Review Notes for the

RADIOGRAPHY EXAM

Chapter 4: Image Production And Evaluation

Note:

1. If a lateral projection of the chest is being performed on an asthenic patient and the outer photocells are
selected, what is likely to be the outcome?
(A) Decreased density
(B) Increased density
(C) Scattered radiation fog
(D) Motion blur
—————————————————————————
If a lateral projection of the chest is being performed on an asthenic patient and the outer photocells are
incorrectly selected, the outcomeis likely to be an underexposed radiograph. The patient is thin, and the lateral
cells have no tissue superimposed on them. Therefore, as soon as the lateral photocells detect radiation
(which will be immediately) the exposure will be terminated, giving the lateral chest insufficient exposure.
(Shephard, pp 280-281)

2. When an automatic processor is started up at the beginning of the day, or restarted after an extended
standby period, the technologist should process an
(A) unexposed, undeveloped 14 × 17-in film.
(B) exposed and developed 14 × 17-in film.
(C) unexposed and developed 14 × 17-in film.
(D) unexposed or unexposed and developed 14 × 17-in film.
—————————————————————————
After the processor has been turned off overnight, or after it has been on standby for an extended period of
time, artifacts can be produced on the first few films processed. "Delay streaks" can be producedand are
usually caused by a buildup of oxidized developer on the crossover rack as a result of inadequate ventilation. A
"cleanup" film or two should first be processed to rid the rollers of any accumulated foreign particles, such as
lint, oxidized developer, and gelatin. It is important that the cleanup film be unprocessed film to avoid
contamination of the developer with any retained fixer on the film or redepositing of any foreign particles on the
rollers.

3. For which of the following examinations can the anode heel effect be an important consideration?
1. Lateral thoracic spine
2. AP femur
3. RAO sternum
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
The heel effect is characterized by a variation in beam intensity, which gradually increases from anode to
cathode. This can be effectively put to use when performing radiographic exams on large body parts with
uneven tissue density. For example, the AP thoracicspine is thicker caudally than cranially, and so the thicker
portion is best placed under the cathode. However, in the lateral projection of the thoracic spine, the upper
portion is thicker because of superimposed shoulders, and therefore that portion isbest placed under the
cathode end of the beam. The femur is also uneven in density, particularly in the AP position, and can benefit
from use of the heel effect. However, the sternum and its surrounding anatomy are fairly uniform in thickness
and would not benefit from use of the anode heel effect. The anode heel effect is most pronounced when using
large-size films, at short SIDs, and with an anode having a steep (small) target angle. (Saia, p 298)

4. A wire mesh test is performed to diagnose screen

(A) lag.
(B) contact.
(C) resolution.
(D) intensification.
—————————————————————————
A wire mesh supported between two rigid pieces of clear plastic is used to evaluate screen / film contact. The
mesh is placed on an image receptor and radiographed. Upon viewing, any areas that appear unsharp or
blurry are indicative of poor screen / film contact. A screen lag test is performed by radiographing a phantom

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using an empty cassette /image receptor, then loading it with film and leaving for it a few minutes. If, after
processing, there is any indication of an image, there is most probably screen lag.

5. The major function of filtration is to reduce

(A) film noise.
(B) scatter radiation.
(C) operator dose.
(D) patient dose.
—————————————————————————
X-rays produced at the target make up a heterogeneous primary beam. There are many "soft," low-energy
photons that, if not removed, would only contribute to greater patient (skin) dose. They do not have enough
energy to penetrate the patient and expose the film; they just penetrate a small thickness of the patient's tissue
and are absorbed. These photons are removed by aluminum filters.

6. The radiograph in Figure 4-18 exhibits an artifact caused by

(A) an inverted focused grid.
(B) poor screen / film contact.
(C) a foreign body in the image receptor.
(D) static electricity.
—————————————————————————
Static electricity is a problem, especially in cool, dry weather. Sliding the film in and outof the cassette / image
receptor can be the cause of a static electrical discharge. Removing one's sweater in the darkroom on a dry
winter day can cause static electrical sparking. The film exposed by a large static discharge ("tree static")
frequently exhibits black, branching artifacts such as those illustrated. Poor screen / film contact results in very
blurry areas of the finished radiograph. A foreign body in the image receptor will be sharply imaged on the
finished radiograph. An inverted focused grid will result in an area of exposure down the middle of the film and
grid cutoff everywhere else.

7. Types of shape distortion include

1. magnification.
2. elongation.
3. foreshortening.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Size distortion (magnification) is inversely proportional to SID and directly proportional to OID. Increasing the
SID and decreasing the OID decreases size distortion. Aligning the tube, part, and film so that they are parallel
reduces shape distortion. There are two types of shape distortion, elongation and foreshortening. Angulation of
the part with relation to the film results in foreshortening of the object. Tube angulation causes elongation of
the object.

8. Disadvantage(s) of using low-kV technical factors include

1. insufficient penetration.
2. increased patient dose.
3. diminished latitude.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
As the kilovoltage is decreased, x-ray beam energy (that is, penetration) is also decreased. Consequently, a
shorter scale of contrast is obtained and, at lower kilovoltage levels, there is less exposure latitude (less
margin for error in exposure). As kilovoltage is reduced, the mAs must be increased accordingly in order to
maintain adequate density. This increase in mAs results in greater patient dose.

9. The radiograph shown in Figure 4-7 is an example of

(A) linear tomography.
(B) computed tomography (CT).
(C) grid cutoff.
(D) poor screen / film contact.

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 —————————————————————————
Body section tomography functions to provide an image of a particular plane (objective plane) of tissues within
the body, blurring out everything above and below the plane of interest. The radiograph shown in Figure 4-7 is
an example of linear tomography; the x-ray tube moves in one direction, while the x-ray film moves in the
opposite direction. The two pivot at a fixed fulcrum that corresponds to the objective plane and is therefore the
level of no motion. A variety of x-ray tube motions (circular, hypocycloidal, etc.) is available with more complex
tomographic equipment.

10. Recorded detail can be improved by decreasing

1. the SID.
2. the OID.
3. motion unsharpness.
(A) 1 only
(B) 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Motion, voluntary or involuntary, is most detrimental to good recorded detail. Even if all other detailfactors are
adjusted to maximize detail, if motion occurs during exposure, detail is lost. The most important ways to reduce
the possibility of motion are using the shortest possible exposure time, careful patient instruction (for
suspended respiration),and adequate immobilization when necessary. Minimizing magnification through the
use of increased SID and decreased OID functions to improve recorded detail

11. A quality assurance program serves to

1. keep patient dose to a minimum.
2. keep radiographic quality consistent.
3. ensure equipment efficiency.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
A quality assurance program includes regular overseeing of all components of the imaging system: film and
cassettes, processor, x-ray equipment, and so on. With regular maintenance, testing, and repairs, equipment
should operate efficiently and consistently. In turn, radiographic quality will be consistent and repeat exposures
will be minimized, thereby reducing patient exposure.

12. Which of the following groups of exposure factors would be most effective in eliminating prominent
pulmonary vascular markings in an RAO position of the sternum?
(A) 500 mA, 1/30 s, 70 kVp
(B) 200 mA, 0.04 s, 80 kVp
(C) 300 mA, 1/10 s, 80 kVp
(D) 25 mA, 7/10 s, 70 kVp
—————————————————————————
In the RAO position, the sternum must be visualized through the thorax and heart. Prominent pulmonary
vascular markings can hinder good visualization. A method frequently used to overcome this problem is to use
an mAs with a long exposure time. The patient is permitted to breathe normally during the (extended) exposure
and, by doing so, blurs out the prominent vascularities.

13. With all other factors constant, as a digital image matrix size increases,
1. pixel size decreases.
2. resolution increases.
3. pixel size increases.
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 2 and 3 only
—————————————————————————
A digital image is formed by a matrix of pixels (picture elements) in rows and columns. A matrix that has 512
pixels in each row and column is a 512 × 512 matrix. The term field of view is used to describe how much of
the patient (e.g., 150 mm diameter) is included in the matrix. The matrix and the field of view can be changed
independently, without one affecting the other, but changes in either will change pixel size. As in traditional

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radiography, spatial resolution is measured in line pairs per mm (lp/mm). As matrix size is increased, there are
more and smaller pixels in the matrix, and therefore improved resolution. Fewer and larger pixels results in a
poor-resolution, "pixelly" image, i.e., one in which you can actually see the individual pixel boxes.

14. The term latitude describes

1. an emulsion's ability to record a range of densities.
2. the degree of error tolerated with given exposure factors.
3. the conversion efficiency of a given intensifying screen.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The term latitude may refer to either film latitude or exposure latitude. Exposure latitude refers to the margin of
error inherent in a particular group of exposure factors. Selection of high-kVp and low-mAs factors will allow
greater exposure latitude than low-kVp and high-mAs factors. Film latitude is chemically built into the film
emulsion and refers to the emulsion's ability to record a long range of densities from black to white (long-scale
contrast).

15. What combination of exposure factors and image receptor speed would best function to reduce quantum
mottle?
(A) Decreased mAs, decreased kVp, fast-speed screens
(B) Increased mAs, decreased kVp, slow-speed screens
(C) Decreased mAs, increased kVp, fast-speed screens
(D) Increased mAs, increased kVp, fast-speed screens
—————————————————————————
Quantum mottle is a grainy appearance on a finished radiograph that is seen especially in fast imaging
systems. It is very similar in appearance to an enlarged photograph taken with fast film; it has a spotted or
freckled appearance. Fast film and fast screens with low-mAs and high-kVp factors are most likely to be the
cause of quantum mottle

16. Which of the following quantities of filtration is most likely to be used in mammography?
(A) 0.5 mm Mo
(B) 1.5 mm Al
(C) 1.5 mm Cu
(D) 2.0 mm Cu
—————————————————————————
Soft tissue radiography requires the use of long-wavelength, low-energy x-ray photons. Very little filtration is
used in mammography. Certainly, anything more than 1.0 mm of aluminum would remove the useful soft
photons, and the desired high contrast could not be achieved. Dedicated mammographic units usually have
molybdenum targets (for the production of soft radiation) and a small amount of molybdenum filtration.

17. All of the following are related to recorded detail except

(A) motion.
(B) screen speed.
(C) OID.
(D) grid ratio.
—————————————————————————
Motion is said to be the greatest enemy of recorded detail because it completely obliterates image sharpness.
Screen speed can reduce recorded detail according to the degree of light diffusion from the phosphors. OID
causes magnification and blurriness of recorded detail. Grid ratio is related to cleanup of scattered radiation; it
is unrelated to detail.

18. Misalignment of the tube-part-film relationship results in

(A) shape distortion.
(B) size distortion.
(C) magnification.
(D) blur.
—————————————————————————
Shape distortion (foreshortening, elongation) is caused by improper alignment of the tube, part, and film. Size
distortion, or magnification, is caused by too great an OID or too short an SID. Focal spot blur is caused by the
use of a large focal spot.

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19. High-kilovoltage exposure factors are usually required for radiographic examinations using
1. water-soluble, iodinated media.
2. a negative contrast agent.
3. barium sulfate.
(A) 1 only
(B) 2 only
(C) 3 only
(D) 1 and 3 only
—————————————————————————
Positive-contrast medium is radiopaque; negative-contrast material is radioparent. Barium sulfate (radiopaque,
positive-contrast material) is most frequently used for exams of the intestinal tract, and high-kVp exposure
factors are used in order to penetrate (to see through and behind) the barium. Water-based iodinated contrast
media (Conray, Amipaque) are also positive-contrast agents. However, the K-edge binding energy of iodine
prohibits the use of much greater than 70 kVp with these materials. Higher kVp values will obviate theeffect of
the contrast agent. Air is an example of a negative-contrast agent, and high-kVp factors are clearly not
indicated.

20. Glutaraldehyde is added to the developer solution of automatic processors to

1. keep emulsion swelling to a minimum.
2. decrease the possibility of a processor jam-up.
3. remove unexposed silver halide crystals.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The distance between transport rollers in an automatic processor is extremely critical and allows for exact film
thickness with minimum emulsion swelling. If the emulsion is allowed to swell excessively (as a result of
excessive temperature or inadequate replenishment), the emulsion will stick to the rollers and cause a
processor jam-up. Glutaraldehyde is a hardener that is added to the developer to keep the emulsion swelling to
a minimum. Unexposed silver halide crystals are removed in the fixer solution.

21. What is the purpose of the thin layer of lead that is often located behind the rear intensifying screen in a
image receptor?
(A) To prevent crossover
(B) To increase screen speed
(C) To diffuse light photons
(D) To prevent scattered radiation fog
—————————————————————————
The purpose of the thin layer of lead that is often located behind the rear intensifying screen in a cassette is to
absorb x-rays that penetrate the screens, strike the rear of the cassette, and bounce back toward the film
emulsion, resulting in scattered radiation fog. The thin layer of lead absorbs these x-ray photons and thus
improves the radiographic image. (Shephard, pp 41-42)

22. The mottled appearance of the radiograph in Figure 4-21 is most likely representative of
(A) Paget's disease.
(B) osteoporosis.
(C) safelight fog.
(D) pillow artifacts.
—————————————————————————
The lateral skull radiograph pictured illustrates the result of great care taken by the radiographer to secure
patient comfort. A skull examination was requested for this patient of advanced years. The radiographer
positioned the patient, taking care to position and collimate accurately, all the while trying to ensure the
patient's comfort by letting her keep her pillow! The foam stuffing of the pillow is nicely imaged. Although the
artifacts somewhat resemble Paget's disease or osteoporosis note that they extend outside the collimated
field. Safelight fog would be shown as a more uniform "blanket" of fog. (Saia, p 408)

23. Which of the following can cause poor screen / film contact?
1. Damaged image receptor frame
2. Foreign body in image receptor
3. Warped image receptor front

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(A) 1 only
(B) 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Perfect contact between the intensifying screens and the film is essential in order to maintain image
sharpness. Any separation between them allows diffusion of fluorescent light and subsequent blurriness and
loss of detail. Screen / film contact can be diminished if the image receptor frame is damaged and misshapen,
if the front is warped, or if there is a foreign body between the screens, elevating them. (Selman, p 185)

24. Why is a very short exposure time essential in chest radiography?

(A) To avoid excessive focal spot blur
(B) To maintain short-scale contrast
(C) To minimize involuntary motion
(D) To minimize patient discomfort
—————————————————————————
Radiographers are usually able to stop voluntary motion using suspended respiration, careful instruction, and
immobilization. However, involuntary motion must also be considered. In order to have a "stop action" effect on
the heart when radiographing the chest, it is essential to use a short exposure time. (Fauber, pp 87-88)

25. Why are a single intensifying screen and single-emulsion film used for select radiographic examinations?
(A) To decrease patient dose
(B) To achieve longer-scale contrast
(C) For better recorded detail
(D) To decrease fiscal expenses
—————————————————————————
The diffusion of fluorescent light from intensifying screens is responsible for a loss of recorded detail on
double-emulsion film. Therefore, by changing the system to include only one intensifying screen and single-
emulsion film, as in mammographic systems, light diffusion is reduced and better recorded detail results.
Patient dose is somewhat greater than with a two-screen cassette system, but the advantage of significantly
improved recorded detail greatly offsets this. (Shephard, p 49)

26. When the use of grids is indicated in mammography, which of the following would be most appropriate?
(A) 12:1 stationary grid
(B) 12:1 moving grid
(C) 5:1 stationary grid
(D) 5:1 moving grid
—————————————————————————
Grids are frequently used to improve the visibility of detail in mammographic examinations. They are especially
useful when examining breast tissue that is likely to produce more scattered radiation than usual.Large breasts
that are unable to be compressed to a thickness of 6 cm or less and particularly dense breasts are examples of
cases in which a grid is especially useful. Because low kilovoltage is employed in mammography, only a low-
ratio grid, such as a 4:1 or 5:1, is generally used. The grid must be a moving grid, because a stationary grid
would produce very objectionable grid lines.

27. Which of the following examinations might require the use of 120 kVp?
1. AP abdomen
2. Chest radiograph
3. Barium-filled stomach
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 2 and 3 only
—————————————————————————
High-kilovoltage factors are frequently used to even out densities in anatomic parts with high tissue contrast
(e.g., the chest). However, as high kilovoltage produces added scatter radiation, it generally must be used with
a grid. It would be inappropriate to perform an AP abdomen with high kilovoltage because it has such low
subject contrast. Barium-filled structures are frequently radiographed using 120 kV or more in order to
penetrate the bariumto see through to structures behind.

28. If the radiographer is unable to achieve a short OID because of the structure of the body part or patient
condition, which of the following adjustments can be made to minimize magnification distortion?

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(A) A smaller focal spot size should be used.
(B) A longer SID should be used.
(C) Faster intensifying screens should be used.
(D) A lower-ratio grid should be used.
—————————————————————————
An increase in SID will help decreasethe effect of excessive OID. For example, in the lateral projection of the
cervical spine, there is normally a significant OID that would result in obvious magnification at a 40-in SID. This
effect is decreased by the use of a 72-in SID. However, especially with larger body parts, increased SID
usually requires a significant increase in exposure factors. Focal spot size, screen speed, and grid ratio are
unrelated to magnification.

29. Which of the following focal spot sizes should be employed for magnification radiography?
(A) 0.2 mm
(B) 0.6 mm
(C) 1.2 mm
(D) 2.0 mm
—————————————————————————
Proper use of focal spot size is of paramount importance in magnification radiography. A magnified image that
is diagnostic can be obtained only by using a fractional focal spot of 0.3 mm or smaller. The amount of blur or
geometric unsharpness produced by focal spots that are larger in size render the radiograph undiagnostic.

30. Unopened boxes of radiographic film should be stored away from radiation and
(A) in the horizontal position.
(B) in the vertical position.
(C) stacked with the oldest on top.
(D) stacked with the newest on top.
—————————————————————————
Boxes of x-ray film, especially the larger sizes, should be stored in the vertical (upright) position. If film boxes
are stacked upon one another, the sensitive emulsion can be affected by pressure from the boxes above.
Pressure marks are produced and result in loss of contrast in that area of the radiographic image. When
retrieving x-ray film from storage, the oldest should be used first.

31. Boxes of film stored in too warm an area may be subject to

(A) static marks.
(B) film fog.
(C) high contrast.
(D) loss of density.
—————————————————————————
X-ray film emulsion is sensitive and requires proper handling and storage. It should be stored in a cool (40 to
60º), dry (40 to 60 percent humidity) place. Exposure to excessive temperatures or humidity can lead to film
fog and loss of contrast. Static marks are a result of low humidity.

32. An increase in the kilovoltage applied to the x-ray tube increases the
1. x-ray wavelength.
2. exposure rate.
3. patient absorption.
(A) 1 only
(B) 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
As the kilovoltage is increased, a greater number of electrons are driven across to the anode with greater
force. Therefore, as energy conversion takes place at the anode, more high-energy (short-wavelength)
photons are produced. However, because they are higher-energy photons, there will be less patient absorption

33. All of the following statements regarding CR (computed radiography) cassettes are true, except
(A) CR cassettes do not contain radiographic film
(B) CR cassettes use no intensifying screens
(C) CR cassettes must exclude all white light
(D) CR cassettes function to protect the IP (image plate)
—————————————————————————

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Externally, CR (computed radiography) cassettes appear very much like traditional film / screen cassettes.
However, the main function of a CR cassette is to support and protect the IP (Image Plate) that lies within the
CR cassettes. CR cassettes do not contain intensifying screens or film and therefore do not need to be light
tight. The photostimulable IP is not affected by light.

34. How is the mAs adjusted in an AEC system as the film / screen combination is decreased?
(A) The mAs increases as film / screen speed decreases.
(B) Both the mAs and the kVp increase as film / screen speed decreases.
(C) The mAs decreases as film / screen speed decreases.
(D) The mAs remains unchanged as film / screen speed decreases.
—————————————————————————
As the speed of the film / screen system decreases, an increase in mAs is usually required in order to maintain
radiographic density. However, when an automatic exposure control (phototimer or ionization chamber) is
used, the system is programmed for the use of a particular film / screen speed. If a slower-speed screen
cassette / image receptor is placed in the bucky tray, the AEC has no way of recognizing it as different and will
time the exposure for the system that it is programmed for. For example, if the system is programmed for a
400-speed film / screen combination, and if a 200-speed screen cassette / image receptor was placed in the
bucky tray, the resulting radiograph would have half the required radiographic density.

35. Which of the following is (are) causes of grid cutoff when using reciprocating grids?
1. Inadequate SID
2. X-ray tube off-center with the long axis of the lead strips
3. Angling the beam in the direction of the lead strips
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
If the SID is above or below the recommended focusing distance, the primary beam will not coincide with the
angled lead strips at their lateral edges. Consequently, there will be absorption of the primary beam, termed
grid cutoff. If the central ray is off-center longitudinally, there will be no ill effects. If the central ray is off-center
side-to-side, the lead strips are no longer parallel with the divergent x-ray beam, and there will be loss of
density due to grid cutoff. Central ray angulation in the direction of the lead strips is appropriate and will not
cause grid cutoff. Central ray angulation against the direction of the lead strips will cause grid cutoff.

36 The variation in photon distribution between the anode and cathode ends of the x-ray tube is known as
(A) the line focus principle.
(B) the anode heel effect.
(C) the inverse square law.
(D) Bohr's theory.
—————————————————————————
Because the focal spot (track) of an x-ray tube is along the anode's beveled edge, photons produced at the
target are able to diverge toward the cathode end of the tube, but are absorbed by the "heel" of the anode at
the opposite anode end of the tube. This results in a greater number of x-ray photons distributed toward the
cathode end and is known as the anode heel effect. The line focus principle is a geometric principle illustrating
that the effective focal spot is always smaller than the actual focal spot. The inverse square law of radiation
deals with the relationship between distance and radiation intensity. Bohr's theory refers to an atom's
resemblance to the solar system.

37. Which of the following may be used to reduce the effect of scattered radiation on the finished radiograph?
1. Grids
2. Collimators
3. Compression bands
(A) 1 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Collimators restrict the size of the irradiated field, thereby limiting the volume of irradiated tissue, and hence
less scatter radiation is produced. Once radiation has scattered and emerged from the body, it can be trapped
by the grid's lead strips. Grids effectively remove much of the scatter radiation in the remnant beam before it

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reaches the x-ray film. Compression can be applied to reduce the effect of excessive fatty tissue (e.g., in the
abdomen), in effect reducing the thickness of the part to be radiographed.

38. Base-plus fog is a result of

1. blue-tinted film base.
2. chemical development.
3. the manufacturing process.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Every film emulsion has a particular base-plus fog, which should not exceed 0.2. This base density is a result
of the manufacturing process (environmental radiation) and the blue tint added to the base to reduce glare.
The remaining fog density is a result of the chemical development process, when exposed silver bromide
grains are converted to black metallic silver.

39. A lateral radiograph of the cervical spine was made at 40 in using 100 mA and 0.1 s exposure. If it is
desired to increase the distance to 72 in, what should be the new mA, all other factors remaining the same?
(A) 100 mA
(B) 200 mA
(C) 300 mA
(D) 400 mA
—————————————————————————
When exposure rate decreases (as a result of increased SID), an appropriate increase in mAs is required in
order to maintain the original radiographic density. Unless exposure is increased, the resulting radiograph will
be underexposed. The formula used to determine the new mAs (density maintenance formula) is

(old mAs) 10 (old D2) 402 10 1600

 = ; = 
(new mAs) x (new D2) 722 x 5184

1600x = 51,840; x = 32.4 mAs at 72 SID

To determine the required mA (mA × s = mAs)

40. Although the stated focal spot size is measured directly under the actual focal spot, focal spot size really
varies along the length of the x-ray beam. At which portion of the x-ray beam is the effective focal spot the
largest?
(A) At its outer edge
(B) Along the path of the central ray
(C) At the cathode end
(D) At the anode end
—————————————————————————
X-ray tube targets are constructed according to the line focus principlethe focal spot is angled (usually 12 to
17º) to the vertical (Fig. 4-30). As the actual focal spot is projected downward, it is foreshortened; thus, the
effective focal spot is always smaller than the actual focal spot. As it is projected toward the cathode end of the
x-ray beam, the effective focal spot becomes larger and approaches the actual size. As it is projected toward
the anode end, it gets smaller because of the anode "heel" effect.

41. X-ray photon energy is inversely related to

1. photon wavelength.
2. applied mA.
3. applied kVp.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
As kVp is increased, more high-energy photons are produced and the overall energy of the primary beam is
increased. Photon energy is inversely related to wavelength; that is, as photon energy increases, wavelength

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decreases. An increase in milliamperage serves to increase the number of photons produced at the target, but
is unrelated to their energy.

42. Which of the following can result from improper film storage or darkroom conditions?
1. Safelight fog
2. Background radiation fog
3. Screen lag
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
If the safelight bulb is of a higher wattage than it should be, the safelight filter is incorrect for the film type, or
the filter is cracked, film fog can occur. If film is not stored in a radiation-safe area, it can be fogged by
background radiation. Screen lag is not caused by improper film storage conditions, but rather by aged or
defective intensifying screens.

43. Which of the following is (are) characteristic(s) of mammography film emulsion?

1. High contrast
2. Fine grain
3. Single emulsion

(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Because breast tissue is of such uniform density, every effort must be made to enhance what little subject
contrast does exist. High-contrast film emulsion helps to accomplish this. It is essential that any existing
microcalcifications be clearly imaged; therefore, fine grain is also an important emulsion characteristic.
Mammography film is single-emulsion, used with a single intensifying-screen image receptor, for best detail.

44. The device shown in Figure 4-12 is used for

(A) tomographic quality assurance (QA) testing.
(B) timer and rectifier testing.
(C) mammography QA testing.
(D) kV calibration testing.
—————————————————————————
Quality control in mammography includes scrupulous testing of virtually all component parts of the
mammographic imaging system. It includes processor checks, screen maintenance, accurate and consistent
viewing conditions, and evaluation of phantom images, to name a few. The device pictured is the structures to
be imaged within a mammography phantom. A mammographic phantom contains Mylar fibers, simulated
masses, and specks of simulated calcifications. The American College of Radiology accreditation criteria state
that a minimum of ten objects (four fibers, three specks, and three masses) must be visualized on test
films.Changes in any part(s) of the imaging system (film, screens, image receptors, x-ray equipment, filtration,
or viewbox) can result in unsuccessful results.

45. Which of the following terms is used to describe unsharp edges of tiny radiographic details?
(A) Diffusion
(B) Mottle
(C) Blur
(D) Umbra
—————————————————————————
Recorded detail is evaluated by how sharply tiny anatomic details are imaged on the radiograph. The area of
blurriness that may be associated with small image details is termed geometric blur. The blurriness can be
produced by using a large focal spot, or by diffused fluorescent light from intensifying screens. The image
proper (i.e., without blur) is termed the umbra. Mottle is a grainy appearance caused by fast imaging systems.

46. Which of the following have an effect on recorded detail?

1. Focal spot size
2. Type of rectification
3. SID

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Property of Hamilcar Eldo B. Chanjueco
(A) 1 and 2 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Focal spot size affects recorded detail by its effect on focal spot blur: The larger the focal spot size, the greater
the blur produced. Recorded detail is significantly affected by distance changes because of their effect on
magnification. As SID increases, magnification decreases and recorded detail increases. The method of
rectification has no effect on recorded detail. Single-phase rectified units produce "pulsed" radiation, whereas
three-phase units produce almost constant potential

47. Greater latitude is available to the radiographer in which of the following circumstances?
1. Using high-kVp technical factors
2. Using a slow film / screen combination
3. Using a low-ratio grid
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
In the low kilovoltage ranges, a difference of just a few kVp makes a very noticeable radiographic difference.
High-kVp technical factors offer much greater margin for error, as do slow film / screen combinations. Lower-
ratio grids offer more tube centering latitude than high-ratio grids.

48. Which of the following chemicals is used in the production of radiographic film emulsion?
(A) Sodium sulfite
(B) Potassium bromide
(C) Silver halide
(D) Chrome alum
—————————————————————————
Film emulsion consists of silver halide crystals suspended in gelatin. Sodium sulfite is a film-processing
preservative, and potassium bromide is a developer restrainer. Potassium and chrome alum are emulsion
hardeners used in fixer solution.

49. Which of the following pathologic conditions will probably require a decrease in exposure factors?
(A) Osteomyelitis
(B) Osteoporosis
(C) Osteosclerosis
(D) Osteochondritis
—————————————————————————
Osteoporosis is a condition, often seen in the elderly, marked by increased porosity and softening of bone. The
bones are much less dense, and thus a decrease in exposure is required. Osteomyelitis and osteochondritis
are inflammatory conditions that usually have no effect on bone density. Osteosclerosis is abnormal hardening
of the bone, and an increase in exposure factors would be required.

50. What information, located on each box of film, is important to note and has a direct relationship to film
quality?
(A) Number of films in the box
(B) Manufacturer's name
(C) Expiration date
(D) Emulsion lot
—————————————————————————
Every box of film comes with the expiration date noted. Film used after its expiration date will usually suffer a
loss of speed and contrast and will exhibit fog. Film should be ordered in quantities that will ensure that it is
used before it becomes outdated, and it should be rotated in storage so that the oldest is used first.

51. Which of the two film emulsions illustrated in Figure 4-8 requires less exposure to produce a density of 2.0?
(A) Number 1 requires less exposure to produce a density of 2.0.
(B) Number 2 requires less exposure to produce a density of 2.0.
(C) Emulsions 1 and 2 are of identical speed.
(D) Speed cannot be predicted from the illustration.
—————————————————————————

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Property of Hamilcar Eldo B. Chanjueco
A characteristic curve is representative of a film emulsion's response to light or x-rays. A slow film emulsion
(one with greater latitude and lower contrast) responds more gradually than does a fast film. In general, the
more gentle or gradual the slopeof a particular film's characteristic curve, the slower the film is, the longer the
scale of contrast it will produce, the more latitude it possesses, and the more exposure that is required to
produce a particular density. A line is drawn vertically fromeach curve at a density of 2.0 to where it intersects
with the horizontal axis (exposure). Film 1 requires an exposure of about 1.7 to produce a density of 2.0. Film
2 requires an exposure of about 2.1 to produce a density of 2.0.

52. How are mAs and radiographic density related in the process of image formation?
(A) mAs and radiographic density are inversely proportional.
(B) mAs and radiographic density are directly proportional.
(C) mAs and radiographic density are related to image unsharpness.
(D) mAs and radiographic density are unrelated.
—————————————————————————
Radiographic density is described as the overall degree of blackening of a radiograph or a part of it. The mAs
regulates the number of x-ray photons produced at the target, and thus regulates radiographic density. If it is
desired to double the radiographic density, one simply doubles the mAs; therefore mAs and radiographic
density are directly proportional.

53. The left and right oblique cervical spine radiographs seen in Figure 4-3 were performed using automatic
exposure control (AEC) during a particular examination. Which of the following is most likely to account for the
difference in radiographic density between the images?
(A) Focused grid placed upside down
(B) Incorrect photocell selected
(C) Incorrect positioning of the part being imaged
(D) Patient motion during exposure
—————————————————————————
In the left and right oblique cervical spine radiographs seen in Figure 4-3, radiograph A appears lighter than
radiograph B. The key to their density difference lies in the fact that both were performed using AEC during a
particular examination. If the focused grid had been placed upside down, only the central portion of the image
(along the long axis of the image receptor) would have been imaged. The remainder would demonstrate grid
cutoff. Incorrect photocell selection would most likely produce unsatisfactory images in both instances, not just
in one of the obliques. The lack of blurriness indicates that this is not a case of patient motion. However,
incorrect or different positioning of the part being imaged will cause the AEC photocell (the center cell is
selected for the cervical spine) to react differently. When the photocell is "reading" exit radiation emerging from
the cervical bodies, one exposure is recorded. When the photocell is "reading" exit radiation emerging from the
cervical spinous processes / soft tissue, quite another (much lower) exposure is recordedhence the
difference in radiographic density between the two radiographs in this example. This example demonstrates
the critical relationship between exact positioning and recorded density when using AEC.

54. What will result from using single-emulsion film in an image receptor having a two intensifying screens?
(A) Double exposure
(B) Decreased density
(C) Increased recorded detail
(D) Greater latitude
—————————————————————————
Dual-screen cassettes are made to be used with dual-emulsion film. The fluorescing screens are adjacent to
the emulsions. If single-emulsion film is placed in a dual-screen cassette, the emulsion will receive only one-
half the intended exposure, and the resulting image will exhibit decreased density.

55. Which of the following are methods of limiting the production of scattered radiation?
1. Using moderate-ratio grids
2. Using the prone position for abdominal exams
3. Restricting the field size to the smallest practical size
(A) 1 and 2 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
If a fairly large patient is turned prone, the abdominal measurement will be significantly different from the AP
measurement as a result of the effect of compression. Thus, the part is essentially "thinner," and less scatter
radiation will be produced. If the patient remains supine and a compression band is applied, a similar effect will

12
Property of Hamilcar Eldo B. Chanjueco
be produced. Beam restriction is probably the single most effective means of reducing the production of
scattered radiation. Grid ratio affects the cleanup of scattered radiation; it has no effect on the production of
scattered radiation.

56. Chemical fog may be attributed to

1. excessive developer temperature.
2. oxidized developer.
3. excessive replenishment.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
If developer temperature is too high, some of the less-exposed or unexposed silver halide crystals may be
reduced, thus creating chemical fog. If the developer solution has become oxidized from exposure to air,
chemical fog also results. If developer replenishment is excessive, too much new solution is replacing the
deteriorated developer, and chemical fog is again the result.

57. Which of the following groups of technical factors will produce the greatest radiographic density?
(A) 400 mA, 0.010 s, 94 kVp, 100-speed screens
(B) 500 mA, 0.008 s, 94 kVp, 200-speed screens
(C) 200 mA, 0.040 s, 94 kVp, 50-speed screens
(D) 100 mA, 0.020 s, 80 kVp, 200-speed screens
—————————————————————————
Each mAs is determined (A = 4; B = 4; C = 8; D = 2) and numbered in order of greatest to leastdensity (C = 1;
A and B = 2; D = 3). Then the kilovoltages are reviewed and also numbered in order of greatest to least density
(A, B, and C = 1; D = 2). Next, screen speeds are numbered from greatest-density-producing to least-density-
producing (D and B= 1; A = 2; C = 3). Finally, the numbers assigned to the mAs, kVp, and screen speed are
added up for each of the four groups (B = 4; A and C = 5; D = 6); the lowest total(B) indicates the group of
factors that will produce the greatest radiographic density. This process is illustrated as follows:
A. 4 mAs (2) + 94 kVp (1) + 100 screens (2) = 5
B. 4 mAs (2) + 94 kVp (1) + 200 screens (1) = 4
C. 8 mAs (1) + 94 kVp (1) + 50 screens (3) = 5
D. 2 mAs (3) + 80 kVp (2) + 200 screens (1) = 6
(Shephard, p 179)

58. Which of the following can affect the amount of developer replenisher delivered per film in an automatic
processor?
(A) Developer temperature
(B) Amount of film exposure
(C) Film size
(D) Processor capacity
—————————————————————————
The film processor is automated, and replenishment quantities are preset. A microswitch is activated as a film
enters the processor at the entrance rollers. Replenisher is added according to the length of the x-ray filmfor
as long as the detector senses the presence of film. Once the back end of the film passes the entrance roller
sensor, replenishment stops. When films are fed into the processor the "long way," too much replenishment
occurs, and the image can exhibit excessive density.

59. Which of the following factors contribute(s) to the efficient performance of a grid?
1. Grid ratio
2. Number of lead strips per inch
3. Amount of scatter transmitted through the grid
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
Grid ratio is defined as the ratio of the height of the lead strips to the width of the interspace material; the
higher the lead strips, the more scatter radiation they will trap and the greater the grid's efficiency. The greater
the number of lead strips per inch, the thinner and less visible they will be on the finished radiograph. The
function of a grid is to absorb scattered radiation in order to improve radiographic contrast. The selectivity of a

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Property of Hamilcar Eldo B. Chanjueco
grid is determined by the amount of primary radiation transmitted through the grid divided by the amount of
scattered radiation transmitted through the grid.

60. Factor(s) that can be used to regulate radiographic density is (are)

1. milliamperage.
2. exposure time.
3. kilovoltage.
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
Factors that regulate the number of x-ray photons produced at the target can be used to control radiographic
density, namely milliamperage and exposure time (mAs). Radiographic density is directly proportional to mAs;
if the mAs is cut in half, the radiographic density will decrease by one-half. Although kilovoltage is used
primarily to regulate radiographic contrast, it may also be used to regulate radiographic density in variable-kVp
techniques, according to the 15 percent rule.

61. The cause of films coming from the automatic processor still damp can be
(A) air velocity too high.
(B) unbalanced processing temperatures.
(C) insufficient hardening action.
(D) underreplenishment.
—————————————————————————
If the fixer fails to harden the gelatin emulsion sufficiently, water will remain within the still-swollen emulsion.
The dryer mechanism will be unable to completely rid the emulsion of wash water, and the film will emerge
from the processor damp and tacky. On the other hand, excessive hardening action may produce brittle
radiographs. High air velocity usually encourages more complete drying. Unbalanced processing temperatures
can result in blistering of the emulsion. Developer underreplenishment results in "light" images and can be the
cause of transport problems as a result of insufficient hardener.

62. Which of the following can be used to determine the sensitivity of a particular film emulsion?
(A) Sensitometric curve
(B) Dose-response curve
(C) Reciprocity law
(D) Inverse square law
—————————————————————————
The characteristic (sensitometric) curve is used to show the relationship between the exposure given the film
and the resulting film density. It can therefore be used to evaluate a particular film emulsion's response (speed,
sensitivity) by determining how long it takes to record a particular density. A dose-response curve is used in
radiation protection and illustrates the quantity of dose required to produce a particular effect. The reciprocity
law states that a particular mAs, regardless of the combination of milliamperage and time, should produce the
same degree of blackening. The inverse square law illustrates the relationship between distance and radiation
intensity.

63. Radiographic contrast is a result of

1. differential tissue absorption.
2. emulsion characteristics.
3. proper regulation of mAs.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Radiographic contrast is defined as the degree of difference between adjacent densities. These density
differences represent sometimes very subtle differences in the absorbing properties of adjacent body tissues.
The type of film emulsion used also brings with it its own contrast characteristics. Different types of film
emulsions have different degrees of contrast "built into" them chemically. The technical factor used to regulate
contrast is kilovoltage. Radiographic contrast is unrelated to mAs.

64. A 15 percent increase in kVp accompanied by a 50 percent decrease in mAs will result in a(n)
(A) shorter scale of contrast.

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Property of Hamilcar Eldo B. Chanjueco
(B) increase in exposure latitude.
(C) increase in radiographic density.
(D) decrease in recorded detail.
—————————————————————————
A 15 percent increase in kVp with a 50 percent decrease in mAs serves to produce a radiograph similar to the
original, but with some obvious differences. The overall blackness (radiographic density) is cut in half because
of the decrease in mAs. However, the loss of blackness is compensated for by the addition of grays (therefore,
longer-scale contrast) from the increased kVp. The increase in kVp also increases exposure latitude; there is a
greater margin for error in higher kVp ranges. Recorded detail is unaffected by changes in kVp.

65. A film emulsion having wide latitude is likely to exhibit

(A) high density.
(B) low density.
(C) high contrast.
(D) low contrast.
—————————————————————————
Every film emulsion has a characteristic curve representative of that film's speed, contrast, and latitude. A
gentle curve (as opposed to a steep curve) usually indicates a film with slow speed, low contrast, and more
latitude.

66. Using fixed-mAs and variable-kVp technical factors, each centimeter increase in patient thickness requires
what adjustment in kilovoltage?
(A) Increase 2 kVp
(B) Decrease 2 kVp
(C) Increase 4 kVp
(D) Decrease 4 kVp
—————————————————————————
When the variable-kVp method is used, a particular mAs is assigned to each body part. As part thickness
increases, the kVp (penetration) is also increased. The body part being radiographed must be carefully
measured, and for each centimeter of increase in thickness, 2 kVp is added to the exposure.

67. A compensating filter is used to

(A) absorb the harmful photons that contribute only to patient dose.
(B) even out widely differing tissue densities.
(C) eliminate much of the scattered radiation.
(D) improve fluoroscopy.
—————————————————————————
A compensating filter is used to make up for widely differing tissue densities. For example, it is difficult to
obtain a satisfactory image of the mediastinum and lungs simultaneously without the use of a compensating
filter to "even out" the densities.With this device, the chest is radiographed using mediastinal factors, and a
trough-shaped filter (thicker laterally) is used to absorb excess photons that would overexpose the lungs. The
middle portion of the filter lets the photons pass to the mediastinum almost unimpeded. Filters that absorb the
photons contributing to skin dose are inherent and added filters. Compensating filtration is unrelated to
elimination of scatter radiation or fluoroscopy.

68. Grid cutoff due to off-centering would result in

(A) overall loss of density.
(B) both sides of the film being underexposed.
(C) overexposure under the anode end.
(D) underexposure under the anode end.
—————————————————————————
Grids are composed of alternate strips of lead and interspace material and are used to trap scatter radiation
after it emerges from the patient and before it reaches the film. Accurate centering of the x-ray tube isrequired.
If the x-ray tube is off-center, but within the recommended focusing distance, there will usually be an overall
loss of density. Over- or underexposure under the anode is usually the result of exceeding the focusing
distance limits in addition to being off center.

69. Which of the following is most likely to produce a radiograph with a long scale of contrast?
(A) Increased photon energy
(B) Increased screen speed
(C) Increased mAs
(D) Increased SID

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Property of Hamilcar Eldo B. Chanjueco
 —————————————————————————
An increase in photon energy accompanies an increase in kilovoltage. Kilovoltage regulates the penetrability of
x-ray photons; it regulates their wavelengththe amount of energy with which they are associated. The higher
the related energy of an x-ray beam, the greater its penetrability (kilovoltage and photon energy are directly
related; kilovoltage and wavelength are inversely related). Adjustments in kilovoltage have a big impact on
radiographic contrast: As kilovoltage (photon energy) is increased, the number of grays increases, thereby
producing a longer scale of contrast. In general, as screen speed increases, so does contrast (resulting in a
shorter scale of contrast). An increase in mAs is frequently accompanied by an appropriate decrease in
kilovoltage, which would also shorten the contrast scale. SID and radiographic contrast are unrelated.

70. Which of the following statements are true with respect to the radiograph shown in Figure 4-6?
1. The radiograph exhibits long-scale contrast.
2. The radiograph exhibits a clothing artifact.
3. The radiograph demonstrates motion blur.
(A) 1 and 2 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The abdomen radiograph seen in Figure 4-6 demonstrates motion blur. This can be seen particularly in the
upper abdomen and in the bowel gas patterns. Motion obliterates detail. Patients who are in pain are often
unable to cooperate as fully as patients who are not in pain. Careful positioning and patient instruction are
often helpful, but it remains useful to employ the shortest exposure time possible. The radiograph also
demonstrates good long-scale contrast that enables visualization of many tissue densities. The dark horizontal
line across the abdomen is a clothing artifact resulting from a taut elastic underwear waistband.

71. The continued emission of light by a phosphor after the activating source has ceased is termed
(A) fluorescence.
(B) phosphorescence.
(C) image intensification.
(D) quantum mottle.
—————————————————————————
Fluorescence occurs when an intensifying screen absorbs x-ray photon energy, emits light, and then ceases to
emit light as soon as the energizing source ceases. Phosphorescence occurs when an intensifying screen
absorbs x-ray photon energy, emits light, and continues to emit light for a short time after the energizing source
ceases. Quantum mottle is the freckle-like appearance on some radiographs made using a very fast imaging
system. The brightness of a fluoroscopic image is amplified through image intensification.

72. The artifacts on the radiograph in Figure 4-20 are called

(A) pi lines.
(B) guide shoe marks.
(C) hesitation marks.
(D) reticulation.
—————————————————————————
Guide shoes are found at crossover and turnaround assemblies and function to direct the film around corners
as it changes direction. If a guide shoe becomes misaligned, it will scratch the emulsion and leave the
characteristic guide shoe marks running in the direction of film travel, as seen in the pictured radiograph. Pi
lines appear as plus-density lines running perpendicular to the direction of film travel; they are sometimes seen
in new processors or after a complete maintenance / overhaul. Hesitation marks areplus-density lines
occurring as a result of pauses, or hesitations, in a faulty roller transport system.

73. Image receptors / cassettes frequently have a lead foil layer behind the rear screen that functions to
(A) improve penetration.
(B) absorb backscatter.
(C) preserve resolution.
(D) increase the screen speed.
—————————————————————————
Many cassettes / image receptors have a thin lead foil layer behind the rear screen to absorb backscatter
radiation that is energetic enough to exit the rear screen, strike the metal back, and bounce back to fog the
image. When this happens, the image receptor's metal hinges or straps may be imaged in high-kVp
radiography. The lead foil absorbs the backscatter before it can fog the film.

16
Property of Hamilcar Eldo B. Chanjueco
74. The steeper the straight-line portion of a characteristic curve for a particular film, the
1. slower the film speed.
2. higher the film contrast.
3. greater the exposure latitude.
(A) 1 only
(B) 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The steepness of the characteristic curve is representative of film contrast. The steeper the curve, the greater
the density differences and the higher the contrast. The speed of the film is determined by the curve's position
on the log relative scale: When comparing two or more characteristic curves, the faster film lies farthest to the
left. The faster the film speed, the less the exposure latitude

75. An exposure was made using 300 mA, 0.04 s exposure, and 85 kVp. Each of the following changes will
decrease the radiographic density by one-half except change to
(A) 1/50 s exposure.
(B) 72 kVp.
(C) 10 mAs.
(D) 150 mA.
—————————————————————————
Radiographic density is directly proportional to mAs. If exposure time is halved from 0.04 (1/25) s to 0.02 (1/50)
s, radiographic density will be cut in half. Changing to 150 mA will also halve the mAs, effectively halving the
radiographic density. If the kVp is decreased by 15 percent, from 85 to 72 kVp, radiographic density will be
halved according to the 15 percent rule. In order to cut the density in half, the mAs must be reduced to 6
(rather than 10).

76. Compression of the breast during mammographic imaging improves the technical quality of the image
because
1. geometric blurring is decreased.
2. less scatter radiation is produced.
3. patient motion is reduced.
(A) 1 only
(B) 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Compression of the breast tissue during mammographic imaging improves the technical quality of the image
for several reasons. Compression brings breast structures into closer contact with the image recorder, thus
reducing geometric blur and improving detail. As the breast tissue is compressed and essentially becomes
thinner, less scatter radiation is produced. Compression serves as excellent immobilization as well.

77. The plus-density artifact pictured in Figure 4-14 was probably produced
1. by careless handling.
2. after exposure.
3. before exposure.
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 1 and 3 only
—————————————————————————
The crescent-shaped kink, or crinkle, marks seen on the radiographic image are caused by acutely bending
the x-ray film. The artifact will usually appear as a plus-density (dark) artifact if it is produced before exposure,
and as a minus-density (light) artifact if it is produced after exposure. X-ray film emulsion is very sensitive to
mishandling, particularly after exposure.

78. When involuntary motion must be considered, the exposure time may be cut in half if the kVp is
(A) doubled.
(B) increased by 15 percent.
(C) increased by 25 percent.
(D) increased by 35 percent.
—————————————————————————

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Property of Hamilcar Eldo B. Chanjueco
If the exposure time is cut in half, one would normally double the milliamperage in order to maintain the same
mAs and, consequently, the same radiographic density. However, increasing the kVp by 15 percent has a
similar effect. For example, if the original kVp was 85, 15 percent of that is 13, and therefore the new kVp
would be 98. The same percentage value would be used to cut the radiographic density in half (reduce kVp by
15 percent).

79. Methods that help reduce the production of scattered radiation include using
1. compression.
2. beam restriction.
3. a grid.
(A) 1 and 2 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Limiting the size of the irradiated field is a most effective method of decreasing the production of scattered
radiation. The smaller the volume of tissue irradiated, the smaller the amount of scattered radiation generated;
this can be accomplished using compression (prone position instead of supine or a compression band). Use of
a grid does not affect the production of scatter radiation, but rather removes it once it has been produced.

80. The relationship between the height of a grid's lead strips and the distance between them is referred to as
grid
(A) ratio.
(B) radius.
(C) frequency.
(D) focusing distance.
—————————————————————————
Grids are used in radiography to trap scatter radiation that would otherwise cause fog on the radiograph. Grid
ratio is defined as the ratio of the height of the lead strips to the distance between them. Grid frequency refers
to the number of lead strips per inch. Focusing distance and grid radius are terms denoting the distance range
with which a focused grid may be used.

81. The sensitometric curve may be used to

1. identify automatic processing problems.
2. determine film sensitivity.
3. illustrate screen speed.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The sensitometric, or characteristic curve is used to illustrate the relationship between the exposure given the
film and the resulting film density. It can be used to predict a particular film emulsion's response (speed,
sensitivity) by determining how long it takes to record a particular density. The sensitometric curve is used in
sensitometry to monitor automatic processing efficiency and consistency. A film is given a series of
predetermined exposures and processed. The resulting densities are plotted, and the resulting curve is
compared with a known correct curve. Any deviation between the two may indicate processing difficulties. The
sensitrometric curve illustrates the effects of exposure and processing on radiographic film emulsion; it is
unrelated to film speed.

82. What are the effects of scattered radiation on the radiographic image?
1. It produces fog.
2. It increases contrast.
3. It increases grid cutoff.
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
Scattered radiation is produced as x-ray photons travel through matter, interact with atoms, and are scattered
(change direction). If these scattered rays are energetic enough to exit the body, they will strike the film from all
different angles. They therefore do not carry useful information and merely produce a flat, gray (low-contrast)

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Property of Hamilcar Eldo B. Chanjueco
fog over theimage. Grid cutoff increases contrast and is caused by an improper relationship between the x-ray
tube and the grid, resulting in absorption of some of the useful / primary beam.

83. Use of high-ratio grids is associated with

1. increased patient dose.
2. higher contrast.
3. pediatric radiography.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Grids are used to absorb scattered radiation produced with high kilovoltage and tissues of greater thickness
and density. They require an adjustment in exposure factors to two to six times the mAs used without a grid,
and therefore a considerable increase in patient dose. Because they also absorb scatter radiation, they
contribute to a higher radiographic contrast. Pediatric radiography does not generally require the use of light
ratio grids.

84. A change from 100-speed screens to 200-speed screens would require what change in mAs?
(A) mAs should be increased by 15 percent.
(B) mAs should be increased by 30 percent.
(C) mAs should be doubled.
(D) mAs should be halved.
—————————————————————————
As screen speed is increased, exposure factors must be decreased in order to maintain the original film
density. A change from 100 to 200 speed usually requires that the mAs be reduced by one-half. If screen
speed were changed from 400 to 200 speed, twice the mAs would be required.

85. The rate of chemical replenishment in automatic processing is based on:

(A) solution temperature
(B) processor speed
(C) amount of film processed*
(D) solution agitation
—————————————————————————
The rate of chemical replenishment in automatic processing is based on the amount (length) of film processed.
Typically, a 14 × 17 film will require 60-70 ml of developer replenisher and 100-110 ml of fixer replenisher.
Processor transport speed is constant. Solution temperature and agitation are unrelated to replenishment.

86. Which of the following pathologic conditions would require an increase in exposure factors?
(A) Pneumoperitoneum
(B) Obstructed bowel
(C) Renal colic
(D) Ascites
—————————————————————————
Because pneumoperitoneum is an abnormal accumulation of air or gas in the peritoneal cavity, it would require
a decrease in exposure factors. Obstructed bowel usually involves distended, air- or gas-filled bowel loops,
again requiring a decrease in exposure factors. With ascites, there is an abnormal accumulation of fluid in the
abdominal cavity, necessitating an increase in exposure factors. Renal colic is the pain associated with the
passage of renal calculi; no change from the normal exposure factors is usually required.

87. An unexposed and processed film will have a density of about

(A) zero.
(B) 0.1.
(C) 1.0.
(D) 2.5.
—————————————————————————
Film that is unexposed and has been processed will not be completely clear. The blue-tinted base contributes
a small measure of density. A small but measurable amount of exposure from background radiation can also
be present, and processing itself produces a small amount of density from chemical fog. Together, this is
expressed as base-plus fog and should never exceed a density of 0.2.

88. Exposure factors of 90 kVp and 4 mAs are used for a particular nongrid exposure. What should be the new

19
Property of Hamilcar Eldo B. Chanjueco
mAs if an 8:1 grid is added?
(A) 8 mAs
(B) 12 mAs
(C) 16 mAs
(D) 20 mAs
—————————————————————————
In order to change nongrid to grid exposure or to adjust exposure when changing from one grid ratio to
another, it is necessary to recall the factor for each grid ratio:

No grid = 1 × the original mAs

5:1 grid = 2 × the original mAs
6:1 grid = 3 × the original mAs
8:1 grid = 4 × the original mAs
12:1 (or 10:1) grid = 5 × the original mAs
16:1 grid = 6 × the original mAs

Therefore, to change from nongrid to an 8:1 grid, multiply the original mAs by a factor of 4. A new mAs of 16 is
required.

89. What is added to the developer to prevent excessive softening of the emulsion and its sticking to processor
rollers?
(A) Hydroquinone
(B) Glutaraldehyde
(C) Ammonium thiosulfate
(D) Potassium bromide
—————————————————————————
Automatic processing chemically converts the invisible latent image to a visible, or manifest, image in a very
short timeusually 90 s. One of the ways it achieves this speed is by using higher solution temperatures than
those used in manual processing. However, at higher temperatures, the film emulsion tends to swell
excessively, causing the emulsion to stickto the processor rollers. Glutaraldehyde is a hardener that is added
to the developer solution to minimize emulsion swelling.

90. Exposure rate increases with an increase in

1. mA.
2. kVp.
3. SID.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The quantity of x-ray photons produced at the target is the function of mAs. The quality (wavelength,
penetration, energy) of x-ray photons produced at the target is the function of kVp. The kVp also has an effect
on exposure rate, because an increase in kVp will increase the number of high-energy x-ray photons produced
at the target. Exposure rate decreases with an increase in SID.

91. As grid ratio is increased,

(A) the scale of contrast becomes longer.
(B) the scale of contrast becomes shorter.
(C) radiographic density increases.
(D) radiographic distortion decreases.
—————————————————————————
Because lead content increases when grid ratio increases, a greater amount of scattered radiation is trapped
before reaching the film. Fewer grays are therefore recorded, and a shorter scale of contrast results.
Radiographic density would decrease with an increase in grid ratio. Grid ratio is unrelated to distortion.

92. Radiographic recorded detail is directly related to

1. SID.
2. OID.
3. imaging-system speed.
(A) 1 only
(B) 1 and 2 only

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Property of Hamilcar Eldo B. Chanjueco
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
SID is directly related to recorded detail because as SID increases, so does recorded detail (because
magnification is decreased). OID is inversely related to recorded detail because as OID increases, recorded
detail decreases. As screen speed increases, recorded detail decreases, as a result of greater diffusion of
light. Therefore, of the given choices, only SID is directly related to recorded detail. OID and screen speed are
inversely related to recorded detail.

93. The microswitch for controlling the amount of replenishment used in an automatic processor is located at
the
(A) receiving bin.
(B) crossover roller.
(C) entrance roller.
(D) replenishment pump.
—————————————————————————
The wider dimension of the x-ray film is usually placed on the feed tray so that the film is fed into the processor
in that direction. The entrance roller is the first roller of the transport system, located at the end of the feed tray;
this is where the microswitch that determines the amount of replenishment is located. The length of the film
(the shorter dimension) activates the microswitch, and replenisher is added according to the length of the film;
a 10 × 12-in film will receive less replenisher than will a 14 × 17-in film. Crossover rollers are located between
the different tanks. The receiving bin is where the films exit the processor. The replenishment pump is
activated by the microswitch.

94. Of the following groups of exposure factors, which will produce the shortest scale of radiographic contrast?
(A) 500 mA, 0.040 s, 70 kVp
(B) 100 mA, 0.100 s, 80 kVp
(C) 200 mA, 0.025 s, 92 kVp
(D) 700 mA, 0.014 s, 80 kVp
—————————————————————————
The single most important factor regulating radiographic contrast is kVp. The lower the kVp, the shorter the
scale of contrast. All the mAs values in this problem have been adjusted for kVp changes in order to maintain
density, but just a glance at each of the kilovoltages is often a good indicator of which will produce the longest-
scale or shortest-scale contrast.

95. Most laser film must be handled

(A) under a Wratten 6B safelight.
(B) in total darkness.
(C) under a GBX safelight.
(D) with high-temperature processors.
—————————————————————————
Most laser film is sensitive to both the Wratten 6B and the GBX safelight filters. Laser film will fog if it is
handled under these safelight conditions. Most laser film is loaded into a film magazine in total darkness.
Processing temperatures for laser film are the same as those for regular x-ray film.

96. Which of the following terms refers to light being reflected from one intensifying screen, through the film, to
the opposite emulsion and screen?
(A) Reflectance
(B) Crossover
(C) Scatter
(D) Filtration
—————————————————————————
If fluorescent light from one intensifying screen passes through the film to the opposite emulsion and
intensifying screen, the associated diffusion creates a type of distortion called crossover. Intensifying screens
do need a degree of reflectance to enhance their speed. Scatter and filtration are unrelated to intensifying
screens.

97. Which of the following is (are) part of the daily recommendations for processor quality control?
1. Sensitometry testing
2. Temperature checks
3. Crossover rack cleaning
(A) 1 only

21
Property of Hamilcar Eldo B. Chanjueco
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Quality control is required in order to ensure consistent high-quality images. The automatic processor is an
important link in the imaging chain. A quality control program for automatic processing requires that
sensitometry testing be performed daily. A sensitometric strip is processed, and the resulting densities are read
with a densitometer; the results must be within certain norms that are established by the department. Solution
temperatures are checked and recorded daily. Crossover racks are cleaned daily to remove any accumulated
gelatin, crystallized chemicals, etc.

98. Which of the following statements is (are) true regarding Figure 4-23?
1. Film A was made using a higher kVp than film B.
2. Film A was made with a higher-ratio grid than film B.
3. Film A demonstrates shorter-scale contrast than film B.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Film A was made using 80 kVp at 75 mAs; film B was made using 100 kVp at 18 mAs; all other exposure
factors remained the same. As kVp is increased, the percentage of scattered radiation relative to primary
radiation increases; hence the grayer appearance of film B. Use of optimal kilovoltage for each anatomic part is
helpful in keeping scatter to a minimum. The production of scattered radiation will also be limited if the field
size is as small as possible. A grid is the most effective way to remove scattered photons from those exiting
the patient. Grids are designed to selectively absorb scattered radiation while absorbing as little of the primary
radiation as possible. Films produced with higher-ratio grids will possess fewer grays than those made with
lower-ratio grids. (Saia, p 362)

99. Which of the following is (are) characteristic(s) of a 16:1 grid?

1. It absorbs a high percentage of scattered radiation.
2. It has little positioning latitude.
3. It is used with high-kVp exposures.
(A) 1 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
High-kilovoltage exposures produce large amounts of scattered radiation, and therefore high-ratio grids are
used in an effort to trap more of this scattered radiation. However, accurate centering and positioning become
more critical in order to avoid grid cutoff.

100. Which portion of the characteristic curve represents overexposure of the film emulsion?
(A) Toe portion
(B) Straight-line portion
(C) Shoulder portion
(D) Average gradient portion
—————————————————————————
A characteristic curve is used to demonstrate the relationship between the film and the resulting radiographic
density. It has three main portions: the toe, the straight-line portion or average gradient, and the shoulder. The
toe is the lower portion, the beginning of the slope. Exposures made in the toe portion of the curve (Fig. 4-28A)
will be underexposed. The straight-line portion or average gradient is the region of correct exposure. The
useful diagnostic density range is generally said to be between0.25 and 2.5 density (Fig. 4-28B); this
corresponds to the straight-line portion of the characteristic curve. The shoulder is the rounded upper portion of
the characteristic curve, often referred to as Dmax the portion of maximum film exposure. Exposuresmade in
the shoulder portion of the curve will be overexposed (Fig. 4-28C).

101. How is SID related to exposure rate and radiographic density?

(A) As SID increases, exposure rate increases and radiographic density increases.
(B) As SID increases, exposure rate increases and radiographic density decreases.
(C) As SID increases, exposure rate decreases and radiographic density increases.
(D) As SID increases, exposure rate decreases and radiographic density decreases.

22
Property of Hamilcar Eldo B. Chanjueco
 —————————————————————————
According to the inverse square law of radiation, the intensity or exposure rate of radiation is inversely
proportional to the square of the distance from its source. Thus, as distance from the source of radiation
increases, exposure rate decreases. Because exposure rate and radiographic density are directly proportional,
if the exposure rate of a beam directed to a film is decreased, the resultant radiographic density would be
decreased proportionally. (Selman, p 117)
102. Of the following groups of technical factors, which will produce the greatest radiographic density?
(A) 10 mAs, 74 kVp, 44-in SID
(B) 10 mAs, 74 kVp, 36-in SID
(C) 5 mAs, 85 kVp, 48-in SID
(D) 5 mAs, 85 kVp, 40-in SID
—————————————————————————
If A and B are reduced to 5 mAs for mAs consistency, the kVp will increase to 85 kVp in both cases, thereby
balancing radiographic densities. Thus, the greatest density is determined by the shortest SID (greatest
exposure rate). (Shephard, pp 306-307)

103. When green-sensitive rare earth screens are properly matched with the correct film, what type of safelight
should be used in the darkroom?
(A) Wratten 6B
(B) GBX or GS1
(C) Amber
(D) None
—————————————————————————
The GBX or GS1 is a red filter that is safe with green-sensitive film emulsion. The amber-colored Wratten 6B
filter is safe for blue-sensitive film only. Although using no safelight is possible, it is not a practical way to
function. (Carlton & Adler, p 356)

104. In a PA projection of the chest being used for cardiac evaluation, the heart measures 15.2 cm between its
widest points. If the magnification factor is known to be 1.3, what is the actual diameter of the heart?
(A) 9.7 cm
(B) 11.7 cm
(C) 19.7 cm
(D) 20.3 cm
—————————————————————————
The formula for magnification factor is MF = image size ÷ object size. In the stated problem, the anatomic
measurement is 15.2 cm, and the magnification factor is known to be 1.3. Substituting the known factors in the
appropriate equation,

MF = image size ÷ object size ; 1.3 = x ÷ 15.2;

x = 15.2 ÷ 1.3 = 11.69 cm (actual anatomic size)
(Fauber, pp 90-92)

105. What apparatus is needed for the construction of a sensitometric curve?

1. Penetrometer
2. Densitometer
3. Electrolytic canister
(A) 1 and 2 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Only two pieces of apparatus are needed to construct a sensitometric curve (Fig. 4-32). First, a penetrometer
(aluminum step wedge) is used to expose a film. Once the film is processed, a densitometer is needed to read
the resulting densities. Log relative exposure is charted along the x (horizontal) axis; an increase in log relative
exposure of 0.3 results from doubling the exposure. Optical density is plotted on the y (vertical) axis and
represents the amount of light transmitted through a film compared to the amount of light striking the film
(expressed as a logarithm). (Bushong, p 256)

106. The function of the developing solution is to

(A) reduce the manifest image to a latent image.
(B) increase production of silver halide crystals.
(C) reduce the latent image to a manifest image.

23
Property of Hamilcar Eldo B. Chanjueco
(D) remove the unexposed crystals from the film.
—————————————————————————
The latent image is the invisible image produced within the film emulsion as a result of exposure to radiation.
The developing solution converts this to a visible, manifest image. The exposed silver halide grains in the
emulsion undergo chemical change in the developing solution, and the unexposed crystals are removed from
the film during the fixing process. (Carlton & Adler, p 296)
107. Conditions contributing to poor radiographic film archival quality include
1. fixer retention.
2. insufficient developer replenishment.
3. poor storage conditions.
(A) 1 only
(B) 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The archival quality of a film refers to its ability to retain its image for a long period of time. Many states have
laws governing how long a patient's medical records, including films, must be retained. Very importantly, they
must be retained in their original condition. Archival quality is poor if radiographic films begin to show evidence
of stain after being stored for only a short time. Probably the most common cause of stain, and hence of poor
archival quality, is retained fixer within the emulsion. Fixer may be retained as a result of poor washing or
because there was insufficient hardener (underreplenishment) in the developer, thus permitting fixer to be
retained by the swollen emulsion. A test for quantity of retained fixer in film emulsion is often included as part
of a quality control program. Stain may also be caused by poor storage conditions. Storage in a hot, humid
place will cause even the smallest amount of retained fixer to react with silver, causing stain. (Shephard, pp
110, 135, 137)

108. The squeegee assembly in an automatic processor

1. functions to remove excess solution from films.
2. is located near the crossover rollers.
3. helps establish the film's rate of travel.
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
An exposed radiographic film contains an invisible (latent) image. Only through processing can this image be
converted to a permanent, visible (manifest) image. As the film exits the developer section, it passes through
the crossover assembly, and before it enters the fixer section, it passes through the squeegee assembly. The
squeegee assembly rollers function to remove excess developer solution from the emulsion before the film
enters the fixer. This process helps to maintain fixer strength / activity. The rate of travel through the processor
is determined by the transport mechanism, that is, the speed of the rollers as established at time of
manufacture. (Shephard, p 143)

109. The reduction in x-ray photon intensity as the photon passes through material is termed
(A) absorption.
(B) scattering.
(C) attenuation.
(D) divergence.
—————————————————————————
Absorption occurs when an x-ray photon interacts with matter and disappears, as in the photoelectric effect.
Scattering occurs when there is partial transfer of energy to matter, as in the Compton effect. The reduction in
the intensity of an x-ray beam as it passes through matter is called attenuation. (Bushong, p 158)

110. The darkroom should be constructed and equipped so as to avoid

1. external light leaks.
2. film bin light leaks.
3. safelight fog.
(A) 1 only
(B) 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————

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Property of Hamilcar Eldo B. Chanjueco
The darkroom must be constructed in such a way as to be free from any white-light leaks. The film bin should
be secure and should have a sign warning against opening in white light. Safelight bulbs must be of the correct
wattage, and the filter should be appropriate for the type of film used. (Fauber, p 183)

111. If a radiograph exposed using a 12:1 ratio grid exhibits a loss of density at its lateral edges, it is probably
because the
(A) SID was too great.
(B) grid failed to move during the exposure.
(C) x-ray tube was angled in the direction of the lead strips.
(D) central ray was off-center.
—————————————————————————
If the SID is above or below the recommended focusing distance, the primary beam will not coincide with the
angled lead strips at the lateral edges. Consequently, there will be absorption of the primary beam, termed grid
cutoff. If the grid failed to move during the exposure, there would be grid lines throughout. Central ray
angulation in the direction of the lead strips is appropriate and will not cause grid cutoff. If the central ray was
off-center, there would be uniform loss of density. (Carlton & Adler, p 274)

112. Which of the following is (are) associated with subject contrast?

1. Patient thickness
2. Tissue density
3. Kilovoltage
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Radiographic contrast is the sum of film contrast and subject contrast. Subject contrast has by far the greatest
influence on radiographic contrast. Several factors influence subject contrast, each as a result of beam
attenuation differences in the irradiated tissues. As patient thickness and tissue density increase, attenuation
increases and subject contrast is increased. As kilovoltage increases, higher-energy photons are produced,
beam attenuation is decreased, and subject contrast decreases. (Carlton & Adler, pp 387-389)

113. An exposure was made at a 38-in SID using 300 mA, a 0.03-s exposure, and 80 kVp with a 400 film /
screen combination and an 8:1 grid. It is desired to repeat the radiograph and, in order to improve recorded
detail, to use a 42-in SID and a 200 film / screen combination. With all other factors remaining constant, what
exposure time will be required to maintain the original radiographic density?
(A) 0.03 s
(B) 0.07 s
(C) 0.14 s
(D) 0.36 s
—————————————————————————
A review of the problem reveals that three changes are being made: an increase in SID, a change from a 400-
speed system to a 200-speed system, and a change in exposure time (to be considered last). Because the
original mAs was 9, cutting the speed of the system in half (from 400 to 200) will require a doubling of the mAs,
to 18 mAs, in order to maintain density. Now we must deal with the distance change. Using the density
maintenance formula (and remembering that18 is now the old mAs), we find that the required new mAs at 42 in
is 22.

(old mAs) 18 (old D2) 382

 = ; 1444x = 31,752; x = 21.9 mAs at 42 in SID
(new mAs) x (new D2) 422

Because we are not changing mA, we must determine the exposure time that, when used with 300 mA, will
yield 22 mAs.

300x = 22
x = 0.07 s exposure
(Selman, p 124)

114. Which of the following will influence recorded detail?

1. Screen speed
2. Screen / film contact

25
Property of Hamilcar Eldo B. Chanjueco
 3. Focal spot
(A) 1 and 2 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The faster the imaging system, the greater the sacrifice of image clarity (recorded detail). As intensifying-
screen speed increases, recorded detail decreases. Perfect screen / film contact is essential for good detail.
Any areas of poor contact result in considerable blurriness in the radiographic image. Focal spot blur is related
to focal spot size; smaller focal spots produce less blur and thus better recorded detail. (Selman, pp 206-210)

115. The function(s) of automatic beam limitation devices include

1. reducing the production of scattered radiation.
2. increasing the absorption of scattered radiation.
3. changing the quality of the x-ray beam.
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
Beam restrictors function to limit the size of the irradiated field. In doing so, they limit the volume of tissue
irradiated (thereby decreasing the percentage of scattered radiation generated in the part) and help reduce
patient dose. Beam restrictors do not affect the quality (energy) of the x-ray beamthat is the function of kVp
and filtration. Beam restrictors do not absorb scatter radiationthat is a function of grids. (Shephard, p 27)

116. An increase in kilovoltage will serve to

(A) produce a longer scale of contrast.
(B) produce a shorter scale of contrast.
(C) decrease the radiographic density.
(D) decrease the production of scatter radiation.
—————————————————————————
An increase in kilovoltage increases the overall average energy of the x-ray photons produced at the target,
thus giving them greater penetrability. (This can increase the incidence of Compton interaction and therefore
the production of scattered radiation.) Greater penetration of all tissues serves to lengthen the scale of
contrast. However, excessive scattered radiation reaching the film will cause a fog and carries no useful
information. (Selman, pp 127-128)

117. Which of the following materials may be used as grid interspace material?
1. Lead
2. Plastic
3. Aluminum
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
A grid is composed of alternate strips of lead and interspace material. The lead strips serve to trap scatter
radiation before it fogs the film. The interspace material must be radiolucent; plastic or sturdier aluminum is
usually used. Cardboard was formerly used as interspace material, but it had the disadvantage of being
affected by humidity (moisture). (Selman, p 234)

118. Which of the two characteristic curves shown in Figure 4-13 will require more exposure to produce a
density of 1.5 on the finished radiograph?
(A) Film 1.
(B) Film 2.
(C) They require identical exposures.
(D) Insufficient information is provided.
—————————————————————————
Locate density 1.5 on the vertical axis. Follow it across to where it intersects with film 1, then to where it
intersects with film 2. At each intersection, follow the vertical line down and note the corresponding log relative

26
Property of Hamilcar Eldo B. Chanjueco
exposure. Film 1 requires an exposure of about 1.6 to record a density of 1.5, while film 2 requires an exposure
of about 1.8 to record the same density. Film 2 is the slower film and requires more exposure to record a
density of 1.5. The faster film always occupies the position farthest to the left in a comparison of two or more
films. (Shephard, p 105) (Selman, p 221)

119. The effect described as differential absorption is

1. responsible for radiographic contrast.
2. a result of attenuating characteristics of tissue.
3. minimized by the use of high kVp.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Differential absorption refers to the x-ray absorption characteristics of neighboring anatomic structures. The
radiographic representation of these structures is referred to as radiographic contrast; it may be enhanced with
high-contrast technical factors, especially using low kilovoltage levels. At low kilovoltage levels, the
photoelectric effect predominates. (Bushong, p 171)

120. Quantum mottle is most obvious when using

(A) slow-speed screens.
(B) rare earth screens.
(C) fine-grain film.
(D) minimal filtration.
—————————————————————————
Quantum mottle is a grainy appearance on a finished radiograph that is seen especially in fast (rare earth)
imaging systems. It is very similar in appearance to an enlarged photograph taken with fast film; ithas a spotted
or freckled appearance. Fast film and screens with low-mAs and high-kVp factors are most likely to be the
cause of quantum mottle. (Bushong, p 254)

121. A focal spot size of 0.3 mm or smaller is essential for

(A) small-bone radiography.
(B) magnification radiography.
(C) tomography.
(D) fluoroscopy.
—————————————————————————
A fractional focal spot of 0.3 mm or smaller is essential for reproducing fine detail without focal spot blurring in
magnification radiography. As the object image is magnified, so will be anyassociated blur unless a fractional
focal spot is used. Use of the fractional focal spot on a routine basis is unnecessary; it is not advised because
it causes unnecessary wear on the x-ray tube and offers little radiographic advantage. (Shephard, p 217)

122. The exposure factors of 300 mA, 0.017 s, and 72 kVp produce an mAs value of
(A) 5.
(B) 50.
(C) 500.
(D) 5000.
—————————————————————————
To calculate mAs, multiply milliamperage times exposure time. In this case, 300 mA × 0.017 s = 5.10 mAs.
Careful attention to proper decimal placement will help avoid basic math errors. (Shephard, p 170)

123. The relationship between the intensity of light striking a film and the intensity of light transmitted through
the film is an expression of which of the following?
(A) Radiographic contrast
(B) Radiographic density
(C) Recorded detail
(D) Radiographic filtration
—————————————————————————
The greater the quantity of black metallic silver deposited on a film, the greater the radiographic density. The
greater the degree of radiographic density (degree of blackening), the less the quantity of illuminator light
transmitted through the film. Therefore, the relationship between the amount of illuminator light striking the film
and the amount of light transmitted through the film is an expression of radiographic density. It is expressed by

27
Property of Hamilcar Eldo B. Chanjueco
the formula

incident light intensity

Density = log10 
transmitted light intensity

(Bushong, p 279)

124. Film base is currently made of which of the following materials?

(A) Cellulose nitrate
(B) Cellulose acetate
(C) Polyester
(D) Glass
—————————————————————————
Film base functions to support the silver halide emulsion. Today's film base is made of tough, nonflammable
polyester. Cellulose nitrate was used in the past, but it was highly flammable. Cellulose acetate, also used in
the past, was not flammable, but it was not as durable as polyester. The earliest supports for emulsion were
plates of glass (hence the term flat plate). (Selman, p 194)

125. Which of the following groups of technical factors would be most appropriate for the radiographic
examination shown in Figure 4-24?
(A) 400 mA, 1/30 s, 72 kVp
(B) 300 mA, 1/50 s, 82 kVp
(C) 300 mA, 1/120 s, 94 kVp
(D) 50 mA, 1/4 s, 72 kVp
—————————————————————————
A 15-min oblique image of an intravenous urogram is pictured. Intravenous urography requires the use of
iodinated contrast media. Low kilovoltage (about 70) is usually employed to enhance the photoelectric effect
and, in turn, better visualize the renal collecting system. High kilovoltage will produce excessive scatter
radiation and obviate the effect of the contrast agent. A higher milliamperage with a shorter exposure time is
preferred in order to decrease the possibility of motion. (Saia, p 347)

126. Which of the following technical changes would best serve to remedy the effect of widely different tissue
densities?
(A) Use of high-speed screens
(B) Use of a high-ratio grid
(C) High-kVp exposure factors
(D) High-mAs exposure factors
—————————————————————————
When tissue densities within a part vary greatly (e.g., chest x-ray), the radiographic result can be unacceptably
high contrast. In order to "even out" these densities and produce a more appropriate scale of grays, exposure
factors using high kVp should be employed. Radiographic contrast generally increases with an increase in
screen speed. The higher the grid ratio, the higher the contrast. Exposure factors using high mAs generally
result in excessive film density, frequently obliterating much of the gray scale. (Shephard, p 200) (Bushong, p
273)

127. A radiograph made using 300 mA, 0.1 s, and 75 kVp exhibits motion unsharpness, but otherwise
satisfactory technical quality. The radiograph will be repeated using a shorter exposure time. Using 86 kV and
500 mA, what should be the new exposure time?
(A) 0.12 s
(B) 0.06 s
(C) 0.03 s
(D) 0.01 s
—————————————————————————
The mAs formula is milliamperage × time = mAs. With two of the factors known, the third can be determined.
To find the mAs that was originally used, substitute the known values:
300 × 0.1 = 30
We have increased the kilovoltage to 86, an increase of 15 percent, which has an effect similar to that of
doubling the mAs. Therefore, only 15 mAs is now required as a result of the kV increase:
mA × s = mAs; 500x = 15; x = 0.03 s exposure

(Selman, p 214)

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Property of Hamilcar Eldo B. Chanjueco
128. Which of the following is the correct order of radiographic film processing?
(A) Developer, wash, fixer, dry
(B) Fixer, wash, developer, dry
(C) Developer, fixer, wash, dry
(D) Fixer, developer, wash, dry
—————————————————————————
During automatic processing (Fig. 4-29), radiographic film is first immersed in the developer solution, which
functions to reduce the exposed silver bromide crystals in the film emulsion to black metallic silver (which
constitutes the image). Next, the film goes directly into the fixer, which functions to remove the unexposed
silver bromide crystals from the emulsion. The film is then transported to the wash tank, where chemicals are
removed from the film, and then into the dryer section, where it is dried before leaving the processor. (Fauber,
p 162) (Shephard, p 134)

129. The conversion of the invisible latent image into a visible manifest image takes place in the
(A) developer.
(B) stop bath.
(C) first half of the fixer process.
(D) second half of the fixer process.
—————————————————————————
The invisible silver halide image is composed of exposed silver grains. These are "reduced" to a visible black
metallic silver image in the developer solution. The fixer solution functions to remove unexposed silver halide
crystals from the film. (Shephard, pp 97-98)

130. The term spectral matching refers to the fact that film sensitivity must be matched with the
(A) proper color screen fluorescence.
(B) correct kVp level.
(C) correct mA level.
(D) proper developer concentration.
—————————————————————————
Different types of intensifying screens are available for radiographic use, and they can differ greatly. Some
intensifying screens emit a blue and others a green fluorescent light. Film emulsions are manufactured to be
sensitive to one of these colors. This is termed spectral matching. If the film emulsion and intensifying screens
are incorrectly matched, speed will be reduced. (Shephard, pp 65-66) (Bushong, p 187)

131. Types of moving grid mechanisms include

1. oscillating.
2. reciprocating.
3. synchronous.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 2 and 3 only
—————————————————————————
Grids are devices constructed of alternating strips of lead foil and radiolucent interspacing material. They are
placed between the patient and the film, and they function to remove scatter radiation from the remnant beam
before it forms the latent image. Stationary grids will efficiently remove scatter radiation from the remnant
beam; however, their lead strips will be imaged on the radiograph. If the grid is made to move (usually in a
direction perpendicular to the lead strips) during the exposure, the lead strips will be effectively blurred. The
motion of a moving grid, or Potter-Bucky diaphragm, may be reciprocating (equal strokes back and forth),
oscillating (almost circular direction), or catapult (rapid forward motion and slow return). Synchronous refers to
a type of x-ray timer. (Bushong, p 239)

132. If 82 kVp, 300 mA, and 0.05 s were used for a particular exposure using three-phase, twelve-pulse
equipment, what mAs would be required, using single-phase equipment, to produce a similar radiograph?
(A) 7.5 mAs
(B) 20 mAs
(C) 30 mAs
(D) 50 mAs
—————————————————————————
With three-phase equipment, the voltage never drops to zero and x-ray intensity is significantly greater. When
changing from single-phase to three-phase, six-pulse equipment, two-thirds the original mAs is required to

29
Property of Hamilcar Eldo B. Chanjueco
produce a radiograph with similar density. When changing from single-phase to three-phase, twelve-pulse
equipment, only one-half the original mAs is required. In this problem, we are changing from three-phase,
twelve-pulse to single-phase equipment; therefore, the mAs should be doubled (from 15 to 30 mAs). (Carlton &
Adler, p 98)

133. An AP radiograph of the hip was made using 400 mA, 0.05 s, 76 kVp, 40-in SID, 1.2-mm focal spot, and a
400-speed film / screen system. With all other factors remaining constant, which of the following exposure
times would be required in order to maintain radiographic density using 400 mA and a 200-speed film / screen
system, and with the addition of an 8:1grid?
(A) 0.12 s
(B) 0.18 s
(C) 0.4 s
(D) 0.6 s
—————————————————————————
If the imaging system speed is cut in half (from 400 to 200 speed), the result will be half of the original density
on the radiograph. Therefore, to maintain the original density, the mAs must be doubled from the original 20 to
40 mAs. Grids are used to absorb scatter radiation from the remnant beam before it can contribute to the latent
image. Because the grid removes scatter (and some primary) radiation from the beam, an increase in
exposure factors is required. The amount of increase is dependent on the grid ratio: The higher the grid ratio,
the higher the correction factor. The correction factor for an 8:1 grid is 4; therefore, the mAs (40) is multiplied
by 4 to arrive at the new required mAs (160). Usingthe mAs equation mA × s = mAs, it is determined that 0.4 s
will be required at 400 mA:

400x = 160
x = 0.4 s

(Fauber, pp 62, 148)

134. X-ray photon beam attenuation is influenced by

1. tissue type.
2. subject thickness.
3. photon quality.
(A) 1 only
(B) 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Attenuation (decreased intensity through scattering or absorption) of the x-ray beam is a result of its original
energy and its interactions with different types and thicknesses of tissue. The greater the original energy /
quality (the higher the kilovoltage) of the incident beam, the less the attenuation. The greater the effective
atomic number of the tissues (tissue type determines absorbing properties), the greater the beam attenuation.
The greater the volume of tissue (subject density and thickness), the greater the beam attenuation. (Bushong,
p 174)

135. Which of the following groups of exposure factors would be most appropriate to control involuntary
motion?
(A) 400 mA, 0.03 s
(B) 200 mA, 0.06 s
(C) 600 mA, 0.02 s
(D) 100 mA, 0.12 s
—————————————————————————
Control of motion, both voluntary and involuntary, is an important part of radiography. Patients are unable to
control certain types of motion, such as heart action, peristalsis, and muscle spasm. In these circumstances, it
is essential to use the shortest possible exposure time in order to have a "stop action" effect. (Carlton & Adler,
p 410)

136. If the quantity of black metallic silver on a particular radiograph is such that it allows 1 percent of the
illuminator light to pass through the film, that film has a density of
(A) 0.01.
(B) 0.1.
(C) 1.0.
(D) 2.0.

30
Property of Hamilcar Eldo B. Chanjueco
 —————————————————————————
If a film is placed on an illuminator and 100 percent of the illuminator's light is transmitted through the film, that
film must have a density of 0. According to the equation

incident light intensity

Density = log10 
transmitted light intensoty

if 10 percent of the illuminator's light passes through the film, that film has a density of 1. If 1 percent of the
light passes through the film, that film has a density of 2. (Shephard, p 102)

137. Focal spot blur is greatest

(A) directly along the course of the central ray.
(B) toward the cathode end of the x-ray beam.
(C) toward the anode end of the x-ray beam.
(D) as the SID is increased.
—————————————————————————
Focal spot blur, or geometric blur, is caused by photons emerging from a large focal spot. The actualfocal spot
is always larger than the effective (or projected) focal spot, as illustrated by the line focus principle. In addition,
the effective focal spot size varies along the longitudinal tube axis, being greatest in size at the cathode end of
the beam and smallest at the anode end of the beam. Because the projected focal spot is greatest at the
cathode end of the x-ray tube, geometric blur is also greatest at the corresponding part (cathode end) of the
radiograph. (Bushong, p 268)

138. The exposure factors of 300 mA, 0.07 s, and 95 kVp were used to produce a particular radiographic
density and contrast. A similar radiograph can be produced using 500 mA, 80 kVp, and
(A) 0.01 s.
(B) 0.04 s.
(C) 0.08 s.
(D) 0.16 s.
—————————————————————————
First, evaluate the change(s): The kVp was decreased by about 15 percent [95  (0.15 × 95) = 80.7]. A 15
percent decrease in kVp will cut the radiographic density in half; therefore, it is necessary to use twice the
original mAs to maintain the original density. The original mAs was 21, and so we now need 42 mAs, using the
500-mA station.Because mA × s = mAs,

500x = 42
x = 0.084 s

(Fauber, pp 55, 59-60)

139. When a slow screen / film system is used with a fast screen / film automatic exposure control system, the
resulting images
(A) are too light.
(B) are too dark.
(C) have improved detail.
(D) have poor detail.
—————————————————————————
When an automatic exposure control (AEC) (phototimer or ionization chamber) is used, the system is
programmed for the use of a particular screen / film speed (e.g., 400 speed). If a slower-speed screen image
receptor is placed in the bucky tray, the AEC has no way of recognizing it as different, and will time the
exposure for the system that it is programmed for. For example, if the AEC is programmed for a 400 screen /
film combination, and if a 200-speed screen image receptor is placed in the bucky tray, the resulting
radiograph will have half the required radiographic density. (Shepherd, pp 65-66)

140. Which of the following is (are) classified as rare earth phosphors?

1. Lanthanum oxybromide
2. Gadolinium oxysulfide
3. Cesium iodide
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only

31
Property of Hamilcar Eldo B. Chanjueco
(D) 1, 2, and 3
—————————————————————————
Rare earth phosphors have a greater conversion efficiency than do other phosphors. Lanthanum oxybromide is
a blue-emitting rare earth phosphor, and gadolinium oxysulfide is a green-emitting rare earth phosphor.
Cesium iodide is the phosphor used on the input screen of image intensifiers; it is not a rare earthphosphor.
(Shephard, p 68)
141. Which of the following is (are) essential to high-quality mammographic examinations?
1. Small focal spot x-ray tube
2. Long scale of contrast
3. Use of a compression device
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Breast tissue has very low subject contrast, but visualizing microcalcifications and subtle density differences is
imperative (see Fig. 4-26). Fine detail is necessary in order to visualize the microcalcifications; therefore, a
small focal spot tube is essential. High contrast (and therefore low kilovoltage) is needed to accentuate any
differences in tissue density. A compression device serves to even out differences in tissue thickness (thicker
at chest wall, thinner at nipple) and decrease OID, and thus helps to decrease the production of scatter
radiation. (Selman, pp 286-289)

142. With a given exposure, as intensifying-screen speed decreases, how is radiographic density affected?
(A) Decreases
(B) Increases
(C) Remains unchanged
(D) Is variable
—————————————————————————
As intensifying-screen speed decreases, less fluorescent light is emitted from the phosphors. If less fluorescent
light strikes the film emulsion, a smaller number of silver halide grains are changed to black metallic silver in
the developer, and hence there is a decrease in radiographic density. As intensifying-screen speed decreases,
so does radiographic density. Intensifying-screen speed and radiographic density are directly related.
(Shephard, pp 67-68)

143. If 0.05 s was selected for a particular exposure, what mA would be necessary to produce 30 mAs?
(A) 900 mA
(B) 600 mA
(C) 500 mA
(D) 300 mA
—————————————————————————
The formula for mAs is mA × s = mAs. Substituting known values,

0.05x = 30
x = 600 mA
(Selman, p 214)

144. Compared to a low-ratio grid, a high-ratio grid will

1. absorb more primary radiation.
2. absorb more scattered radiation.
3. allow more centering latitude.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Grid ratio is defined as the height of the lead strips to the width of the interspace material (Fig. 4-27). The
higher the lead strips (or the smaller the distance between the strips), the greater the grid ratio and the greater
the percentage of scatter radiation absorbed. However, a grid does absorb some primary radiation as well. The
higher the lead strips, the more critical the need for accurate centering, as the lead strips will more readily trap
photons whose direction do not parallel them. (Shephard, pp 245, 255)

145. Slow-speed screens are used

32
Property of Hamilcar Eldo B. Chanjueco
(A) to minimize patient dose.
(B) to keep exposure time to a minimum.
(C) to image fine anatomic details.
(D) in pediatric radiography.
—————————————————————————
The slower the screen speed, the smaller the quantity of fluorescent light emitted during x-ray exposure.
Therefore, slow-speed screens require more x-ray exposure to provide adequate radiographic density and
cannot be used when exposure reduction or fast exposure time is essential. However, because they are
associated with less diffusion of fluorescent light, they produce better recorded detail and are used to image
structures requiring excellent recorded detail. Pediatric radiography is likely to require fast screens in order to
reduce exposure time and dose. (Shephard, p 67)

146. Distortion can be caused by

1. tube angle.
2. the position of the organ or structure within the body.
3. the radiographic positioning of the part.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Distortion is caused by improper alignment of the tube, body part, and image recorder. Anatomic structures
within the body are rarely parallel to the film in a simple recumbent position. In an attempt to overcome this
distortion, we position the part to be parallel with the film, or angle the central ray to "open up" the part.
Examples of this technique are obliquing the pelvis to place the ilium parallel to the film, or angling the central
ray cephalad in order to "open up" the sigmoid colon. (Shephard, pp 228-234)

147. A particular radiograph was produced using 6 mAs and 110 kVp with an 8:1 ratio grid. The radiograph is
to be repeated using a 16:1 ratio grid. What should be the new mAs?
(A) 3 mAs
(B) 6 mAs
(C) 9 mAs
(D) 12 mAs
—————————————————————————
In order to change nongrid exposures to grid exposures, or to adjust exposure when changing from one grid
ratio to another, you must remember the factor for each grid ratio:

No grid = 1 × the original mAs

5:1 grid = 2 × the original mAs
6:1 grid = 3 × the original mAs
8:1 grid = 4 × the original mAs
12:1 grid = 5 × the original mAs
16:1 grid = 6 × the original mAs
To adjust exposure factors, you simply compare the old with the new:

6 (old mAs) 4 (old grid factor)

 = 
x (new mAs) 6 (new grid factor)

4x = 36; x = 9 mAs using 16:1 grid

(Saia, p 328)

148. Which of the following will result if developer replenishment is inadequate?

(A) Films with excessively high contrast
(B) Films with excessively low contrast
(C) Films with excessively high density
(D) Dry, brittle films
—————————————————————————
As films are developed, the developer solution becomes weaker and oxidation products are produced in the
solution. If sufficient replenishment of new developer solution does not take place, the activity of the older
solution decreases, and chemical fog is produced. Films lack contrast and have a flat, gray appearance.

33
Property of Hamilcar Eldo B. Chanjueco
(Shephard, p 153)

149. Which of the following pathologic conditions would require a decrease in exposure factors?
(A) Congestive heart failure
(B) Pneumonia
(C) Emphysema
(D) Pleural effusion
—————————————————————————
Emphysema is abnormal distention of the pulmonary alveoli (or tissue spaces) with air. The presence of
abnormal amounts of air makes a decrease from normal exposure factors necessary in order to avoid
excessive density. Congestive heart failure, pneumonia, and pleural effusion all involve abnormal amounts of
fluid in the chest and would therefore require an increase in exposure factors. (Carlton & Adler, p 258)
(Shephard, p 189)

150. The area of blurriness seen in the upper part of the radiograph shown in Figure 4-15 is most likely due to
(A) scatter radiation fog.
(B) patient motion.
(C) poor screen / film contact.
(D) grid cutoff.
—————————————————————————
The radiograph is an illustration of poor screen / film contact. Motion and scatter radiation fog can be ruled out
because the blur-riness is seen only in the apical region. Screen / film contact is evaluated using a wire mesh
that is placed on the questionable image receptor and radiographed (see Fig. 4-31). Any areas of unsharpness
represent poor contact, which can result from warped screens, a foreign body in the image receptor, or a
damaged image receptor frame. (Selman, pp 183-186)

151. For which of the following examinations may the use of a grid not be necessary in the adult patient?
(A) Hip
(B) Knee
(C) Abdomen
(D) Lumbar spine
—————————————————————————
The abdomen is a thick structure that contains many structures of similar density, and thus it requires
increased exposure and a grid to absorb scatter radiation. The lumbar spine and hip are also dense structures
requiring increased exposure and use of a grid. The knee, however, is frequently small enough to be
radiographed without a grid. The general rule is that structures measuring more than 10 cm should be
radiographed with a grid. (Saia, p 322)

152. Which of the following will contribute to the production of longer-scale radiographic contrast?
1. An increase in kV
2. An increase in grid ratio
3. An increase in photon energy
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Increased photon energy is caused by an increase in kVp, resulting in more penetration of the part and a
longer scale of contrast. Increasing the grid ratio will result in a larger percentage of scattered radiation being
absorbed and hence a shorter scale of contrast. (Shephard, pp 203-204)

153. Which of the following factors influence(s) the production of scattered radiation?
1. Kilovoltage level
2. Tissue density
3. Size of field
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
As photon energy (kVp) increases, so does the production of scattered radiation. The greater the density of the
irradiated tissues, the greater the production of scattered radiation. As the size of the irradiated field increases,

34
Property of Hamilcar Eldo B. Chanjueco
there is an increase in the volume of tissue irradiated, and the percentage of scatter again increases. Beam
restriction is the single most important way to limit the amount of scattered radiation produced. (Saia, p 322)

154. Which of the following contribute to the radiographic contrast present on the finished radiograph?
1. Atomic number of tissues radiographed
2. Any pathologic processes
3. Degree of muscle development
(A) 1 and 2 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The radiographic subject, the patient, is composed of many different tissue types that have varying densities,
resulting in varying degrees of photon attenuation and absorption. The atomic number of the tissues under
investigation is directly related to their attenuation coefficient. This differential absorption contributes to the
various shades of gray (scale of radiographic contrast) on the finished radiograph. Normal tissue density may
be significantly altered in the presence of pathologic processes. For example, destructive bone disease can
cause a dramatic decrease in tissue density (and subsequent increase in radiographic density). Abnormal
accumulation of fluid (as in ascites) will cause a significant increase in tissue density. Muscle atrophy or highly
developed muscles will similarly decrease or increase tissue density. (Saia, p 364)

155. All of the following have an impact on radiographic contrast, except

(A) photon energy.
(B) grid ratio.
(C) OID.
(D) focal spot size.
—————————————————————————
As photon energy increases, more penetration and greater production of scattered radiation occur, producing a
longer scale of contrast. As grid ratio increases, more scattered radiation is absorbed, producing a shorter
scale of contrast. As OID increases, the distance between the part and the film acts as a grid, and
consequently less scatter radiation reaches the film, producing a shorter scale of contrast. Focal spot size is
related only to recorded detail. (Shephard, p 203)

156. An AP radiograph of the hip was made using 400 mA, 0.05 s, 76 kVp, 40-in SID, 1.2-mm focal spot, and a
400-speed film / screen system. With all other factors remaining constant, which of the following exposure
times would be required in order to maintainradiographic density at a 36-in SID using the 500-mA station, and
with an increase to 87 kVp?
(A) 0.04 s
(B) 0.08 s
(C) 0.016 s
(D) 0.032 s
—————————————————————————
The original mAs was 20 (400 mA × 0.05 s). Using the density maintenance formula, the new mAs must be
determined for the distance change from 40 to 36 in of SID:

(old mAs) 20 (old D2) 402 20 1600

 = ; = 
(new mAs) x (new D2) 362 x 1296

1600x = 25,920; x = 16.2 mAs at 36 SID

A 15 percent increase in kilovoltage was made, increasing the kilovoltage to 87. Because the kilovoltage
change effectively doubles the radiographic density, the mAs must be cut in half (from 16.2 to 8.1) to
compensate. Then, if 500 is the new milliamperage, we must determine what exposure time is required to
achieve 8.1 mAs:

500x = 8.1
x = 0.016 s at 87 kVp and 36 SID

(Selman, pp 214-215)

157. If a 4-in collimated field is changed to a 14-in collimated field, with no other changes, the radiographic

35
Property of Hamilcar Eldo B. Chanjueco
image will possess
(A) more density.
(B) less density.
(C) more detail.
(D) less detail.
—————————————————————————
More scattered radiation is generated within a part as the kilovoltage is increased, the size of the field is
increased, and the thickness and density of tissue increases. As the quantity of scattered radiation increases
from any of these sources, more density is added to the radiographic image. (Carlton & Adler, p 375)

158. The chest radiograph shown in Figure 4-1 demonstrates

(A) motion.
(B) focal spot blur.
(C) double exposure.
(D) poor screen / film contact.
—————————————————————————
The radiographic image seen in Figure 4-1 demonstrates double exposure. Notice the double image of the
ribs, humerus, and clavicle, especially on the left side of the chest. The anatomic parts and diaphragm are
sharply defined, not blurry, as they would be in the case of motion. Focal spot blur would also cause a slight
blur of anatomic details. Poor screen / film contact would most likely appear as localized blurriness in one area;
poor contact is unlikely to affect the entire cassette. (Bushong, p 441)

159. f a radiograph exhibits insufficient density, this might be attributed to

1. inadequate kVp.
2. inadequate SID.
3. grid cutoff.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
As kVp is reduced, the number of high-energy photons produced at the target is reduced; therefore, a
decrease in radiographic density occurs. If a grid has been used improperly (off-centered or out of focal range),
the lead strips will absorb excessive amounts of primary radiation, resulting in grid cutoff and loss of
radiographic density. If the SID is inadequate (too short), an increase in radiographic density will occur.
(Selman, pp 214, 240-242)

160. A satisfactory radiograph was made using a 40-in SID, 10 mAs, and a 12:1 grid. If the exam will be
repeated at a distance of 48 in and using an 8:1 grid, what should be the new mAs in order to maintain the
original density?
(A) 5.6 mAs
(B) 8.8 mAs
(C) 11.5 mAs
(D) 14.4 mAs
—————————————————————————
According to the density maintenance formula, if the SID is changed to 48 in, 14.4 mAs is required in order to
maintain the original radiographic density.

(old mAs) 10 (old D2) 402 10 1600

 = ; = 
(new mAs) x (new D2) 482 x 2304

1600x = 23,040; x = 14.4 mAs at 48 SID

Then, to compensate for changing from a 12:1 grid to an 8:1 grid, the mAs becomes 11.5:

(old mAs) 14.4 (old grid factor) 5

 = 
(new mAs) x (new grid factor) 4

5x = 57.6
x = 11.5 mAs with 8:1 grid at 48 in SID

36
Property of Hamilcar Eldo B. Chanjueco
Thus, 11.5 mAs is required to produce a film density similar to that of the original radiograph. The following are
the factors used for mAs conversion from nongrid to grid:

No grid = 1 × the original mAs

5:1 grid = 2 × the original mAs
6:1 grid = 3 × the original mAs
8:1 grid = 4 × the original mAs
12:1 grid = 5 × the original mAs
16:1 grid = 6 × the original mAs

(Selman, pp 214, 243)

161. Which of the following errors is illustrated in Figure 4-11?

(A) Patient not centered to film
(B) X-ray tube not centered to grid
(C) Inaccurate collimation
(D) Unilateral grid cutoff
—————————————————————————
The illustrated radiograph demonstrates a 1½-in unexposed strip along the length of the film. This occurred
because, although the patient was centered correctly to the collimator light and x-ray field, the x-ray tube was
not centered to the grid. If the patient was off-center, the entire film would be exposed and the patient's spine
would be off-center. Grid cutoff would not appear as such a sharply delineated line, but rather as a gradually
decreasing density. (Fauber, p 125)

162. An exposure was made of a part using 300 mA and 0.06s and using a 100-speed film / screen
combination. An additional radiograph is requested using a 400-speed system in order to reduce motion
unsharpness. Using 200 mA, all other factors remaining constant, what should be the new exposure time?
(A) 0.02 s
(B) 0.04 s
(C) 0.45 s
(D) 0.80 s
—————————————————————————
High-speed imaging systems are valuable for reducing patient exposure and patient motion. However, some
detail will be sacrificed, and quantum mottle can cause further image impairment. In general, doubling the film /
screen speed doubles the radiographic density, thereby requiring that the mAs be halved in order to maintain
the original radiographic density. Changing from 100 to 400 screens requires halving the mAs valuetwice, to
4.5 mAs. That is, when going from 100- to 200-speed screens, the mAs is changed from 18 to 9; when going
from 200- to 400-speed screens, the mAs is changed from 9 to 4.5.

The new exposure time, using 200 mA, is

200x = 4.5
x = 225 s exposure using a 200 mA and 400-speed screens

(Selman, p 181)

163. Underexposure of a radiograph can be caused by all of the following except insufficient
(A) mA.
(B) exposure time.
(C) kVp.
(D) SID.
—————————————————————————
Insufficient milliamperage and/or exposure time will result in lack of radiographic density. Insufficient kVp will
result in underpenetration and excessive contrast. Insufficient SID, however, will result in increased exposure
rate and radiographic overexposure. (Selman, pp 214-215)

164. Screen / film imaging is one example of a(n)

(A) analog system.
(B) digital system.
(C) electromagnetic system.
(D) direct-action radiation system.

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Property of Hamilcar Eldo B. Chanjueco
 —————————————————————————
Screen / film imaging consists of an exposure method of converting x-ray energy to light energy, then
converting light energy to electrochemical energy in the development process. Processing changes the
invisible electrochemical image to a visible / manifest radiographic image. This process endswith analog data.
Digital imaging is an electronic imaging method that allows data capture and manipulation in an electron
pattern. The resulting image can be turned into an analog image after going through several energy changes
(electron to light to film or TV screen). The direct action of x-rays has very little influence on a radiographic
image produced with intensifying screens (fluorescent light is responsible for the majority of film exposure).
(Selman, p 310)

165. Decreasing field size from 14 × 17 in to 8 × 10 in will

(A) decrease radiographic density and decrease the amount of scatter radiation generated within the
part.
(B) decrease radiographic density and increase the amount of scatter radiation generated within the part.
(C) increase radiographic density and increase the amount of scatter radiation generated within the part.
(D) increase radiographic density and decrease the amount of scatter radiation generated within the part.

—————————————————————————
Limiting the size of the radiographic field serves to limit the amount of scatter radiation produced within the
anatomic part. As the amount of scatter radiation generated withinthe part decreases, so does the resultant
density within the radiographic image. Hence, beam restriction is a very effective means of reducing the
quantity of non-information-carrying scatter radiation (fog) produced, resulting in a shorter scale of contrast
with fewer radiographic densities. (Shephard, p 203)

166. An increase in kVp will have which of the following effects?

1. More scatter radiation will be produced.
2. The exposure rate will increase.
3. Radiographic contrast will increase.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
An increase in kilovoltage (photon energy) will result in a greater number (i.e.: exposure rate) of scattered
photons (Compton interaction). These scattered photons carry no useful information and contribute to radiation
fog, thus decreasing radiographic contrast. (Selman, p 117)

167. SID affects recorded detail in which of the following ways?

(A) Recorded detail is directly related to SID.
(B) Recorded detail is inversely related to SID.
(C) As SID increases, recorded detail decreases.
(D) SID is not a detail factor.
—————————————————————————
As the distance from focal spot to film (SID) increases, so does recorded detail. Because the part is being
exposedby more perpendicular (less divergent) rays, less magnification and blur are produced. Though the
best recorded detail is obtained using a long SID, the necessary increase in exposure factors and resulting
increased patient exposure becomes a problem. Anoptimal 40-in SID is used for most radiography, with the
major exception being chest examinations. (Selman, pp 206-207) (Shephard, pp 221-222)

168. A radiograph made with a parallel grid demonstrates decreased density on its lateral edges. This is most
likely due to
(A) static electrical discharge.
(B) the grid being off-centered.
(C) improper tube angle.
(D) decreased SID.
—————————————————————————
The lead strips in a parallel grid are parallel to one another, and therefore are not parallel to the x-ray beam.
The more divergent the x-ray beam, the more likely there is to be cutoff / decreased density at the lateral
edges of the radiograph. This problem becomes more pronounced at short SIDs. If there was a centering or
tube angle problem, there would be more likely to be a noticeable density loss on one side or the other. (Saia,
p 324)

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Property of Hamilcar Eldo B. Chanjueco
169. Which of the following would be useful for an examination of a patient suffering from Parkinson's disease?
1. High-speed screens
2. Short exposure time
3. Compensating filtration
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
The shortest possible exposure should be used as a matter of routine. Parkinson's disease is characterized by
uncontrollable tremors, and the resulting unsharpness can destroy image detail. It is therefore necessary to
use as fast an imaging system as possible. High-speed (rare earth) intensifying screens will permit a
considerable reduction in mAs (specifically, exposure time). Compensating filtration is unrelated to the problem
and is not indicated here. (Fauber, p 188)

170. All of the following are related to recorded detail except

(A) mA.
(B) focal spot size.
(C) screen speed.
(D) OID.
—————————————————————————
The focal spot size selected will determine the amount of focal spot, or geometric, blur produced in the image.
Different screen speeds will create differing degrees of fluorescent light diffusion, affecting recorded detail. OID
is responsible for image magnification, and hence recorded detail. The milliamperage is unrelated to recorded
detail; it affects only the quantity of x-ray photons produced and thus the radiographic density. (Selman, pp
206-210)

171. In general, as the intensification factor increases,

1. radiographic density increases.
2. screen resolution increases.
3. recorded detail increases.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Factors that contribute to an increase in the intensification factor generally function to reduce resolution. Slow-
speed (detail or "extremity") screens resolve more line pairs per millimeter (lp/mm) than much faster screens.
The use of fast screens results in some loss of recorded detail. As intensification factor increases, radiographic
density generally increases. (Bushong, pp 208-209)

172. The primary source of scattered radiation is the

(A) patient.
(B) tabletop.
(C) x-ray tube.
(D) grid.
—————————————————————————
The scatterer between the target and the image recorder is the patient. After the radiation has scattered once,
it has been significantly attenuated. The intensity of scattered radiation 1 m from the patient is approximately
0.1 percent of the intensity of the primary beam. (Bushong, p 535)

173. The number of x-ray photons delivered to the patient in a given exposure is primarily regulated by
(A) mAs.
(B) kVp.
(C) SID.
(D) focal spot size.
—————————————————————————
The mAs is primarily used to regulate x-ray quantity, the number of x-ray photons produced in a given
exposure. The kVp is generally used to regulate x-ray quality, the energy or wavelength of the x-ray photons
produced at the target during a given exposure. Although SID significantly affects radiographic density, it is not
used to regulate the quantity of photons produced. Focal spot size is unrelated to radiation quantity or quality.
(Carlton & Adler, p 181)

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Property of Hamilcar Eldo B. Chanjueco
174. Which of the following is (are) method(s) that would enable the radiographer to reduce the exposure time
required for a particular radiograph?
1. Use higher mA.
2. Use higher kVp.
3. Use faster film / screen combination.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
If it is desired to reduce the exposure time for a particular radiograph, as it might be when radiographing those
who are unable to cooperate fully, the milliamperage must be increased sufficiently to maintain the original
mAs, and thus radiographic density. A higher kilovoltage could be useful because it would allow further
reduction of the mAs (exposure time) according to the 15 percent rule. Use of a higher-speed film / screen
combination also helps reduce mAs (exposure time) through more efficient conversion of photon energy to
fluorescent light energy. (Selman, pp 182, 214)

175. The device used to give a film a predetermined exposure in order to test its response to processing is
called the
(A) sensitometer.
(B) densitometer.
(C) step wedge.
(D) spinning top.
—————————————————————————
In order to test a film's response to processing, the film must first be given a predetermined exposure with a
sensitometer. The film is then processed, and the densities are read using a densitometer. Any significant
variation from the expected densities is further investigated. A step wedge is used to evaluate the effect of kVp
on contrast, and a spinning top test is used to check timer accuracy. (Shephard, pp 99-100)

176. A film emerging from the automatic processor exhibits excessive density. This may be attributable to
which of the following?
1. Developer temperature too high
2. Chemical fog
3. Underreplenishment
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Excessive radiographic density may be a result of overdevelopment. Overdevelopment may be due to
excessive developer temperature, resulting in chemical fog. Excessive density can also be a result of
overreplenishment as a result of faulty microswitches or of feeding film into the processor "the long way" rather
than "the wide way." (Shephard, pp 151-153) (Fauber, p 181)

177. A 3-in object to be radiographed at a 36-in SID lies 4 in from the image recorder. What will be the image
width?
(A) 2.6 in
(B) 3.3 in
(C) 26 in
(D) 33 in
—————————————————————————
Magnification is part of every radiographic image. Anatomic parts within the body are at various distances from
the image recorder and therefore have various degrees of magnification. The formula used to determine the
amount of image magnification is:

Image size SID

 = 
Object Size SOD

Substituting known values:

40
Property of Hamilcar Eldo B. Chanjueco
 x 36 in SID
 = 
3 in 32 in SOD (SOD = SID minus OID)

32x = 108; x = 3.37 in image width

(Bushong, p 265)

178. How can the radiograph in Figure 4-22 be improved?

1. Decrease mAs.
2. Eliminate motion.
3. Lengthen the scale of contrast.
(A) 1 only
(B) 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
The radiograph illustrated in Figure 4-22 demonstrates adequate positioning, inspiration, and beam restriction.
However, it has too much background density (too much mAs), excessively high contrast (too low kVp, too
short a scale of contrast), and areas of inadequate penetration. This radiograph should be repeated at a lower
mAs and appropriately higher kVp. (Carlton & Adler, pp 367-369)

179. What determines the quantity of fluorescent light emitted from a fluorescent screen?
1. Thickness of the phosphor layer
2. Type of phosphor used
3. kV range used for exposure
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The thicker the layer of phosphors, the more fluorescent light is emitted from the screen. Different types of
phosphors have different conversion efficiencies; rare earth phosphors emit more light during a given exposure
than do calcium tungstate phosphors. As the kVp level is increased, so is the amount of fluoroscopic light
emitted by intensifying-screen phosphors. (Selman, pp 181-183)

180. Which of the following radiographic accessories functions to produce uniform density on a radiograph?
(A) Grid
(B) Intensifying screens
(C) Compensating filter
(D) Penetrometer
—————————————————————————
When the anatomic part is of greatly differing densities, a compensating filter is frequently helpful.
Compensating filters can be accommodated by tracks in the collimator housing. They can be wedge-shaped,
with the thinner part of the wedge paralleling the thicker body part, thus compensating for greater or lesser
tissue densities (as for a foot exam). A grid is used to absorb scatter radiation before it reaches the film;
intensifying screens amplify the action of x-rays; and a penetrometer (Al step wedge) is used to illustrate the
effect of kVp on contrast. (Selman, p 254)

181. A satisfactory radiograph of the abdomen was made at a 42-in SID using 300 mA, 0.06 s exposure, and
80 kVp. If the distance is changed to 38 in, what new exposure time would be required?
(A) 0.02 s
(B) 0.05 s
(C) 0.12 s
(D) 0.15 s
—————————————————————————
According to the inverse square law of radiation, as the distance between the radiation source and the film
decreases, the exposure rate increases. Therefore, a decrease in technical factors is indicated. The density
maintenance formula is used to determine new mAs values when changing distance:

(old mAs) 18 (old D2) 422 18 1764

 = ; = 

41
Property of Hamilcar Eldo B. Chanjueco
 (new mAs) x (new D2) 382 x 1444

1764x = 25,992; x = 14.7 mAs at 38 SID

Then, to determine the new exposure time (mA × s = mAs),

300x = 14.7
x = 0.049 s at 300 mA
(Selman, p 214)

182. If a particular grid has lead strips 0.40 mm thick, 4.0 mm high, and 0.25 mm apart, what is its grid ratio?
(A) 8:1
(B) 10:1
(C) 12:1
(D) 16:1
—————————————————————————
Grid ratio is defined as the ratio between the height of the lead strips and the width of the distance between
them (i.e., their height divided by the distance between them). If the height of the lead strips is 4.0 mm and the
lead strips are 0.25 mm apart, the grid ratio must be 16:1 (4.0 divided by 0.25). The thickness of the lead strip
is unrelated to grid ratio. (Selman, p 236)

183. Which of the following conditions would require an increase in exposure factors?
1. Congestive heart failure
2. Pleural effusion
3. Emphysema
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Emphysema is abnormal distention of the alveoli (or tissue spaces) with air. The presence of abnormal
amounts of air makes it necessary to decrease from normal exposure factors. Congestive heart failure and
pleural effusion involve abnormal amounts of fluid in the chest and thus require an increase in exposure
factors. (Carlton & Adler, p 258)

184. Exposed silver halide crystals are changed to black metallic silver by the
(A) preservative.
(B) reducers.
(C) activators.
(D) hardener.
—————————————————————————
As the film emulsion is exposed to light or x-rays, latent image formation takes place. The exposed silver halide
crystals are reduced to black metallic silver in the developer solution. Automatic processor developer agents
are hydroquinone and phenidone. The preservativesodium sulfitehelps prevent oxidation. The activator
provides the necessary alkalinity for the developer solution, and hardener is added to the developer in
automatic processing to keep emulsion swelling to a minimum. (Fauber, p 164)

185. Which of the following is an abnormal intensifying-screen action?

(A) Fluorescence
(B) Luminescence
(C) Speed
(D) Lag
—————————————————————————
Luminescence is the production of energy in the form of light. Two types of luminescence are fluorescence and
phosphorescence. Fluorescence occurs when an intensifying (radiographic) screen absorbs x-ray photon
energy, emits light, and ceases to emit light as soon as the energizing source ceases. Fluoroscopic screens
continue to emit light for a short time after the exposure has terminated.This characteristic (phosphorescence)
is a desirable quality in fluoroscopic screens. Lag occurs when an intensifying (radiographic) screen continues
to fluoresce after the x-ray stimulation has terminated. This characteristic is undesirable and causes excessive
density. Screen speed is identified by the amount of light emitted by the phosphors. (Carlton & Adler, p 330)

186. The radiograph pictured in Figure 4-10 demonstrates

42
Property of Hamilcar Eldo B. Chanjueco
(A) overdevelopment.
(B) quantum noise.
(C) scattered radiation fog.
(D) grid cutoff.
—————————————————————————
Quantum noise, or mottle, is a grainy appearance on a finished radiograph that is seen especially in fast
imaging systems. It is very similar in appearance to a photograph taken with fast film and enlarged; it has a
spotted or freckled appearance. Fast film and screens with low-mAs and high-kVp factors are most likely to be
the cause of quantum noise / mottle. Overdevelopment makes a radiograph appear very dark, and sometimes
gray. Scattered radiation fog gives the radiograph a flat, gray appearance. Grid cutoff is absorption of the
primary beam by the grid and usually results in loss of density and visibility of grid lines. (Selman, p 211)

187. Shape distortion is influenced by the relationship between the

1. x-ray tube and the part to be imaged.
2. part to be imaged and the image recorder.
3. image recorder and the x-ray tube.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
Shape distortion is caused by misalignment of the x-ray tube, the part to be radiographed, and the image
recorder / film. An object can be falsely imaged (foreshortened or elongated) by incorrect placement of the
tube, the body part, or the image recorder. Only one of the three need be misaligned for distortion to occur.
(Saia, p 293)

04218C|Evaluation of radiographs`04-22q,0502x0586
How can the radiograph in Figure 4-22 be improved?
1. Decrease mAs.
2. Eliminate motion.
3. Lengthen the scale of contrast.
(A) 1 only
(B) 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
The radiograph illustrated in Figure 4-22 demonstrates adequate positioning, inspiration, and beam restriction.
However, it has too much background density (too much mAs), excessively high contrast (too low kVp, too
short a scale of contrast), and areas of inadequate penetration. This radiograph should be repeated at a lower
mAs and appropriately higher kVp. (Carlton & Adler, pp 367-369)

188. The radiograph seen in Figure 4-16 illustrates

(A) high contrast.
(B) light fog.
(C) chemical fog.
(D) double exposure.
—————————————————————————
The illustrated shoulder radiograph looks dark and overexposed. On careful examination, especially ofthe
clavicle and upper ribs areas, it is seen to be double-exposed. Two clavicles are seen separately, and there
seems to be an abundance of superimposed first to third ribs. Two exposures were inadvertently made on
different phases of respiration; thus there is an overexposed double exposure. A high-contrast film would have
more light / underexposed areas; chemical fog usually produces a very gray image; light fog generally results
in a very black finished radiograph. (Bushong, p 441)

189. All of the following affect the exposure rate of the primary beam except
(A) mA.
(B) kVp.
(C) distance.
(D) field size.
—————————————————————————
Exposure rate is regulated by milliamperage. Distance significantly affects the exposure rate, according to the
inverse square law of radiation. Kilovoltage also has an effect on exposure rate, because an increase in kVp
will increase the number of high-energy photons produced at the target. The size of the x-ray field determines

43
Property of Hamilcar Eldo B. Chanjueco
the volume of tissue irradiated, and hence the amount of scattered radiation generated, but is unrelated to the
exposure rate. (Selman, p 117)

190. Which of the following groups of exposure factors will produce the greatest radiographic density?
(A) 100 mA, 0.30 s
(B) 200 mA, 0.10 s
(C) 400 mA, 0.03 s
(D) 600 mA, 0.03 s
—————————————————————————
The mAs is the exposure factor governing radiographic density. Using the equation milliamperage × time =
mAs, determine each mAs: A = 30 mAs; B = 20 mAs; C = 12 mAs; D = 18 mAs. Group A will produce the
greatest radiographic density. (Selman, p 214)

191. X-ray film is packaged in a foil bag to protect it from

(A) excessive heat.
(B) excessive humidity.
(C) radiation fog.
(D) dust.
—————————————————————————
Unopened film is sealed in a moisture-proof package to protect it from excessive humidity. The unopened bag
will not protect it from radiation or excessive heat. Once the foil bag is open, the film is much more susceptible
to excessive humidity. (Shephard, pp 110-111)

192. The advantage(s) of high-kilovoltage chest radiography is (are) that

1. exposure latitude is increased.
2. it produces long-scale contrast.
3. it reduces patient dose.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The chest is composed of tissues with widely differing densities (bone and air). In an effort to "even out" these
tissue densities and better visualize pulmonary vascular markings, high kilovoltage is generally used. This
produces more uniform penetration and results in a longer scale of contrast, with visualization of the pulmonary
vascular markings as well as bone (which is better penetrated) and air densities. The increased kilovoltage
also affords the advantage of greater exposure latitude (an error of a few kV will make little if any difference).
The fact that the kilovoltage is increased means that the mAs is accordingly reduced, and thus patient dose is
reduced as well. A grid is usually used whenever high kilovoltage is required. (Carlton & Adler, p 471)

193. Acceptable method(s) of minimizing motion unsharpness is (are)

1. suspended respiration.
2. short exposure time.
3. patient instruction.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
The shortest possible exposure time should be used to minimize motion unsharpness. Motion causes
unsharpness that destroys detail. Careful and accurate patient instruction is essential for minimizing voluntary
motion. Suspended respiration eliminates respiratory motion. Using the shortest possible exposure time is
essential for decreasing involuntary motion. Immobilization is also very useful in eliminating motion
unsharpness. (Carlton & Adler, p 410)

194. A decrease in recorded detail may be expected with a decrease in

1. SID.
2. focal spot size.
3. screen speed.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only

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Property of Hamilcar Eldo B. Chanjueco
(D) 1, 2, and 3
—————————————————————————
A decrease in screen speed is associated with less diffusion of fluorescent light and therefore an increase in
recorded detail. Decreasing the focal spot size will increase the recorded detail because smaller focal spot
sizes are associated with less blur (edge gradient). Decreasing the SID will reduce the recorded detail by
increasing magnification. (Selman, pp 206, 211)
195. X-ray film emulsion is most sensitive to safelight fog
(A) before exposure and development.
(B) after exposure.
(C) during development.
(D) at low humidity.
—————————————————————————
X-ray film emulsion becomes more sensitive to safelight fog following exposure to fluorescent light from
intensifying screens. Care must be taken not to leave exposed film on the darkroom workbench for any length
of time, as its sensitivity to safelight fog is now greatly heightened. (Saia, p 405)

196. An exposure was made using 12 mAs and 60 kVp. If the kVp was changed to 70 in order to obtain longer-
scale contrast, what should be the new mAs?
(A) 3 mAs
(B) 6 mAs
(C) 18 mAs
(D) 24 mAs
—————————————————————————
According to the 15 percent rule, if the kVp is increased by 15 percent, radiographic density will be doubled.
Therefore, to compensate for this change and to maintain radiographic density, the mAs should be reduced to
6 mAs. (Saia, p 320)

197. The exposure factors used for a particular nongrid radiograph were 400 mA, 0.02 s, and 90 kVp. Another
radiograph using an 8:1 grid is requested. Which of the following groups of factors is most appropriate?
(A) 400 mA, 0.02 s, 110 kVp
(B) 200 mA, 0.08 s, 90 kVp
(C) 300 mA, 0.05 s, 100 kVp
(D) 400 mA, 0.08 s, 90 kVp
—————————————————————————
The addition of a grid will help clean up the scatter radiation produced by higher kVp, but it requires an mAs
adjustment. According to the grid conversion factors listed here, the addition of an 8:1 grid requires that the
original mAs be multiplied by a factor of 4:

No grid = 1 × the original mAs

5:1 grid = 2 × the original mAs
6:1 grid = 3 × the original mAs
8:1 grid = 4 × the original mAs
12:1 (or 10:1) grid = 5 × the original mAs
16:1 grid = 6 × the original mAs

The adjustment therefore requires 32 mAs at 90 kVp. (Saia, p 328)

198. A lateral radiograph of the lumbar spine was made using 200 mA, 1 s exposure, and 90 kVp. If the
exposure factors were changed to 200 mA, 1/2 s, and 104 kVp, there would be an obvious change in which of
the following?
1. Radiographic density
2. Scale of radiographic contrast
3. Distortion
(A) 1 only
(B) 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
The original mAs (regulating radiographic density) was 200. The original kVp (regulating radiographic contrast)
was 90. The mAs was cut in half, to 100, causing a decrease in density. The kVp was increased (by 15
percent) to compensate for the density loss and thereby increase the scale of contrast. (Shephard, p 203)

45
Property of Hamilcar Eldo B. Chanjueco
199. The developer temperature in a 90-s automatic processor is usually about
(A) 75 to 80ºF.
(B) 80 to 85ºF.
(C) 85 to 90ºF.
(D) 90 to 95ºF.
—————————————————————————
The advantages of automatic processors are quick, efficient operation and consistent results. Quick operation
is attained with increased solution temperatures. The usual temperature of a 90-s processor is 90 to 95º.
Excessively high developer temperature can cause chemical fog. (Selman, p 200)

200. Which of the following statements is true with respect to the diagram in Figure 4-19?
(A) Film 2 has more sensitivity above the point of intersection.
(B) Film 1 has more sensitivity below the point of intersection.
(C) Film 1 has more sensitivity above the point of intersection.
(D) Film 2 has less sensitivity below the point of intersection.
—————————————————————————
The answer to this question conforms to the general rule that when two or more characteristiccurves are being
compared, the fastest film emulsion is the one furthest to the left. The one difference is that there are
intersecting characteristic curves here. Simply see which curve is farther to the left above the intersection
(number 1) and which is farther to the left below the intersection (number 2). As you can see, film 1 has more
sensitivity (speed) above the point of intersection. (Shephard, p 105) (Selman, p 221)

201. Which of the following devices is used to overcome severe variation in patient anatomy or tissue density,
providing more uniform radiographic density?
(A) Compensating filter
(B) Grid
(C) Collimator
(D) Intensifying screen
—————————————————————————
A compensating filter is used when the part to be radiographed is of uneven thickness or density (in the chest,
mediastinum versus lungs). The filter (made of aluminum or lead acrylic) is constructed in such a way that it
will absorb much of the primary radiation that would expose the low-tissue density area, while allowing the
primary radiation to pass unaffected to the high-tissue density area. A collimator is used to decrease the
production of scattered radiation by limiting the volume of tissue irradiated. The grid functions to trap scatter
radiation before it reaches the film, thus reducing scatter radiation fog. (Selman, pp 254-255)

202. Which of the following groups of exposure factors will produce the longest scale of contrast?
(A) 200 mA, 0.08 s, 95 kVp, 12:1 grid
(B) 500 mA, 0.03 s, 81 kVp, 8:1 grid
(C) 300 mA, 0.05 s, 95 kVp, 8:1 grid
(D) 600 mA, 1/40 s, 70 kVp, 6:1 grid
—————————————————————————
Of the given factors, kilovoltage and grid ratio will have a significant effect on radiographic contrast. mAs has
no effect on contrast. Because a combination of increased kilovoltage and a low-ratio grid would allow the
greatest amount of scattered radiation to reach the film, thereby producing more gray tones, C is the best
answer. D also uses a low-ratio grid, but the kilovoltage is too low to produce as many gray tones as C.
(Shephard, pp 305-308)

203. In order to produce a just perceptible increase in radiographic density, the radiographer must increase the
(A) mAs by 30 percent.
(B) mAs by 15 percent.
(C) kVp by 15 percent.
(D) kVp by 30 percent.
—————————————————————————
If a radiograph lacks sufficient blackening, an increase in mAs is required. The mAs regulates the number of x-
ray photons produced at the target. An increase or decrease in mAs of at least 30 percent is necessary in
order to produce a perceptible effect. Increasing the kVp by 15 percent will have about the same effect as
doubling the mAs. (Shephard, p 173)

204. The three radiographs illustrated in Figure 4-2 were made with identical exposures, but one was
developed at 90ºF, one at the usual 95ºF, and one at 100ºF. Which is the radiograph made at 100ºF?
(A) Film A

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Property of Hamilcar Eldo B. Chanjueco
(B) Film B
(C) Film C
(D) none of these
—————————————————————————
Radiograph B was made of a chest phantom and processed using the recommended 95ºF developer
temperature. Radiograph A was exposed under the same conditions but was processed with a developer
temperature of 90ºF. The development process slows at the lower temperature, and a much lighter radiograph
results. In order to produce the original density using a 90ºF developer, higher exposure factors would be
required. Radiograph C was exposed under the same conditions as radiographs A and B but was developed at
100ºF; at this temperature, the development process is accelerated and the radiograph is too dark. (Saia, p
409)

205. Which of the following tests is performed to evaluate screen contact?

(A) Spinning top test
(B) Wire mesh test
(C) Penetrometer test
(D) Star pattern test
—————————————————————————
Perfect film / screen contact is essential to sharply recorded detail. Screen contact can be evaluated with a
wire mesh test (Fig. 4-31). A spinning top test is used to evaluate timer accuracy and rectifier operation. A
penetrometer (aluminum step wedge) is used to illustrate the effect of kilovoltage on contrast. A star pattern is
used to measure the resolving power of the imaging system. (Selman, pp 183-186)

206. The function(s) of the fixer in film processing is (are) to

1. remove the unexposed silver bromide crystals.
2. change the unexposed silver bromide crystals to black metallic silver.
3. harden the emulsion.
(A) 1 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Developing agents change the exposed silver bromide crystals to black metallic silver, thus producing a
manifest image. The fixer solution removes the unexposed silver bromide crystals from the emulsion and
hardens the gelatin emulsion, thus ensuring permanence of the radiograph. (Fauber, p 167)

207. In comparison to 60 kVp, 80 kVp will

1. permit greater exposure latitude.
2. produce longer-scale contrast.
3. produce more scatter radiation.
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
The higher the kVp range, the greater the exposure latitude (margin of error in exposure). Higher kVp is more
penetrating and produces more grays on the radiograph, lengthening the scale of contrast. As kVp increases,
the percentage of scatter radiation also increases. (Saia, p 360)

208. If the developer temperature in the automatic processor is higher than normal, what will be the effect on
the finished radiograph?
1. Loss of contrast
2. Increased density
3. Wet, tacky films

(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Higher than normal developing temperatures cause overdevelopment of the less-exposed silver halide
crystals, producing chemical fog. The resulting radiograph will appear very gray, exhibiting loss of contrast and

47
Property of Hamilcar Eldo B. Chanjueco
increased density. Wet, tacky films are usually the result of lower than normal dryer temperature or fixer
underreplenishment. (Shephard, p 153)

209. Which of the following is performed to check the correctness of the developing parameters?
(A) Densitometry
(B) A thorough cleaning of rollers
(C) A warm-up procedure
(D) Sensitometry
—————————————————————————
Sensitometry is a method of quality control for daily monitoring of the automatic film processor. A densitometer
is a device used to read optical density. Crossover rollers should be cleaned daily to prevent the buildup of
crystallized solution on the rollers. A warm-up procedure is performed on an x-ray tube for safe operation after
prolonged disuse. (Selman, pp 292-293)

210. Using a short (25-30-in) SID with a large-size (14 × 17-in) image receptor is likely to
(A) increase the scale of contrast.
(B) increase the anode heel effect.
(C) cause malfunction of the AEC.
(D) cause premature termination of the exposure.
—————————————————————————
Use of a short SID with a large-size image receptor (and also with anode angles of 10º or less) causes the
anode heel effect to be much more apparent. The x-ray beam needs to diverge more to cover a large-size
image receptor, and it needs to diverge even more for coverage as the SID decreases. The x-ray beam has no
problem diverging toward the cathode end of the beam, but as it tries to diverge toward the anode end of the
beam, it is eventually stopped by the anode (x-ray photons are absorbed by the anode). This causes a
decrease in beam intensity at the anode end of the beam and is characteristic of the anode heel effect.
(Shephard, p 192) (Carlton & Adler, p 120)

211. The line focus principle expresses the relationship between

(A) the actual and the effective focal spot.
(B) exposure given the film and resultant density.
(C) SID used and resultant density.
(D) grid ratio and lines per inch.
—————————————————————————
The line focus principle is a geometric principle illustrating that the actual focal spot is larger than the effective
(projected) focal spot. The actual focal spot (target) is larger, to accommodate heat over a larger area, and is
angled so as to project a smaller focal spot, thus maintaining recorded detail by reducing blur. The relationship
between the exposure given the film and the resulting density is expressed in the reciprocity law; the
relationship between the SID and resulting density is expressed by the inversesquare law. Grid ratio and lines
per inch are unrelated to the line focus principle. (Shephard, pp 218-219) (Selman, p 138)

212. In radiography of a large abdomen, which of the following is (are) effective way(s) to minimize the amount
of scattered radiation reaching the film?
1. Use of close collimation
2. Use of compression devices
3. Use of a low-ratio grid
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
One way to minimize scatter radiation reaching the film is to use optimal kilovoltage; excessive kVp increases
the production of scatter radiation. Close collimation is also important because the smaller the volume of
irradiated material, the less scatter radiation is produced. Using compression bands or the prone position in a
large abdomen has the effect of making the abdomen "thinner"; it will therefore generate less scattered
radiation. Low-ratio grids allow a greater percentage of scattered radiation to reach the film. Use of a high-ratio
grid will clean up a greater amount of scatter radiation before it reaches the film. (Shephard, p 203)

213. What grid ratio is represented in Figure 4-5?

(A) 3:1
(B) 5:1
(C) 10:1

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Property of Hamilcar Eldo B. Chanjueco
(D) 16:1
—————————————————————————
Grid ratio is defined as the height of the lead strips compared to (divided by) the width of the interspace
material. The width of the lead strips has no bearing on the grid ratio. The height of the lead strips is 5 mm; the
width of the interspace material (same as the distance between the lead strips) is 0.5 mm. Therefore the grid
ratio is 5 ÷ 0.5, or a 10:1 grid ratio. (Bushong, p 234)
214. A grid is usually employed in which of the following circumstances?
1. When radiographing a large or dense body part
2. When using high kilovoltage
3. When a lower patient dose is required
(A) 1 only
(B) 3 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
Significant scattered radiation is generated within the part when imaging large or dense body parts and when
using high kilovoltage. A radiographic grid is made of alternating lead strips and interspace material; it is
placed between the patient and thefilm to absorb energetic scatter emerging from the patient. Although a grid
prevents much of the scattered radiation from reaching the radiograph, its use does necessitate a significant
increase in patient exposure. (Saia, p 327)

215. Foreshortening can be caused by

(A) the radiographic object being placed at an angle to the film.
(B) excessive distance between the object and the film.
(C) insufficient distance between the focus and the film.
(D) excessive distance between the focus and the film.
—————————————————————————
Aligning the x-ray tube, anatomic part, and image recorder so that they are parallel reduces shape distortion.
Angulation of the long axis of the part with respect to the film results in foreshortening of the object. Tube
angulation causes elongation of the part. Size distortion (magnification) is inversely proportional to SID and
directly proportional to OID. Decreasing the SID and increasing the OID serve to increase size distortion.
(Shephard, pp 232-233)

216. The speed of an intensifying screen is influenced by which of the following factors?
1. Phosphor-layer thickness
2. Antihalation backing
3. Phosphor type used
(A) 1 only
(B) 1 and 3 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Rare earth phosphors have a much higher conversion efficiency (and therefore speed) and have all but
replaced the older calcium tungstate screens. The larger the phosphor and the thicker the layer of phosphors
(active layer), the greater the light emission and therefore the speed. Antihalation backing is a component of
single-emulsion film that prevents crossover of fluorescent light within an image receptor. (Selman, pp 180-
183)

217. The use of which of the following is (are) essential in magnification radiography?
1. High-ratio grid
2. Fractional focal spot
3. Direct-exposure film
(A) 1 only
(B) 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Magnification radiography is used to enlarge details to make them more perceptible. Hairline fractures, minute
blood vessels, and microcalcifications are candidates for magnification radiography. The problem of
magnification unsharpness is overcome by using a fractional focal spot; larger focal spot sizes will produce
excessive blurring unsharpness. Grids are usually unnecessary in magnification radiography because of the air
gap effect produced by the OID. A direct-exposure technique would not be likely to be used because of the

49
Property of Hamilcar Eldo B. Chanjueco
excessive exposure required. (Selman, pp 226-228)

218. If 300 mA has been selected for a particular exposure, what exposure time would be required to produce
60 mAs?
(A) 1/60 s
(B) 1/30 s
(C) 1/10 s
(D) 1/5 s
—————————————————————————
The mAs is the exposure factor that regulates radiographic density. The equation used to determine mAs is
mA × s = mAs. Substituting the known factors,

400x = 60
x = 0.2 (1/6) s
(Fauber, p 55)

219. The purpose of the automatic processor's circulation system is to

(A) monitor and adjust temperature.
(B) agitate, mix, and filter solutions.
(C) move the film and change its direction.
(D) monitor the solution and replace it as necessary.
—————————————————————————
The automatic film processor has a number of component systems. The circulation system functions to agitate,
mix, and filter solutions. The transport system moves film from solution to solution between rollers, changing
the direction of the film around critical turns. The temperature control system functions to monitor and control
solution temperature. The replenishment system serves to monitor the solution and replace it as needed.
(Bushong, p 199)

220. The process of "leveling and windowing" of digital images determines the image
(A) spatial resolution.
(B) contrast.
(C) pixel size.
(D) matrix size.
—————————————————————————
The digital images' scale of contrast, or contrast resolution, can be changed electronically through leveling and
windowing of the image. Thelevel control determines the central or mid density of the scale of contrast, while
the window control determines the total number of densities / grays (to the right and left of the central / mid
density). Matrix and pixel sizes are related to (spatial) resolution of digital images. (Fosbinder & Kelsey, p 289)

221. Which of the following is (are) tested as part of a QA program?

1. Beam alignment
2. Reproducibility
3. Linearity
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Each of the three is included in a good QA program. Beam alignment must be accurate to within 2 percent of
the SID. Reproducibility means that repeated exposures at a given technique must provide consistent intensity.
Linearity means that a given mAs, using different mA stations with appropriate exposure time adjustments, will
provide consistent intensity. (Bushong, p 432)

222. The interaction between x-ray photons and matter illustrated in Figure 4-17 is most likely to occur
1. in structures having a high atomic number.
2. during radiographic examination of the abdomen.
3. using high-kV and low-mAs exposure factors.
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————

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Property of Hamilcar Eldo B. Chanjueco
Diagnostic x-ray photons interact with tissue in a number of ways, but mostly they are involved in the
production of Compton scatter or in the photoelectric effect. Compton scatter is pictured; it occurs when a
relatively high-energy (kV) photon uses some of its energy to eject an outer-shell electron. In doing so, the
photon is deviated in direction and becomes a scattered photon. Compton scatter causes objectionable
scattered radiation fog in large structures such as the abdomen and poses a radiation hazard to personnel
during procedures such as fluoroscopy. In the photoelectric effect, a relatively low-energy x-ray photon uses all
its energy to eject an inner-shell electron, leaving a "hole" in the K shell. An L-shell electron then drops down to
fill the K vacancy, and in so doing emits a characteristic ray whose energy is equal to the difference between
the binding energies of the K and L shells. The photoelectric effect occurs with high-atomic-number absorbers
such as bone and positive contrast media, and is responsible for the production of radiographic contrast. It is
helpful for the production of the radiographic image, but it contributes to the dose received by the patient
(because it involves complete absorption of the incident photon). (Saia, p 224)

223. Which of the following are methods used for silver reclamation?
1. Photoelectric method
2. Metallic replacement method
3. Electrolytic method
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
About half the silver in a film emulsion remains to form the image. The other half is removed from the film
during the fixing process. Therefore, fixer solution has a high silver content. Silver is a toxic metal and cannot
simply be disposed of into the public sewer system. As silver is also a precious metal, it becomes financially
wise to recycle the silver removed from x-ray film. The three most commonly used silver recovery systems are
the electrolytic, metallic replacement, and chemical precipitation methods. In electrolytic units, an electric
current is passed through the fixer solution. Silver ions are attracted to, and become plated onto, the negative
electrode of the unit. The plated silver is periodically scraped from the cathode and accurately measured so
that the hospital can be appropriately reimbursed. The electrolytic method is a practical recovery system for
moderate- and high-use processors. The metallic replacement (or displacement) method of silver recoveryuses
a steel mesh / steel wool type of cartridge that traps silver as fixer is run through it. This system is useful for
low-volume processors and is often also used as a backup to the electrolytic unit. Chemical precipitation adds
chemicals that release electrons into the fixer solution. This causes the metallic silver to precipitate out, fall to
the bottom of the tank, and form a recoverable sludge. This method is used principally by commercial silver
dealers. (Carlton & Adler, pp 308-310)

224. What is the best way to reduce magnification distortion?

(A) Use a small focal spot.
(B) Increase the SID.
(C) Decrease the OID.
(D) Use a slow screen / film combination.
—————————————————————————
There are two types of distortion: size and shape. Shape distortion relates to the alignment of the x-ray tube,
the part to be radiographed, and the image recorder. There are two kinds of shape distortion: elongation and
foreshortening. Size distortion is magnification, and it is related to the OID and the SID. Magnification can be
reduced by either increasing the SID or decreasing the OID. However, an increase in SID must be
accompanied by an increase in mAs in order to maintain density. It is therefore preferable, in the interest of
exposure, to reduce OID whenever possible. (Fauber, p 90)

225. If 40 mAs and a 50-speed screen / film system were used for a particular exposure, what new mAs value
would be required in order to produce the same density if the screen / film system were changed to 200-
speed?
(A) 10 mAs
(B) 20 mAs
(C) 80 mAs
(D) 160 mAs
—————————————————————————
The screen / film system and radiographic density are directly proportional; that is, if the system speed is
doubled, the radiographic density is doubled. In this case, we started at 40 mAs with a 50-speed system. If the
system speed is doubled to 100, we should decrease the mAs to 20. If the speed is again doubled to 200, we
use half of the 20 mAs, or 10 mAs. Or, mAs conversion factors and the following formula may be used:

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Property of Hamilcar Eldo B. Chanjueco
 screen speed factor 1 mAs1 2 40
 = ; = 
screen speed factor 2 mAs2 0.5 x

2x = 20; x = 10 mA with 200 screen / film system

(Saia, p 327)

226. Which of the following can affect demonstration of the anode heel effect?
1. SID
2. Image recorder size
3. Screen speed
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Because the focal spot (track) of an x-ray tube is along the anode's beveled edge, photons produced at the
target are able to diverge considerably toward the cathode end of the x-ray tube but are absorbed by the heel
of the anode at the opposite end of the tube. This results in a greater number of x-ray photons distributed
toward the cathode end, which is known as the anode heel effect. The effect of this restricting heel is most
pronounced when the x-ray photons are required to diverge more, as would be the case with short SID, large-
size films, and steeper (smaller) target angles. (Shephard, p 192) (Carlton & Adler, p 120)

227. Using a 48-in SID, how much object-image distance (OID) must be introduced to magnify an object two
times?
(A) 8 in OID
(B) 12 in OID
(C) 16 in OID
(D) 24 in OID
—————————————————————————
Magnification radiography may be used to delineate a suspected hairline fracture or to enlarge tiny, contrast-
filled blood vessels. It also has application in mammography. In order to magnify an object to twice its actual
size, the part must be placed midway between the focal spot and the film. (Shephard, pp 229-231) (Selman,
pp 223-225)

228. Materials that emit light when stimulated by x-ray photons are called
(A) ions.
(B) electrodes.
(C) phosphors.
(D) crystals.
—————————————————————————
Materials that emit light when stimulated by x-ray photons are called phosphors. Phosphors are used in
intensifying screens, where they function to absorb x-ray photon energy and convert it to visible light energy.
Typically, for each x-ray photon absorbed, many light photons are emitted; intensifying screens serve to
amplify the action of x-rays. (Carlton & Adler, p 330

229. Which of the following affect(s) both the quantity and the quality of the primary beam?
1. Half-value layer (HVL)
2. kVp
3. mA
(A) 1 only
(B) 2 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
Kilovoltage and the half-value layer (HVL) affect both the quantity and the quality of the primary beam. The
principal qualitative factor for the primary beam is kVp, but an increase in kVp will also create an increase in
the number of photons produced at the target. HVL is defined as the amount of material necessary to decrease
the intensity of the beam to one-half its original value, thereby effecting a change in both beam quality and
quantity. The mAs value is adjusted to regulate the number of x-ray photons produced at the target. X-ray
beam quality is unaffected by changes in mAs. (Carlton & Adler, p 181)

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Property of Hamilcar Eldo B. Chanjueco
230. The absorption of useful radiation by a grid is called
(A) grid selectivity.
(B) contrast improvement factor.
(C) grid cutoff.
(D) latitude.
—————————————————————————
Grids are used in radiography to absorb scatter radiation before it reaches the film, thus improving radiographic
contrast. Contrast obtained with a grid compared to contrast without a grid is termed contrast improvement
factor. The greater the percentage of scatter radiation absorbed compared to absorbed primary radiation, the
greater the "selectivity" of the grid. If a grid absorbs an abnormally large amount of useful radiation as a result
of improper centering, tube angle, or tube distance, grid cutoff occurs. (Selman, p 370)

231. In which of the following examinations should 70 kVp not be exceeded?

(A) Upper GI (UGI)
(B) Barium enema (BE)
(C) Intravenous pyelogram (IVP)
(D) Chest
—————————————————————————
The iodine-based contrast material used in intravenous urography gives optimum opacification at 60 to 70 kVp.
Use of higher kVp will negate the effect of the contrast medium; a lower contrast will be produced, and poor
visualization of the renal collecting system will result. GI and BE exams employ high-kVp exposure factors
(about 120 kVp) to penetrate through the barium. In chest radiography, high-kVp technical factors are preferred
for maximum visualization of pulmonary vascular markings, made visible with long-scale contrast. (Saia, p
347)

232. Factors that contribute to film fog include

1. the age of the film.
2. excessive exposure to safelight.
3. processor chemistry.
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Film age is an important consideration when determining the causes of film fog. Outdated film will exhibit loss
of contrast in the form of fog and loss of speed. A safelight is "safe" only for practical periods of time required
for the necessary handling of film.Films that are left out on the darkroom counter can be fogged by excessive
exposure to the safelight. Film emulsion is much more sensitive to safelight fog after exposure. The high
temperatures required for automatic processors' rapid processing are a source of film fog. Daily QA ensures
that fog levels do not exceed the upper limit of 0.2 D. (Shephard, pp 110, 123, 137)

233. Which combination of exposure factors will most likely contribute to producing the longest-scale contrast?
Film / Screen Grid Field
mAs kVp System Ratio Size
(A) 10 70 400 5:1 14 × 17 in
(B) 12 90 200 8:1 14 × 17 in
(C) 15 90 200 12:1 8 × 10 in
(D) 20 80 400 10:1 11 × 14 in
*Review the groups of factors. First, because mAs has no effect on the scale of contrast produced, eliminate
mAs from consideration by drawing a line through the column. Then, check the two entries in each column that
are most likely to produce long-scalecontrast. For example, in the kVp column, because higher kVp will
produce longer-scale contrast, place check marks next to each 90 kVp. In the Film / Screen column, the slower
screens (200) will produce lower (longer-scale) contrast than the faster screens; place a check mark next to
each. Because lower-ratio grids permit a larger quantity of scatter radiation to reach the film, the 5:1 and 8:1
grids will produce a longer scale of contrast than the higher-ratio grids; check them. As the volume of irradiated
tissue increases, so does the amount of scatter radiation produced and, consequently, the longer the scale of
radiographic contrast; therefore, check the 14 × 17-in field sizes. An overview shows that the factors in groups
A and C have two check marks, whereas the factors in group B have four check marks, indicating that group B
will produce the longest-scale contrast. (Shephard, pp 306-308)

04222D|Selection of technical factors: density

53
Property of Hamilcar Eldo B. Chanjueco
How is SID related to exposure rate and radiographic density?
(A) As SID increases, exposure rate increases and radiographic density increases.
(B) As SID increases, exposure rate increases and radiographic density decreases.
(C) As SID increases, exposure rate decreases and radiographic density increases.
(D) As SID increases, exposure rate decreases and radiographic density decreases.
—————————————————————————
According to the inverse square law of radiation, the intensity or exposure rate of radiation is inversely
proportional to the square of the distance from its source. Thus, as distance from the source of radiation
increases, exposure rate decreases. Because exposure rate and radiographic density are directly proportional,
if the exposure rate of a beam directed to a film is decreased, the resultant radiographic density would be
decreased proportionally. (Selman, p 117)

234. Which of the radiographs in Figure 4-4 most likely required a greater exposure?
(A) Film A
(B) Film B
(C) No difference in exposure was required
(D) Cannot be determined
—————————————————————————
Of the two radiographs illustrated, film A was made recumbent, and film B was made in the erect position; this
may be discerned by the presence of clearly defined air-fluid levels in the lower abdomen. Abdominal viscera
moveto a lower position in the erect position, making the abdomen "thicker" and requiring an increase in
exposure (usually the equivalent of about 10 kVp). (Saia, pp 76, 80, 84)

235. Of the following groups of exposure factors, which will produce the greatest radiographic density?
(A) 200 mA, 0.03 s, 72-in source-image distance (SID)
(B) 100 mA, 0.03 s, 36-in SID
(C) 100 mA, 0.06 s, 36-in SID
(D) 200 mA, 0.06 s, 72-in SID
—————————————————————————
The formula mA × s = mAs is used to determine each mAs. The greatest radiographic density will be produced
by the combination of greatest mAs and shortest SID. The groups in choices B and D should produce identical
radiographic density, according to the inverse square law, because group D includes twice the distance and
four times the mAs of group B. The group in A has twice the distance of the group in B, but only twice the mAs;
therefore, it has less density than the groups in B and D. The group in C has the same distance as the group in
B and twice the mAs, making group C the group of technical factors that will produce the greatest radiographic
density. (Selman, p 214)

236. Focusing distance is associated with which of the following?

(A) Computed tomography
(B) Chest radiography
(C) Magnification radiography
(D) Grids
—————————————————————————
Focusing distance is the term used to specify the optimal SID used with a particular focused grid. It is usually
expressed as focal range, indicating the minimum and maximum SID workable with that grid. Lesser or greater
distances can result in grid cutoff. Although proper distance is important in computed tomography, chest, and
magnification radiography, focusing distance is unrelated to them. (Selman, pp 239-240)

237. Which of the following influences geometric unsharpness?

1. OID
2. Focal-object distance
3. SID
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
Geometric unsharpness is affected by all three factors listed. As OID increases, so does magnification. OID is
directly related to magnification. As focal-object distance and SID decrease, magnification increases. Focal-
object distance and SID are inversely related to magnification. (Carlton & Adler, pp 403-405)

238. What effect will a stained intensifying screen have on the finished radiograph?

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Property of Hamilcar Eldo B. Chanjueco
(A) Blurring
(B) Magnification
(C) Decreased density
(D) Increased density
—————————————————————————
Intensifying screens react to the presence of x-ray photons and change their energy to visible fluorescent light
energy, which serves to expose the adjacent film emulsion. If an intensifying screen becomes stained, either
partly or wholly, the stained area will not react to x-ray photons as completely and will emit less light.
Therefore, the film emulsion adjacent to the stained area(s) will exhibit decreased density on the finished
radiograph. (Shephard, p 75)

239. Because of the anode heel effect, the intensity of the x-ray beam is greatest along the
(A) path of the central ray.
(B) anode end of the beam.
(C) cathode end of the beam.
(D) transverse axis of the film.
—————————————————————————
Because the anode's focal track is beveled (angled, facing the cathode), x-ray photons can freely diverge
toward the cathode end of the x-ray tube. However, the "heel" of the focal track prevents x-ray photons from
diverging toward the anode end of the tube. This results in varying intensity from anode to cathode, with fewer
photons at the anode end and more photons at the cathode end. The anode heel effect is most noticeable
when using large film sizes, short SIDs, and steep target angles. (Saia, p 298)

240. Foreshortening of an anatomic structure means that

(A) it is projected on the film shorter than its actual size.
(B) its image is more lengthened than its actual size.
(C) it is accompanied by geometric blur.
(D) it is significantly magnified.
—————————————————————————
If a structure of a given length is not positioned parallel to the recording medium (film), it will be projected
smaller than its actual size (foreshortened). An example of this can be a lateral projection of the third digit. If
the finger is positioned so as to be parallel to the image receptor, no distortion willoccur. If, however, the finger
is positioned so that its distal portion rests on the cassette while its proximal portion remains a distance from
the film, foreshortening will occur. (Shephard, pp 232-233)

241. Which of the following statements is (are) true regarding the artifact seen in the erect PA projection of the
chest shown in Figure 4-25?
(A) The object is located within the patient.
(B) The object is located within the image receptor.
(C) The object is located between the patient and the x-ray tube.
(D) The object is located between the patient and the image receptor.
—————————————————————————
The artifact seen in the figure has sharply delineated edges, indicating that it is located adjacent to the
intensifying screens within the image receptor. The farther the object is from the image receptor, the more
blurred its edges will be as a result of magnification distortion. (Saia, p 378)

242. Exposure-type artifacts include

1. motion
2. static electricity marks.
3. pi lines
(A) 1 only
(B) 1 and 2 only
(C) 2 and 3 only
(D) 1, 2, and 3
—————————————————————————
Artifacts can be a result of exposure, handling and storage, or processing. Exposure artifacts include motion,
double exposure, poor screen / film contactthe effects of these are seen as a result of the exposure. Handling
and storage artifacts include static electricity discharge, crinkle marks, scratches, and light or radiation
fogthese all occur as a result of improper usage or storage. Processing artifacts occur while the film is in the
automatic processor and include pi lines, guide shoe marks, and chemical fog. (Bushong, p 441)

243. In order to be suitable for use in intensifying screens, a phosphor should have which of the following

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Property of Hamilcar Eldo B. Chanjueco
characteristics?
1. High conversion efficiency
2. High x-ray absorption
3. High atomic number
(A) 1 only
(B) 3 only
(C) 1 and 2 only
(D) 1, 2, and 3
—————————————————————————
Intensifying-screen phosphors that have a high atomic number are more likely to absorb a high percentage of
the incident x-ray photons and convert x-ray photon energy to fluorescent light energy. How efficiently the
phosphors detect and interact with the x-ray photons is termed quantum detection efficiency. How effectively
the phosphors make this energy conversion is termed conversion efficiency. (Shephard, p 65)

244. If a 6-in OID is introduced during a particular radiographic examination, what change in SID will be
necessary in order to overcome objectionable magnification?
(A) The SID must be increased by 6 in.
(B) The SID must be increased by 18 in.
(C) The SID must be decreased by 6 in.
(D) The SID must be increased by 42 in.
—————————————————————————
As OID is increased, recorded detail is diminished as a result of magnification distortion. If the OID cannot be
minimized, an increase in SID is required in order to reduce the effect of magnification distortion. However, the
relationship between OID and SID is not an equal relationship. In fact, to compensate for every 1 in of OID, an
increase of 7 in of SID is required. Therefore, an OID of 6 in requires an SID increase of 42 in. That is why a
chest radiograph with a 6-in air gap is usually performed at a 10-ft SID. (Saia, p 290)

245. OID is related to recorded detail in which of the following ways?

(A) Radiographic detail is directly related to OID.
(B) Radiographic detail is inversely related to OID.
(C) As OID increases, so does radiographic detail.
(D) OID is unrelated to radiographic detail.
—————————————————————————
As the distance from the object to the film (OID) increases, so does magnification distortion thereby decreasing
recorded detail. Some magnification is inevitable in radiography, as it is not possible to place anatomic
structures directly on the image recorder. However, our understanding of how to minimize magnification
distortion is an important part of our everyday work. (Fauber, pp 90-91)

246. The image receptor front can be made of which of the following materials?
1. Carbon fiber
2. Magnesium
3. Lead
(A) 1 only
(B) 1 and 2 only
(C) 1 and 3 only
(D) 1, 2, and 3
—————————————————————————
The cassette / image receptor front material must not attenuate the remnant beam, yet must be sturdy enough
to withstand daily use. Bakelite was long been used as the material for tabletops and image receptor fronts, but
it has now largely been replaced by magnesium and carbon fiber. Lead would not be a suitable material, as it
would absorb the remnant beam, and no image would be formed. (Shephard, p 41)

247. A particular mAs, regardless of the combination of mA and time, will reproduce the same radiographic
density. This is a statement of the
(A) line focus principle.
(B) inverse square law.
(C) reciprocity law.
(D) law of conservation of energy.
—————————————————————————
The reciprocity law states that a particular mAs, regardless of the mA and exposure time used, will provide
identical radiographic density. This holds true with direct exposure techniques, but it does fail somewhat with
the use of intensifying screens. However, the fault is so slight as to be unimportant in most radiographic

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Property of Hamilcar Eldo B. Chanjueco
procedures. (Bushong, p 187) (Shephard, p 193)

248. Which of the following has the greatest effect on radiographic density?
(A) Aluminum filtration
(B) Kilovoltage
(C) SID
(D) Scattered radiation
—————————————————————————
Radiographic density is greatly affected by changes in the SID, as expressed by the inverse square law of
radiation. As distance from the radiation source increases, exposure rate decreases and radiographic density
decreases. Exposure rate is inversely proportional to the square of the SID. Aluminum filtration, kilovoltage,
and scattered radiation all have a significant effect on density, but they are not the primary controlling factors.
(Selman, p 214)

249. Which of the following has the greatest effect on radiographic density?
(A) Aluminum filtration
(B) Kilovoltage
(C) SID
(D) Scattered radiation
-------------------------
Radiographic density is greatly affected by changes in the SID, as expressed by the inverse square law of
radiation. As distance from the radiation source increases, exposure rate decreases and radiographic density
decreases. Exposure rate is inversely proportional to the square of the SID. Aluminum filtration, kilovoltage,
and scattered radiation all have a significant effect on density, but they are not the primary controlling factors.
(Selman, p 214)

250. The radiograph in Figure 4-9 demonstrates an example of

(A) tree static.
(B) underexposure.
(C) processing artifact.
(D) exposure artifact.
—————————————————————————
The illustrated radiograph is that of an adult PA erect chest. The image is well positioned and exposed, but
observe the braids of hair that extend past the neck and superimpose on the pulmonary apices. Braided hair
should be pinned up or otherwise removed from superimposition on thoracic structures. The braided hair was
imaged during the exposure of the PA chest and is therefore referred to as an exposure artifact. Examples of
processing artifacts are guide shoe marks, roller marks, and scratches. Tree static appears as black branching
lines caused by electrical discharge. It is important to inquire or examine patients for materials that will image
radiographically and cast unwanted densities over essential anatomy. (Bushong, pp 442-443)

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