors Affecting Exposure and

Density
KV :

KV-

exposure rate- density

Milli ampere: increases exposure rate

Time: increase in exposure time- increases no. of photons
emitted by target.
mA.s: measure of charge transferred from cathode to anode
during an exposure.

EFFECT OF
DISTANCE :
X-ray photons arise from various
point of focal spot.
Assume photons spread in form of
cone from focal spot after leaving
tube.

 Radiographic exposure rate decreases

as focus film distance increases.

Inverse square law of

Radiation:
Intensity or exposure rate of radiation at a given distance from a point
source is inversely proportional to square of distance.

I2/I1=d12 /d22
I2:exposure at d2

d2:distance of 2 nd film

I1:exposure at d1

d1:distance of 1 st film

Radiographic object
Thicker and denser
anatomical parts

more absorption of x
ray.
less exit of radiation onto film

Order of tissue density

Denta
l
enam
el

Bone

Tissu
e

Fat

gas

To summarize.
Density is darkening of x ray film due to deposition of
silver.
Depends on- kv, mA, exposure time, distance, object
density.
As the distance of film from source increases, exposure
decreases.

DEVICES FOR
IMPROVING
RADIOGRAPHIC
QUALITY
By:
Dr. Nipun Gupta

SCATTERED

RADIATION

As the primary beam pass through the patient,

some of the radiation is absorbed, while the rest
is scattered in many directions
This multidirectional scattered radiation is a
noise factor.

In a radiograph of good
quality, less than one-fourth
the density should result
from scattered radiation.

RATIO OF SCATTERED TO PRIMARY RADIATION

It increases with:
increase in the area of the radiation field
and the thickness of the part.
increase in tube potential.
increase in the density of the tissues.

Chest

80%scattered

Abdomen - 90%scattered

20%primary
10%primary

Methods to control scatter radiation :

GRID
AIR GAP
APERTURE DIAPHRAGMS
COLLIMATORS
CONES
THE ANODE HEEL EFFECT
COMPENSATION FILTERS

RADIOGRAPHIC GRID

Developed by Gustav Bucky in 1913

It is a device placed between the patient and
the cassette for the purpose of reducing
the amount of scattered radiation reaching the
film and improving radiographic contrast.

 Gustav Buckys original gird

Cross hatch type.

Modern stationary grid consists of thin , closely

spaced lead strip measuring about 0.05mm in
width
Radiolucent material, plastic or aluminium
separate them which is 0.33mm wide.
Aluminum is preferred for improved durability of
the grid

ADVANTAGE

DISADVANT
AGE

Cast shadows
on the
radiograph as
thin white lines

Absorb 90%
scattered
radiation

Require
Increased
exposure

EFFICIENCY OF RADIOGRAPHIC GRIDS

Depends on

Physical factors

Functional factors

PHYSICAL FACTORS
1. Grid ratio :- r = d/w
(d-depth of the interspace channel,
w-width of this channel)
2. Grid Frequency :- number of lead
strips per cm or per inch.
3. Lead content

FUNCTIONAL FACTORS

Depends on:
1.

Selectivity

2.

Contrast improvement factors

 grid cutoff
Primary radiation transmitted /
Selectivity scattered radiation transmitted

Contrast
Improvemen
t Factor

k = Radiographic contrast with grid/

Radiographic contrast with out grid

THUMB RULE

If Object > 11 Cm Thick Grid is to be used

Grid is to be always used With Intensifying
Screen

GRID

Stationary grid
Moving grid

STATIONARY

GRID

Thin wafer grids

Taped to the front of cassette.
Used with intensifying screen.
CROSSED GRID is used in Cerebral angiography

Stationary Grid

Non focused

focused

PARALLEL OR NON FOCUSED GRID

Distance decentering

Used in fluoroscopy

PARALLEL OR NON FOCUSED GRID

Angulation decentering

FOCUSED GRID
More frequently used type
Comprise of parallel strips.
Slant more towards lateral edges around a CONVERGENCE LINE
Used in Standing Abdomen Scan, Lateral Cervical
Spine, Swimmers View, Portable

MOVING GRID
Developed by Dr. Hollis Potter - 1920
To eliminate the grid lines
produced in radiograph.
Known as potter Bucky diaphragm
Lead strips are parallel to the long axis of
the table.
It is of focused type
Lead strips are thicker

PRECAUTONS IN THE USE OF FOCUSED GRIDS

1. SOURCE
IMAGE RECEPTOR
DISTANCE

This should be kept more for a clearer

image to minimise the scattered radiation
and also the blurring.

2. ANGULATION
OF THE BEAM

In Focused grid there uniform decrease in density

of radiograph
In Nonfocused grid there is decentering of beam

3. CENTERING OF
THE TUBE

Tube centering is done with center of the grid to

avoid peripheral cut off

PRACTICAL APPLICATION OF RADIOGRAPHIC GRIDS

BUCKY OR GRID FACTOR OF 12 :1 IS PREFERRED BECAUSE:1) Its efficiency in cleaning up scattered radiation.
2) Centering is less critical.
3) Less exposure to the patient.
4) Lead strips are thicker there by absorbing more
efficiently.

REMOVAL OF SCATTERED RADIATION

BY AN AIR GAP :-

Space between the patient and the

image receptor is known as air gap.
Increasing the air gap allows more of the scattered
photons to move laterally outside the film area.
Due to Inverse Square Law, there is only small reduction in primary
intensity which can be compensated by increasing the ma.
This also result in magnification of image.

There is no absorption of scattered radiation in

the air gap.
It require increase in exposure factors to
keep radiographic density unchanged.
This technique has a place in chest radiograph,
magnification radiograph and in cerebral and
renal angiography.

Reduction Of Scattered Radiation By Limitation

Of The Primary Beam
Aperture Diaphragms
Cones
Collimators

APERTURE DIAPHRAGM

CONES

FLARED CONE

CYLINDER CONE

COLLIMATORS

ANODE HEEL EFFECT ANODE CUT OFF

Depends on the angle the rays make with the face

of the target
The variation in exposure rate according to the
angle of emission of the radiation at the focal spot
is called anode cutoff or anode heel effect
Smallest exposure rate occurs at the anode
Useful in radiographing a region with wide range
of thickness .

Thickest part is towards the cathode end of the beam

Thinnest part is towards the anode.

COMPENSATION FILTERS

Made up of aluminium or barium plastic

Wide application in general radiography such as aortic
arch angiography, Anteropost. projections of foot.
These filters help to record body parts that differ
greatly in thickness or density into more uniform
density on a single film.

THANK YOU