X-ray image

luminescence (Any type of energy)

• Process in which a material absorbs energy and

re-emit that energy in the form of visible light
• Photo-luminescence : the absorbed energy is
from radiation source
• Two types:
1)Fluorescence : instantaneous emission of light
after energy input
2)Phosphorescence : delayed light emission (after-
glow)
• The Material which has luminescent properties =
phosphor
 Conduction: another shell ,
which has no e, and when
excitation happens, e in the
conduction valence come out to the
conduction.
valence
-
~ +
~ +
+ ~
-
-
Forbidden zone
•Valence shell = outermost shell occupied with electrons
•Conduction band = next higher energy shell (vacant)
•Forbidden zone = zone between the two shells (could not be occupied by electrons)
•Electron traps= impurities introduced into phosphor that can trap electrons into the
forbidden zone ‫شوائب الها شُل لحالها‬
Luminescence process
1) X-ray is absorbed and produce
recoil electron and photoelectron
2)The secondary electron will cause
atom excitation (electron is raised to
conduction band)
3)Electrons move down to the
electron traps
4) Electrons returns backs to valence
band and release energy in the form
of light
5)Intensity of light emitted from the
phosphor is α intensity of absorbed
x-ray
 Phosphors may:
1)Emit the light spontaneously
2)Emit the light following heating
(thermoluminescence )
3)Emit light when exposed to a light source
(photostimulable luminescence)

This idea is used in digital radiology and radiation detection (see later)
Patient dose and tube factors
 definitions
Entrance surface dose (ESD) : radiation dose to the proximal skin surface
Exit dose = film dose = dose emerging from the patient
ESD is higher than exit dose e.g. ESD/exit dose = 100 for x-ray skull

Our aim is to decrease ESD without affecting exit dose (and so image quality)
 Factors affecting patient’s dose
• 1) mA : increase mA →increase x ray intensity
→ increase patient dose
• 2)Filtration : decrease skin dose
• 3)Tube Kv:
Higher Kv →increase in beam quality (E)
(more penetrating beam more HVL)
This means: for the same exit dose , we need less entrance dose
So that : mA is decreased to reach the same film blackening
So that patient dose is reduced
• 4) focus film distance:
Increase FFD → the radiation is spread over larger
surface area of the skin → lower skin dose
N.B: Increase FFD requires increase in mA
(inverse square law) → increase of tube load
(not patient dose)
 Essential parameters influencing
patient exposure

}
Tube voltage
Tube current Kerma rate
FFD [mGy/min]
Effective filtration

Exposure time [min] } Kerma

[Gy]

Field size [m2] } Area exposure

product
[Gy m2 ]
Image quality
 Image noise
• Random variation in image
density.
• produce variation in the
density of a displayed
image even when no
image detail is present
(unrelated to the structure
imaged)
• This variation is usually
random and has no
particular pattern. And , it
reduces image quality
(gives an image a mottled,
grainy, textured
appearance)
 Types of noise
1) Quantum noise = mottle
Cause: random x-ray emission → statistical fluctuations in # of photons/ unit area
absorbed by receptor
2) structured noise (see film screen)
3) Electronic noise: due to instability of electronic circuits
 Quantum noise
• If average number of photons detected = M → variation
between receptors (standard deviation) = √M (random
process)
• The lower the number of photons detected→ the greater will
be the variation in signal (√M/M)
and less will be the signal to noise ratio SNR (M/√M)
 Effect of mA on the noise
• If mAs is reduced number of photons are
reduced  M/ √M is reduced (SNR)
• If mAs is reduced by ½
– noise increases by √2 =1.414 (40% increase)
Remember : it is about quantity not quality
 Effect of KVp on the noise
• Raising the kilovoltage → lower mAs is used →
less x-ray photons exposing film
• higher quantum mottle and less SNR
• Effects of noise:
1) Decrease the contrast resolution of the image
2) Decrease visibility of low contrast regions
3) Decrease visibility of fine details of the image
Image Quality
 Contrast(= contrast resolution)
• Difference in density between areas on the
radiograph, and so , ability to distinguish
between them.

• Contrast depends on
– subject contrast
– film contrast (see film screen)
– fog and scatter
 Subject Contrast
• Difference in x-ray intensity
transmitted through various
I
parts of subject
• Depends on
– 1) Thickness difference
– 2)Density difference (All attenuation
processes depend on density) S L
– 3) atomic number difference (P.E. ~ Z3 )
– 4)radiation quality (kVp, HVL)
•2 , 3 , 4 are factors affecting µ
•So that : C α (µL-µs) x thickness IS
IL
In other words Subject Contrast
= IS/IL
IL = , IS = (think)
Subject Contrast & Radiation Quality
High Kv
1.high noise.
2.low dose
3.low contrast
* Subject Contrast & Radiation Quality

 high kVp = lower subject

contrast

 low kVp = high subject

contrast
• So that to increase subject contrast
1) Decrease Kvp
2) USE CONTRAST MEDIA:
-Increase Density difference and atomic
number difference
-absorption edge is just to the left of X-ray
spectrum
 Spatial Resolution
• Spatial Resolution is the ability to image small
structures (ability to see fine details )
Grid test for testing spatial resolution
•Consists of equally spaced bars , the space between bars = width of the bars
•Line pair = bar + space
•Spatial frequency= number of line pairs per mm
•Consists of several groups of bars , of progressively higher spatial frequency
•Spatial resolution of the system = highest spatial frequency that can be resolved
•Example : system with spatial resolution of 1 lp.mm¯¹ has ………… Lower spatial resolution
than system with resolution of 2 lp.mm¯¹
•Smallest visible detail size = half of the inverse of the resolution expressed in this
way
0.05
e.g. resolution of 10 lp.mm¯¹ → we are able to resolve detail as small as …………….
•System with Smallest visible detail size of 0.05 mm has …………Higher spatial resolution

than system with detail size of 0.1 mm

Scattered radiation
 Scattered radiation
Amount of scattered radiation reaching
the film =(S)
Amount of primary radiation reaching the
film= (P)

S/P depends on
1)Thickness of the patient : ↑T→ ↑ S/P
2) Area of the beam : ↑area → ↑ S/P
e.g. S/P = 4 for AP chest & = 9 for lateral
pelvis

Source of scatter is ………………….

 Effects of scattered radiation
Decrease contrast of the image by factor of
(1+S/P)
 Scatter reduction
1) COLLIMATION (reduction of field area)
N.B: also reduce patient dose
2) Tissue compression
N.B: also reduce patient dose

e.g. mammography
3) Decrease Kv
• Leads to decrease formation of scatter in forwards
direction (towards the film ) ….why?
• The produced scatter is less penetrative (less
energetic) → less likely to reach the film
N.B: Why decreasing KV will increase the contrast
- decrease scattering
- increase differential in photoelectric absorption (more important)
(Subject contrast)
So shifts the interaction from Compton to
photoelectric because of the decrease in KVP

N.B: also increase patient dose 

4) Air gap technique OFD Between the film and the object not FFD

5) Grids

N.B: 1,2,3 : decrease amount of scatter

produced
4,5 :decrease amount of the scatter that
reach the film (does not affect formation of
scatter)
Air gap technique
•Technique: Film is moved 30 cm away from
the patient →scatter miss the film → contrast
is improved

•Disadvantages:
-Require increase in mA (inverse-square) →
Patient exposure is increased 
-Cause image magnification.

•N.B: very effective in removing scatter originating

closest to film
 Grids
Purpose Focal
Spot
• Directional filter for
photons “Good”
photon
• Ideal grid
– passes all primary photons
• photons coming from focal
spot Patient
– blocks all secondary “Bad”
photons photon
• photons not coming from X Grid
focal spot Film
 Grid Construction

• Lead
~ .05mm thick upright strips Secondary photons usually come with angle so
it will hit and be attenuated by the lead
• Interspace
– material between lead strips
Material of the interspace should have low
– maintains lead orientation Z so it will not affect the primary photons

– materials
• Carbon fiber
• aluminum

Interspace
Lead
• Grid Line density :
• Number of stripes / cm (generally about 40 strips cm ¯¹)
• So that : repetition interval = 0.25 mm
• Lead width = 0.06 mm
• Interspace = 0.19 mm

w
 Ideal Grid
• passes all primary radiation (Not actually present) (I.e. This is a wrong
sentence)

– But in fact: lead strips block some primary

Interspace
Lead
 Ideal Grid
• block all scattered radiation
– But in fact: lead strips permit some scatter
to get through to film

Interspace
Lead
Grid Ratio
• Ratio of interspace height to width
The higher the Grade ratio => the higher the absorption of 2ry radiation => the more efficient the grade will be

Lead
Interspace

Grid ratio = h / w
 Grid Ratio
• Expressed as X:1
• Typical values
8:1 to 12:1 for general work H:W = 12:1

3:1 to 5:1 for mammography

Grid ratio = h / w
Angle of acceptance : angle within which the scattered radiation can
reach the film
θ

film
Note that
•The larger the grid ratio → the less the angle of acceptance → the more efficient is
the grid → the more contrast of the film
•For large field radiology and high Kv → amount of scatter is increased → we must
use higher grid ratio
•For thin body parts (limbs) and for children → amount of scatter is small → no
grid is used
•Grid not used with air gap (Not to be used together)
•The larger the grid ratio → more attenuation of scatter radiation , but also , more
attenuation of primary radiation
 Grid Styles

• Parallel
• Focused (Anode in the pt)
 Parallel= unfocused Grid
• lead strips are parallel to
each other and to the
central beam (The beam descending
vertically in the center of
the field)

– Strips are never aligned

with primary beam since
all are vertical (except for
strips directly under
central ray)
Attenuation happen more in the edges
•Primary rays will be increasingly attenuated
until at an angle of “angle of acceptance” ,
where complete cut-off will occur
•Restricted maximum beam size
•This effect can be reduced by using longer
FFD
•Used for:
-small field sizes
-large FFD
 Focused Grid
• Strips are angled progressively
from center to the edge of the
grid

• Strip lines converge to a point in Focal

range
space called convergence line Not a point

• Focal distance Focal

distance
– distance from convergence line to grid plane
 Conditions for using focused grid
(otherwise cut-off of primary ray will happen)
1)Grid must not be tilted about the axis of the lead strips The axis
2) Distance between grid and anode = focal distance
3)Tube must be accurately centered over the grid Not rt or lt X
4) Grid must not be turned upside-down
If tilted around axis of grid strip nothing will happen

N.B: these tolerances reduce wilth higher grid ratios

 Distance Decentering
X • Grid too close or too far
from focal spot
• Darker center
 Lateral Decentering
• occurs when tube is not accurately centered over the grid OR when
the grid is tilted around the axis of lead strips (not on the perpendicular axis)
• result in uniform loss of intensity
– may be mistaken for technique problems and compensated for by over-exposing patient

Length = AP = from y
to z axis

Axis (plane) = lateral

= from y to x axis

N.B: Tube can be angled

along the length of lead
strips without cut-off of the
primary beam
( not about the plane (axis)
of lead strip)
 Upside Down Focused Grid

• Dark exposed band in

center Similar to central
• Severe peripheral
cutoff
N.B: Cross hatched Grids
• 2 stacked linear grids
• ratio is sum of ratios of two linear grids
• very sensitive to positioning & tilting
• Rarely used
 Stationary Grids
• Grids which does not move
• Grid lines : shadows of lead strips
superimposed on radiological image
→reduces detail definition (disadvantage
of stationary grid)

Stationary grids must be used in some

situation (e.g. ward radiography)
→grids should have increased line
density to decrease grid line artifact
Result in less line thickness
Moving grids:
• move during exposure → blur out grid lines
• Direction of Movement :
perpendicular to grid lines
• Motion starts before the exposure start and
does not stop until the exposure is terminated
Grid line .‫وإال سيطلع عندي‬

Disadvantages:
- increase dose
 Moving Grid Disadvantages

• Increases patient dose

– lateral decentering from motion
• up to 20% loss of primary

– evenly distributes radiation on film

• stationary grid makes interspace gaps darker for
same amount of radiation
 Grid Performance
Measurements
• contrast improvement factor
• Primary Transmission
• Bucky Factor
• Grid selectivity
 Contrast Improvement Factor

• Ratio of contrast with & without grid

• Usually 2-4
• Depends on :
– grid ratio (increase Contrast Improvement
Factor)
– lead content in grid (increase Contrast
Improvement Factor)
 Contrast Improvement Factor

• Depends also on factors affecting relative

amount of scatter
– kVp
– field size
– Tissue thickness
• increase in any of above→
– more scatter
– less contrast
– lower contrast improvement factor
 Primary Transmission
• Fraction of a scatter-free beam
passed by grid
• Ideally 100% (never achieved)

Interspace
Lead
 Primary Transmission
• Upper limit of primary transmission = fraction of
the interspaces = W / (W+w)
• actual transmission < upper limit
– primary attenuated by
interspace material
– focusing imperfections

• Typical values: 55 - 75% w

W
W+w
 Bucky Factor
Radiation incident on grid
-----------------------------------
transmitted radiation

•Measures fraction of radiation absorbed by grid

•Higher bucky factor → higher patient’s dose (mA must be increased)
•high ratio grids have higher bucky factors

N.B: Grid factor =

Exposure necessary with a grid
-----------------------------------------------
Exposure necessary without a grid

Both = 3-5
 Grid selectivity
Fraction of primary radiation transmitted
------------------------------------------------------------ = 6-12
Fraction of secondary radiation transmitted
 Grid Tradeoff
• Advantage
– scatter rejection , increase contrast.

• Disadvantage
– ↑mA →increased patient dose
– increase tube loading Tube damage ( because of high mA)
– increased exposure time (Motion artifact)
– positioning & centering more critical
 Scanned projection radiography
•Alternative to grid
•Moving slot collimator (Slice of the patient
is irradiated at a time)
•Scatter is reduced due to decrease of the
radiation field
•See CT and digital radiology
Geometry of the Radiographic System
 1)Magnification

• Misrepresentation of
object size
• Due to X-ray beam
divergence
 Magnification

Focal
Spot

b a B A

h H
Object
c
Film C
Object
Film

a b c h
---- = --- = --- = ---
A B C H
 size of image Focal
Spot
Magnification = --------------------
size of object h

H
Object
Film f
(image)
focus to film distance H
Magnification = ---------------------------------- = ---
focus to object distance h

focus to film distance H

Magnification = ---------------------------------------------------------- = -----
focus to film distance – object film distance H-f
 * Optimizing Image Quality
focus to film distance H
Magnification = ---------------------------------------------------------- = -----
focus to film distance – object film distance H-f

• So that : to Minimize magnification

1)Minimize object-film distance
2)Maximize focal-film distance (disadvantages: ↑mAs → ↑tube load & motion)

Focal
Spot

h
H

Object
Film f
(image)
 2)Distortion
• Misrepresentation of the shape of an object
• Minimal distortion when object near central beam & close to film
• Can be reduced by using longer FFD X-Ray
Tube

X-Ray
Tube

Film Image Film Image

 Distortion
• Increased by Central ray angulation & body part rotation
3)Sharpness
 Ability of receptor to define an edge

 Unsharpness = blurred edges → decreased

spatial resolution

 Causes of unsharpness:
1) Geometrical unsharpness
2) Movement unsharpness
3) Absorption unsharpness
 Geometrical unsharpness
• X ray intensity at the edge of an object changes
gradually over a distance = penumbra

In fact
 Factors affecting Geometrical unsharpness

1)Focal spot size: increase 2)FFD : increase film focus distance 3)OFD: increase object
focal spot size → increase → decrease unsharpness film distance → increase
unsharpness unsharpness

OFD x Focal spot size

Equation: geometric unsharpness Ug (penumbra) = -------------------------------------------------
FFD - OFD
 Motion Unsharpness
• Caused by motion during exposure of
– patient
– tube
– film
• Effect
– Edge unsharpness
• Minimized by
– immobilizing patient
– short exposure times (t)
• Equation: motion unsharpness (Um) = v t
V=velocity of moving object
t = exposure time
 Absorption unsharpness
– Absorber may not have sharp edges
• round or oval objects
– This leads to gradual change in x-ray absorption
across an object’s edge Effect → Edge unsharpness
 Total Unsharpness
• combination of all the above
BUT
not the sum!
• larger than largest component
• largest component controls unsharpness
– improvement in smaller components don’t help
much
focal spot
Focal spot
Definitions:
Acts as a lens
1)Focusing cup : negatively charged
Focusing device that surrounds the filament on the
cup cathode side of the x-ray tube to prevent
electrons from being emitted in all
directions (mutually repellent)
2)Target angle: angle between central ray
of x-ray beam and target face (7-20⁰)
3)Actual (true) focal spot: area on the
target face on which electrons are
focused , it has elongated shape
(area over which the heat is produced)
4)Effective focal spot: the projected focal
spot area, as seen from the centre of the
X-ray field
It is foreshortened in one direction (in
relation to actual focal spot) → appear
circular or elliptical
Note that :
Shape of effective focal spot size varies across the film
when seen from cathode side →elongated in the
direction of anode cathode axis
when seen from anode side →shortened in the
direction of anode cathode axis
Factors affecting size of effective focal spot
1) ↑ Filament length→↑actual and effective
focal spot

2) ↑ target angle →↑effective focal spot (no

effect on actual focal spot)

3. Increase in KVP will Decrease the

effective focal spot
 Effects of steeper target angle
1) Decrease effective focal spot size (without changing actual
focal spot)→
• Decrease geometrical unsharpness → ↑ spatial resolution
• limits field coverage
(Good for mammo)

2) Increase the actual focal spot size (to produce the same
effective focal spot size) → increased heat production 
 Double Focus Tubes
• Large Filament (2.0 mm): larger effective focal spot - used for
larger body parts - looses some detail.
• Small Filament (0.3 mm): smaller effective focal spot - used
for small body parts such as extremity and detect fine detail.
 Focal spot blooming

• Increased tube current (mA) → impaired

focusing of the electron → unwanted increase
in focal spot size
• More significant for lower kVp settings
• measurement focal spot size
(quality control)
a) Slit camera
b) Pin hole camera:
Direct measurement of focal spot size
Used for focal spot size › 0.3 mm
c) Star test tool :
Indirectly measure focal spot size
Used for focal spot size ‹ 0.3 mm
Anode types
 Anode types
• 1)Stationary anode
 Discussed before (made of tungsten)
 Stationary anode cooling methods
-Heat is transferred from anode to cupper block by conduction
-Heat then passes through the oil to tube housing & to the room
• Rotating anode
– Target is annular rotating disc
– Advantage :spreads heat over large area of anode
– Circumference of anode disc : 200-300 mm
– Rotation speed 3000 rpm (full rotation takes 20 ms)
– High speed anodes energized by three phase mains
→ 9000 rpm
 • Consists of:
1)Anode disc: 7-10 cm in diameter, made of molybdenum (high melting point and
low density)
2) Target annulus : Alloy of tungsten and rhenium (better thermal
characteristics than tungsten alone)
3)Molybdenum stem
4)Cupper rotor
5)Bearings : lubricated with soft metal (e.g. silver)to enable rotor to rotate freely
6)axle: Support the assembly
7)Stator coils: induction motor which drive rotation , without direct mechanical
linkage to rotating parts
Stator alternating currents
→produce varying magnetic
Vacuum

fields →induce rotor currents

N.B: Time delay of 1 s is present

before anode comes to full speed
(no mechanical linkage )
 Rotating anode cooling
• Heat from target is conducted to anode disc and molybdenum stem
- Molybdenum stem is long and narrow and has low conduction rate → control amount
of heat conducted to the rotor
• Heat transferred by radiation from anode to the oil
-Rate of heat radiation α temperature⁴ (in Kelvin)
this means that 40% increase in x ray output → 10% only increase in temperature
• Heat is transferred by convection from oil to the housing
-External heat exchanger may pump new oil in high powered tubes (e.g. angio)
-Bellow system is present to allow oil expansion when heated
• The heat is transferred by radiation From housing to air

oil
housing
• N.B: Most of tubes used in radiology are
rotating anode tubes except:
1-Dental radiology
2-Mobile fluoroscopy units
3-Ward radiography
Tube Ratings
Maximum allowable Kilowatts for an exposure time of 0.1 second
• If excessive heat is produced in the x-ray tube, the
temperature will rise above critical values, and the
tube can be damaged. This damage can be in the
form of melted anode.
• In order to prevent this damage, the x-ray
equipment operator must be aware of the quantity
of heat produced and its relationship to the heat
capacity of the x-ray tube.
 Tube loading
Amount of Heat produced in the focal spot area by the bombarding electrons from the
cathode.

1) Tube loading by joules:

Tube loading (J) = KVe x mAS (in joules)

or

Tube loading (J) = w x KVp x mAS.

KVe is the effective KV value

KVp is the peak KV value.

w is the waveform factor; its value is determined by the waveform e.g. constant
potential, 1.0; three-phase, 0.99; single-phase, 0.71.
2) Tube loading by heat unit (HU):

Used as alternative for joule to calculate tube loading when single-phase

equipment is used.

HU = 1.4 x tube loading by joule

= 1.4 x 0.7 x KVp x mAS.
= KVp x mAS.

3) Tube power:

The rate at which heat is produced in a tube

Power = w x KVp x mA (watts = j/s)

= joules / exposure time
 HEAT CAPACITY= tube rating
• Temperature of tube = heat produced (J) / heat capacity.
• When a given amount of heat is added, the temperature increase is
inversely proportional to the heat capacity.
• The goal is never to exceed specific critical temperatures by keeping
the heat produced below specified critical values (specific to each
tube according to its heat capacity).

If the quantity of heat delivered

during an individual exposure
exceeds the heat capacity, the
anode surface can melt
1) Tube rating for single radiographic exposure:
• The capacity is generally specified by the manufacturer in
the form of a graph
• The curves on the graph show the maximum power (KV
and mA) that can be delivered to the tube for a given
exposure time without producing overload
• Tube rating is expressed as allowable mA

Note that :
1)Allowable mA is decreased with
increasing exposure time
2)Allowable mAs is increased with
increasing exposure time
• Tube rating (allowable mA) depends on:
1)↑ exposure time → ↓tube heat rating
2) ↑ kV→ ↓ tube heat rating
3)↑ effective focal spot size (by using the larger filament) → ↑
tube rating
4) ↑ target angle → ↓ tube rating
5)Rotating anodes have higher tube rating than stationary anodes
6) High speed anodes have higher tube rating than low speed
anodes
7)Constant potential tubes has higher tube rating than pulsating
single phase tubes

Control system of the equipment prevents

exposures exceeding tube rating
So that decrease target angle increase heat production , BUT ALSO increase tube heat rating
2)Tube rating for repeated radiographic exposure
• Example : angiography
• Tube rating depends on maximum amount of
heat that can be temporarily stored in the
anode , and the rate by which the anode lose
heat by cooling processes
 Angiographic Rating Chart
• Provides maximum heat load per
exposure for given number of
– exposures per second
– total exposures
Total # of Exposures

2 5 10 20 30
Exposures 1 37,000 24,000 16,000 10,000 7400
per 2 25,000 17,000 12,200 8,000 6,200
second 3 19,000 13,600 10,000 7,000 5,300
4 15,500 11,400 8,600 6,000 4,500

Maximum heat Load allowed in Peak kV X mA X sec.

Control system does not allow operator to choose exposure number or

frequency which will exceed heat capacity for the given KV and mA
3)Continuous operation (fluoroscopy)
• Heat must be removed at the same rate of its
production
• → tube rating is dependant ONLY on rate of
heat removal from the tube
• Tube rating is expressed in terms of tube
power (J/s = watts)
• e.g. Tube power = 350j/s (watts) → we can use
the equipment at 4mA and 90 kv
 Other ratings
• Maximum Kv: depends on insulation of the tube and cables (about
150 kv)
• Maximum mA: depends on filament heating capacity (about 700 mA)
• Rating of generators which produce high voltage supply : expressed in
KW (why)
e.g. 50 kw generator can operate at 500 mA and 100 Kv
anode filament

filament
+
voltage
source

high
voltage
source
Tube damage
 Anode Damage
1) Heat capacity exceeded→ melted spots on
anode
2)Anode Thermal shock (high mA on cold anode)
→ cracks in anode
Tube warm-up must be performed to protect the anode
 High Voltage Arcs
• very short exposure with instantaneously very
high mA
• electrons move from filament to tube housing
instead of to anode
• can be caused by filament evaporation

arcing
X-Ray Beam Restrictors
 Restrictors Types

• Aperture Diaphragms (leads to large

penumbra )
• Cones and Cylinders (Reduced
Penumbra)
• Collimators
 Collimators
• Function:
-Adjust X-ray beam to the required size
-Provides adjustable rectangular field
• fluoroscopy may also have circular field

• Consists of
– Two sets of parallel plates (shutters) of
high Z material

One set;
two pairs
• light beam indicates x-ray field
Focal Spot
Filter

Lamp
Mirror

Shutters
 Advantages

• 1) decrease scatter
• 2)decrease patient dose
• 3)improve image quality
•
Heel
beam goes through
Effect
more target material
while exiting the anode
• Intensity of x-ray beam
-
significantly reduced on x -
-
anode side
• HVL of beam at anode
side is increased
(filtered) … less imp cathode side
anode side
 Factors affecting Heel effect
• 1) target angle: decrease
target angle (steeper) →
more heel effect

• 2)FFD: ↑FFD → less heel

effect

• 3)Aging of the tube → rough

target surface → more heel
effect
 The Heel Effect
• X-ray tube best positioned with the cathode
over the thicker parts of the patient to
balance the transmitted x-ray photons
incident on the image receptor
THANK YOU