Essentials of

Radiographic
Physics and Imaging
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Second Edition

Essentials of
Radiographic
Physics and Imaging
James N. Johnston, PhD, RT(R)(CV), FASRT
Professor Radiologic Sciences
Dean of the Robert D. & Carol Gunn College of
Health Sciences and Human Services
Midwestern State University
Wichita Falls, Texas

Terri L. Fauber, EdD, RT(R)(M)

Associate Professor and Radiography Program Director
Department of Radiation Sciences
School of Allied Health Professions
Virginia Commonwealth University
Richmond, Virginia
 3251 Riverport Lane
St. Louis, Missouri 63043

ESSENTIALS OF RADIOGRAPHIC PHYSICS AND IMAGING,

SECOND EDITION ISBN: 978-0-323-33966-7

Copyright © 2016 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability, negli-
gence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained
in the material herein.

Previous edition copyrighted 2012.

International Standard Book Number: 978-0-323-33966-7

Executive Content Strategist: Sonya Seigafuse

Content Development Manager: Laurie Gower
Publishing Services Manager: Julie Eddy
Senior Project Manager: Marquita Parker
Designer: Ashley Miner

Printed in China
Last digit is the print number:  9  8  7  6  5  4  3  2  1
Our first edition received great support from our professional colleagues and friends as well as student
users. We thank you for your support, encouragement, and feedback to make this second edition even
better. It is to all of you that we dedicate this work.

jnj/tlf
CONTRIBUTOR AND REVIEWERS
We would also like to acknowledge the reviewers of the first edition:
CONTRIBUTOR Laura Aaron, PhD, RT(R)(M)(QM)
Rebecca Harris Keith, MS, RT(R)(CT) Carla McCaghren Allen, MEd, RT(R)(CT)
Chapter 16
Assistant Professor and Director of Admissions Lori Nowicki Balmer, MPA, RT(R)(MR)
Department of Radiation Sciences
Mary Jo Bergman, MEd, MS, RN, RT(R)
School of Allied Health Professions
Virginia Commonwealth University Melanie L. Billmeier, BSRS, RT(R)
Richmond, Virginia
Deanna Butcher, MA, RT(R)

REVIEWERS William J. Callaway, MA, RT(R)

Melanie L. Billmeier, BSRS, RT(R) Caron Colvett, RT(R)

Radiology Program Coordinator Dominick DeMichele, MEd, RT(R)(CT)
North Central Texas College
Gainesville, Texas Anne Delaney, MBA, RT(R)
Mary C. Doucette, BS, RT(R)(M)(CT)(MR)(QM)
William J. Callaway, MA, RT(R)
Director Cheryl Williams-Elliston, DC, BS, RT(R)
Associate Degree Radiography Program Gail J. Faig, RT(R)(CV)(CT)
Lincoln Land Community College
Springfield, Illinois Lynne Florio, BS, RT(R)
Dan L. Hobbs, MSRS, RT(R)(CT)(MR)
Tracy L. Herrmann, MEd, RT(R)
Professor Kenneth A. Kraft, PhD, DABR
University of Cincinnati Blue Ash College Janice Martin, BA, RT(R)
Cincinnati, Ohio
Mary Jane S. Reynolds, MAIS, RT(R)(T)
Lisa Marie Menzel, BAS (SM), RT(R), ARRT Terry M. Seals, MS, RT(R)(T)
Didactic Professor
Keiser University Nathan Stallings, MS, RT(R)
Daytona Beach, Florida Leslie Jeanne Stiff-Martin, BA, RT(R)(M)

Andrew Woodward MA, RT(R)(CT)(QM), ARRT Gina Tice, MSRS, RT(R)

Clinical Assistant Professor Beth L. Vealé, PhD, RT(R)(QM)
The University of North Carolina at Chapel Hill
School of Medicine Christa R. Weigel, MSRS, RT(R)(M)(BD)
Chapel Hill, North Carolina
Erica Koch Wight, MEd, RT(R)(M)(QM)
Andrew Woodward, MA, RT(R)(CT)(QM), ARRT

vi
 P R E FAC E
They are placed in a chapter with reference to the appro-
PURPOSE priate physics or imaging chapter. In this way the impor-
The purpose of this textbook is not only to present the sub- tance of the information is emphasized. The following are
jects of physics and imaging within the same cover but also examples:
to link them together so that the student understands how
the subjects relate to each other and to clinical practice. This
textbook follows the ASRT-recommended curriculum and
MAKE THE PHYSICS CONNECTION
covers the content specifications of the ARRT radiography
exam, making it easier for faculty to ensure appropriate Chapter 7
coverage and adequate assessment of content mastery. But Differential absorption is the difference between the x-ray
equally important, it provides the knowledge and informa- photons that are absorbed photoelectrically and those that
tion essential to a competent radiographer. This second edi- penetrate the body.
tion continues to provide up-to-date digital information
as well as appropriately covered film/screen subject matter as
it is phased out of the radiography curriculum and practice.
It provides a smooth and seamless presentation of each MAKE THE PHYSICS CONNECTION
within the subjects of physics and imaging. Chapter 7
Photoelectric interactions occur throughout the diagnostic
UNIQUE FEATURES range (i.e., 20 kVp to 120 kVp) and involve inner-shell orbital
electrons of tissue atoms. For photoelectric events to occur,
This textbook was written by radiographers for radiogra- the incident x-ray photon energy must be equal to or greater
phers in a simple, straightforward, but level-appropriate than the orbital shell binding energy. In these events the inci-
manner. It is a comprehensive radiologic physics and imaging dent x-ray photon interacts with the inner-shell electron of a
text that focuses on what the radiographer needs to know and tissue atom and removes it from orbit. In the process, the
understand to safely and competently perform radiographic incident x-ray photon expends all of its energy and is totally
examinations. To achieve this, the following are some of the absorbed.
book’s unique features:
• Each chapter begins with a rationale for studying the con-
tent of that chapter, addressing the often-asked question
“Why do we need to know this?” The introduction to MAKE THE IMAGING CONNECTION
Chapter 2 below is an example. Chapters 9 and 10
The focus of this chapter is on the structure and nature of the
Kilovoltage peak influences many areas of imaging. Among
atom. Students may wonder why such detailed study of the other things, it determines how the beam penetrates the
atom is necessary for education and training in radiographic body part, controls contrast in the film image, and influences
imaging. The following bullet points address this necessity: contrast in the digital image.
• First, the interactions in the x-ray tube that produce x-rays
occur at the atomic level and the nature of the x-ray photon
produced depends on how an electron interacts with an
atom. MAKE THE IMAGING CONNECTION
• Second, the interactions between the x-ray photons and the Chapter 10
human body also occur at the atomic level, determining both
the radiation dose delivered and how the body part will be The quantity of radiation exposing the patient and ulti-
imaged. mately reaching the image receptor is directly related to
the product of milliamperage and exposure time (mAs).
• Third, the interactions between the x-ray photons exiting the
Therefore exposure to the image receptor can be increased
patient to produce the image interact at the atomic level of
or decreased by adjusting the amount of radiation by
the image receptor to generate the final image. adjusting the mAs.
• Finally, other areas of study in the radiologic sciences
also require a working knowledge of the atom. So it is best to
develop a strong foundation at the outset.
• “Make the Physics Connection” and “Make the Imaging • “Theory to Practice” is a callout that explains to the
Connection” are callouts that further explain and “con- student why a particular concept is important and how
nect” for the student the relationship of physics informa- it will apply to his or her daily practice down the road.
tion to imaging and imaging information to physics. The following are examples:

vii
viii PREFACE

THEORY TO PRACTICE CRITICAL CONCEPT

A single-phase machine may require a higher kVp setting Optical Density and Light Transmittance
than a three-phase or high-frequency machine because of the
For every 0.3 change in optical density, the percentage of
difference in efficiency, but it does not expose the patient to
light transmitted has changed by a factor of 2. A 0.3 increase
a different dose of radiation.
in optical density results from a decrease in the percentage
of light transmitted by half, whereas a 0.3 decrease in optical
density results from an increase in the percentage of light
THEORY TO PRACTICE transmitted by a factor of 2.
Knowing that the average energy of brems is one third of the
kVp selected and that most of the beam is made up of
brems, we can predict the average energy of an x-ray beam
• “Math Application” is a callout that further explains and
to be one third of the kVp selected. gives examples of mathematical formulas and applications
important to the radiographer.

THEORY TO PRACTICE MATH APPLICATION

If more photoelectric events are needed to make a particular Adjusting Milliamperage and Exposure Time
structure visible on a radiographic image (when, for example, to Maintain mAs
the tissues to be examined do not have high–atomic number
atoms), contrast agents such as barium or iodine are added. 100 mA  100 ms (0.1 s)  10 mAs
These agents have high atomic numbers and thereby in-
To maintain the mAs, use:
crease the number of photoelectric events in these tissues.
Protective shielding is another way of using photoelectric 50 mA  200 ms (0.2 s)  10 mAs
interactions. Lead has a very high atomic number and is used
as a shielding material because the odds are great that 200 mA  50 ms (0.05 s)  10 mAs
photons will be absorbed by it.

• “Critical Concept” is a special callout that further explains MATH APPLICATION

and/or emphasizes the key points of the chapter. The fol- Using the 15% Rule
lowing are some examples.
To increase exposure to the IR, multiply the kVp by 1.15
(original kVp 1 15%).
CRITICAL CONCEPT
80 kVp  1.15  92 kVp
Ability to Ionize Matter
The highest-energy members of the electromagnetic spec- To decrease exposure to the IR, multiply the kVp by 0.85
trum, x-rays and gamma rays, have the ability to ionize matter. (original kVp 2 15%).
This is an extremely important differentiating characteristic in
that this characteristic can cause biologic changes and harm 80 kVp  0.85  68 kVp
to human tissues.
To maintain exposure to the IR, when increasing the kVp by
15% (kVp 3 1.15), divide the original mAs by 2.

CRITICAL CONCEPT 80 kVp  1.15  92 kVp and mAs/2

The Line-Focus Principle and Anode Heel Effect
When decreasing the kVp by 15% (kVp 3 0.85), multiply the
The rotating anode design uses the line-focus principle, mAs by 2.
which means that the target face is angled to create a large
80 kVp  0.85 and mAs  2
actual focal spot for heat dissipation and a small effective
focal spot for improved image quality. But by angling the face,
the “heel” of the target is partially placed in the path of the
x-ray beam produced, causing absorption and reduced inten- • Stressed in many areas of the textbook is the radiographer’s
sity of the beam on the anode side. responsibility to minimize patient radiation dose and to
practice radiography in a safe and ethical manner. The
following are some excerpts from chapters as examples.
CRITICAL CONCEPT
X-ray Photon Absorption (From Chapter 12 regarding digital imaging) The idea that
excessive mAs can be used to avoid repeats is flawed logic
During attenuation of the x-ray beam, the photoelectric effect and a violation of the ARRT/ASRT codes of ethics and the
is responsible for total absorption of the incoming x-ray
ALARA principle. Although the computer can rescale and
photon.
adjust for overexposure, it does not change the fact that the
 PREFACE ix

patient receives a higher-than-necessary dose of radiation. (From Chapter 15 regarding mobile radiography) A radiog-
Historically, radiographers using film-screen systems main- raphy suite is a “controlled” and shielded environment spe-
tained a 5% or less repeat rate for all causes of repeat (posi- cially designed for radiographic imaging. In a mobile envi-
tioning error, exposure, equipment malfunction, etc.). As- ronment, however, radiographers must take responsibility for
suming the same level of competence in a digital environment, radiation protection for themselves, the patient, and other
to overexpose 95% of the patient population to avoid the individuals within close proximity. Radiographers should
very small percentage of repeats due to exposure factors is wear a lead apron during the radiation exposure and stand as
flawed logic. far from the patient and x-ray tube as possible (at least 6 feet).
Shielding of the patient and other individuals who must re-
(From Chapter 13) Technique charts make setting technical main in the room should be performed as in the radiology
factors much more manageable, but there are always patient department.
factors that require the radiographer’s assessment and judg- • New to this second edition are “Critical Thinking Ques-
ment. When using AEC systems, the radiographer must still tions” and “Review Questions” at the end of each chapter
use individual discretion to select an appropriate kVp, mA, to aid the student and instructor in assessing comprehen-
image receptor, and grid. sion of presented material.
AC K N OW L E D G M E N T S

We would first like to acknowledge those who have mentored to Laura Bayless, Content Development Specialist, and Laurie
us to become the educators, professionals, and researchers Gower Content Development Manager for coordinating,
we are today. A simple thank you does not seem enough but organizing, and guiding us through this second edition.
is heartfelt and offered here. Also a special thanks to Patrick Johnston for taking many
We also acknowledge our families for their continued of the photographs in this text.
support and understanding as we worked on this edition. Finally, we would like to acknowledge and thank all
To Rebecca Keith, thank you for your work on the the reviewers of this edition. It was with your thoroughness,
CT chapter and test bank. Your expertise has added greatly constructive criticism, and attention to detail that we pol-
to this work. ished and refined this textbook.
A special thank you to Sonya Seigafuse, Executive Content
Strategist, for getting this project approved and moving, and jnj/tlf

x
 CONTENTS

Contributors and Reviewers, vi

Preface, vii

1 Introduction to the Imaging Sciences, 1

SECTION I:  Principles of Radiation Physics, 15

2 Structure of the Atom, 16
3 Electromagnetic and Particulate Radiation, 25
4 The X-ray Circuit, 32
5 The X-ray Tube, 50
6 X-ray Production, 61
7 X-ray Interactions with Matter, 73

SECTION II:  Image Production and Evaluation, 81

8 Image Production, 82
9 Image Quality and Characteristics, 92
10 Radiographic Exposure Technique, 117
11 Scatter Control, 139
12 Image Receptors, 156
13 Exposure Technique Selection, 186

SECTION III:  Specialized Radiographic Equipment, 204

4 Image Intensified Fluoroscopy, 205
1
15 Additional Equipment, 219
16 Computed Tomography, 227

Appendix A: Answers to Review Questions, 249

Glossary, 250

Index, 257

xi
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 1
Introduction to the Imaging Sciences

OUTLINE
Discovery and Use of X-rays Radiographic Equipment
Dr. Roentgen’s Discovery The Fundamentals of Radiation Protection
Overview of X-ray Evolution and Use Summary
General Principles
Units of Measure

OBJECTIVES
• Discuss key events in the discovery and evolution of the • Identify the general components of permanently installed
use of x-rays. radiographic equipment.
• Apply general physics fundamentals, including recogni- • Describe the basic role and function of the general com-
tion of units of measure and basic calculations. ponents of a permanently installed radiographic unit.
• Define and use radiologic units of measure. • Apply the basic principles of radiation protection.

KEY TERMS
acute radiodermatitis fluoroscope mobile equipment
cathode ray tube fundamental quantities permanently installed equipment
derived quantities ionizing radiation radiologic quantities

This chapter begins with an overview of the discovery of art” laboratory (for its time) that Dr. Roentgen forever
x-radiation and the evolution of its adoption and use in soci- changed the world of medicine.
ety. Presented next is an introduction to general physics and The story of Dr. Roentgen’s discovery of x-rays has been
the units of measure used in radiologic science. Finally, the recounted with some variability. The general and important
general components of a radiographic suite are described and aspects are presented here, but attempts to establish a full and
illustrated, along with basic principles for safe operation of detailed picture have been complicated by Dr. Roentgen himself:
radiographic equipment. In his last will and testament he requested that, on his death, all
of his laboratory notes and books be destroyed unread. Many
DISCOVERY AND USE OF X-RAYS specifics of his research, however, may be found in his own
publications of the discovery and in some of the biographies
Dr. Roentgen’s Discovery and stories from his friends and colleagues. What is most impor-
Dr. Wilhelm Conrad Roentgen (Figure 1-1) was born March tant to remember, beyond his discovery, is the superb investiga-
27, 1845, in Lennep, Germany. His public education and tive and scientific skill with which he researched this “x-light,”
academic career were marked by struggle, not for lack of as he called it (x being the term representing the unknown).
intelligence but for want of opportunity. Following an unfor- Late on a Friday afternoon, November 8, 1895, Dr. Roent-
tunate prank perpetrated by a classmate, he was expelled gen was working in his laboratory. He had prepared a series
from school because he would not name the perpetrator. This of experiments involving a cathode ray tube of the Crookes
began his struggle to find a place in a university to study. He type (it may have been a Hittorf tube, but the general design
eventually triumphed, receiving his PhD degree from the and features of both types are the same: a partial vacuum
University of Zurich in 1869. He did, however, continue to tube that produces an electron stream). The nature of cath-
struggle initially to establish himself as a professor and acade- ode rays was of interest to many scientists of the day, and
mician. Again, as a credit to his scientific skill and knowledge, much experimentation was being conducted. On this partic-
he achieved considerable success, most notably being named ular evening, after setting up the tube and preparing for
director of the then newly formed Physics Institute at the the evening’s experiments, Dr. Roentgen completely covered
University of Wurzburg in 1894. It was in this “state of the the tube with black cardboard to continue his study of the
1
2 CHAPTER 1  Introduction to the Imaging Sciences

FIG 1-2  ​First Radiograph Created by Dr. Roentgen. Image

is of Dr. Roentgen’s wife’s hand. Note the ring on her fourth
digit.  (From Glasser O: Wilhelm Conrad Roentgen and the
early history of the roentgen rays, 1933.)

FIG 1-1  Dr. Wilhelm Conrad Roentgen. (From Glasser O:

Wilhelm Conrad Roentgen and the early history of the roentgen He completed his investigation and wrote the first of three
rays, 1933.) communications (informal papers) on the subject. He
submitted the first communication to the secretary of the
fluorescent properties of the cathode rays. On a table a few Wurzburg Physical Medical Society on December 29, 1895,
feet away was a piece of cardboard painted with barium and asked that it be published in advance of his scheduled
platinocyanide. On beginning his experiments, he noticed presentation to the society on January 23, 1896. The content
that the piece of cardboard fluoresced each time the tube was of this first communication spread like wildfire through the
energized. He had already verified that the cause could not be scientific community well in advance of his oral presentation
the visible light because he had covered the tube with the and announcement. His discovery and investigation results
black cardboard and checked to be sure no light escaped. He were received around the world with much excitement. He
also knew, according to the common knowledge of the day, completed and published two more communications on the
that the cathode rays could not penetrate the glass walls subject, concluding his initial investigation and results.
of the tube. He moved the barium platinocyanide–coated
cardboard closer and started his fevered investigation of this Overview of X-ray Evolution and Use
unknown light. He was consumed by a desire to understand As noted previously, during Dr. Roentgen’s investigation of
this phenomenon and spent the next 7 weeks investigating it. x-rays (the term we use today instead of “x-light”), he noticed
It is said that he even took his meals in his laboratory and had in one series of experiments that the bones of his hand were
his bed moved there to facilitate his research. So thorough visible on a barium platinocyanide screen. To capture such an
was his investigation that he described practically every prop- image, he experimented with exposing photographic plates
erty of x-rays that we know today. As a part of his investigation, to x-rays and found that they did indeed expose the plate,
he asked his wife to allow him to “photograph” her hand with creating a “photograph.” As part of his initial communica-
this new x-light, and, on December 22, 1895, he produced the tions and presentation, he included the famous “photograph”
first radiograph (Figure 1-2). A profession was born. (now properly referred to as a radiograph) of his wife Bertha’s
hand. The publication of this radiograph led to an almost
CRITICAL CONCEPT 1-1 immediate recognition of the medical value of x-rays. Others
Discovery of X-rays around the world began experimenting with the radiography
of different parts of the body. Physicians readily embraced
Dr. Wilhelm Roentgen discovered x-rays on November 8, this new technology and immediately put it to use to find
1895, while experimenting with a Crookes cathode ray tube.
bullets, kidney and gallbladder stones, and broken bones. The
So thorough was his investigation that he discovered practi-
public was also fascinated by x-rays; because they produced a
cally every property of x-rays we know today.
“photograph,” most considered them a form of light.
 CHAPTER 1  Introduction to the Imaging Sciences 3

In the early days, the cathode ray tubes and generators used Initially the scientific community thought that x-rays were
for such exposures were inefficient and the x-ray output var- harmless because they did not stimulate any of the senses.
ied considerably in quantity and quality. Exposure times were Even though there were early reports of radiation injuries,
commonly in the 20- to 30-minute range; some exposures physicians focused on the beneficial uses of x-rays to treat
took up to 2 hours. Because of this, the early ventures into some skin conditions and ignored these warning signs.
medical imaging came at a price. Many patients and operators Furthermore, because radiation burns did not occur during
suffered from acute radiodermatitis (radiation burns). There or immediately after the exposure, many in the medical com-
were even cases of electrocution of the operator in setting up munity did not make the connection and often attributed the
the equipment for exposure because the equipment was not burns to the electrical effects surrounding x-ray production
enclosed, grounded, and shielded as it is today (Figure 1-3). such as heat and glow from the electrical arc. Some thought
that x-rays were a natural part of sunlight and the burns were
just a form of sunburn.
Thomas Edison brought some attention to the dangers
of x-rays. He suffered a radiation burn to his face and injury
to his left eye from his experimentation with x-rays and
discontinued his investigations. Edison’s assistant, Clarence
Dally, did not cease investigation and truly suffered for it.
Because of his experiments, Dally developed severe radia-
tion burns. The only treatment of his day for such injuries
was amputation, and during the course of his experiments
(1897–1903) his left hand above the wrist, four fingers of
his right hand, his left arm above the elbow, and finally the
right arm at the shoulder were all amputated. At the end of
his life, he was in such pain that he could not lie down and
in 1904 died an agonizing death. Many of the early injuries
FIG 1-3  ​1900s Physician’s Office. Image of circa 1900 x-ray were to “technicians” (as they were initially called) and
machine setup in a physician’s office. Note the x-ray tube sus- doctors who worked with x-rays, and amputations and
pended above the patient and the open nature of the electrical gloved hands became an identifying trait of their profession
wiring and tube. (Photo courtesy Alex Peck Medical Antiques.) (Figure 1-4).

FIG 1-4  ​X-ray Dermatitis. Picture

of x-ray dermatitis and resultant
amputations. Often gloves were
worn to cover these injuries and
amputations.  (From Pancoast HK:
***Amer Quart Roentgen 1:67,
1906.)
4 CHAPTER 1  Introduction to the Imaging Sciences

By 1900, improved imaging plates, equipment, and tech- quickly, “x-ray prophylactics” would prevent a long list of
niques had all but eliminated acute radiodermatitis, but diseases, and even “x-ray golf balls” would fly farther and
there was still a rather carefree attitude toward investigation straighter! Examples of such advertisements are presented
and use of x-rays. Within the medical community, recogni- in Figure 1-5. Of course x-rays had nothing to do with any
tion of the problems and early efforts to minimize them of these products’ effectiveness, only their improved sales.
were underway, but x-rays had also captured the public’s There were, however, actual applications of x-ray machines.
imagination in other ways. Immediately following the dis- One such application was the shoe fitter (Figure 1-6). This
covery and announcement, the public imagination went was a fluoroscope apparatus (a device that allows dynamic
wild with speculation. Imagine a ray that could see through x-ray examination using x-rays and a fluorescent screen)
human flesh! Hopes abounded for this new, mysterious placed in shoe stores to help with the proper fitting of shoes.
light, and there was speculation that it would soon be incor- The advertisement claimed that such machines were vital
porated into a machine that could miraculously cure a host to ensure comfort through the proper alignment of the
of mortal ills. The term x-ray appeared as the subject of bones of the foot within the shoe. Some advertisements
poems, songs, and plays. It also appeared in advertisements stated that this was of particular importance in fitting
for polishes, ointments, batteries, and powders, and the list children’s shoes. Consider the radiation dose that a child
goes on. Opportunistic advertisers and manufacturers took might have received during such a fitting or while playing
advantage of the glamour and mania of the word x-ray and with the machine as entertainment while a mother and
incorporated it into a host of products. Advertisements father shopped! The radiation dose to the salesmen, parents
claimed that “x-ray stove polish” would clean your stove standing beside the device, and other customers was likely
better, “x-ray headache tablets” would cure your headache high too!

FIG 1-5  ​Products Taking Advantage of “X-ray Mania.” Advertisements using the glamour
of the word x-ray circa 1900.  Rights were not granted to include this content in electronic
media. Please refer to the printed book. (Reprinted with permission from RadioGraphics and
Dr. Ed Gerson.)

 CHAPTER 1  Introduction to the Imaging Sciences 5

To better organize how quantities are measured, units are

divided and then subdivided. The foundations of these
divisions are the fundamental quantities of mass, length,
and time. Each of these is defined using an agreed-on stan-
dard, which will be discussed shortly. By combining these
fundamental quantities, the derived quantities of velocity,
acceleration, force, momentum, work, and power are formed.
These formulas form the foundation of the general language
FIG 1-6  ​Shoe-Fitting Fluoroscope. Shoe-fitting fluoroscope of physics. Finally, from these quantities special categories
circa 1930–1940.  (Reprint courtesy Oak Ridge Associated of measure are derived for radiologic science; these are the
Universities.) special radiologic quantities of dose, dose equivalent, expo-
sure, and radioactivity. See Figure 1-7 for an illustration of
this concept.
CRITICAL CONCEPT 1-2 To give true meaning to these quantities, an agreed-on
Lessons Learned unit of measure is needed. The two systems of measure
commonly used in the radiologic sciences are the British
The discovery of x-rays captivated the imagination of the
system, and the system international (SI) or metric system.
medical community and the general public. The value of their
use in medicine was quickly recognized and developed.
The British system uses the pound as the unit of measure
Through trial and error, injuries, and even deaths, the medical for mass, the foot as the unit of measure for length, and
community learned the dangers of x-rays and how to use the second as the unit of measure for time. The SI uses
them safely. the kilogram to quantify mass, the meter for length, and the
second to measure time.
Mass is the quantity of matter contained in an object;
matter is anything that occupies space, has shape or form,
GENERAL PRINCIPLES and has mass. Mass does not change with gravitational
Understanding radiologic physics is vital to the radiogra- force. Mass also does not change if the substance changes
pher’s role as a medical imaging professional and his or form. If 3 kilograms of water are frozen, the large ice cube
her ability to safely and responsibly use ionizing radiation created still has 3 kilograms of mass. If that ice is melted
(radiation with sufficient energy to ionize atoms) for that and boiled away, the water vapor added to the air is still
purpose. A primary goal of this text is to relate the x-ray 3 kilograms. The British system uses the pound to quantify
production process to the imaging process. To understand mass. The pound is actually a measure of the gravitational
radiologic physics, one must first speak the language of phys- force exerted on a body, also known as weight. Such a defini-
ics in general. Although the radiographer may not necessarily tion varies according to the environment. For example, a
use the general physics formulas covered here, knowledge of person weighing 120 pounds on Earth weighs 20 pounds on
these formulas does promote understanding of the radiologic the moon. The SI uses the kilogram to quantify mass. The
concepts covered later in this text. The radiographer must kilogram is based on the mass of 1000 cubic centimeters of
also understand the basic and special radiologic quantities water at 4° C. This measure is a constant that does not vary
and units of measure because both are used regularly in with environment.
medicine. The SI unit of measure for length is the meter, which is
now defined as the distance that light travels in 1/299,792,458
Units of Measure of a second. The British system now bases the foot on a frac-
In our daily lives, units of measure are a routine and impor- tion of a meter.
tant part of our communication with each other. A unit of
measure must be agreed on and understood by a society to
mean the same thing to all of its members. In the United
States, for example, a road sign may simply present the name
of the next city or town followed by a number. All licensed Special
drivers in the United States are expected to know that the quantities
number is expressed in miles. A visitor from Europe may take
Derived
this distance to be in kilometers and think the city or town is quantities
closer than it really is.
In medicine such misinterpretations can be very danger-
Fundamental
ous to patients. When dealing with quantities in fields of
quantities
medicine, it is critical to not only use a commonly under-
stood unit of measure but to always use the correct unit. For FIG 1-7  ​Quantities Pyramid. Fundamental quantities are the
example, there is a big difference between a dose of 1 mg and foundation units. Derived quantities and special radiologic
1 gm of a particular drug. quantities are derived from these.
6 CHAPTER 1  Introduction to the Imaging Sciences

The second is the unit of measure for time in both sys- Force is a push, a pull, or other action that changes the
tems. This unit of measure has also gone through several motion of an object. It is equal to the mass of the object mul-
definitions but is now measured by an atomic clock that is tiplied by the acceleration. The formula is F 5 ma, in which
based on the vibration of cesium atoms. m is mass and a is acceleration. Its unit of measure is the
By combining these fundamental quantities mathemati- newton (N). In this derived quantity, the fundamental quan-
cally, one can create derived quantities. Of particular interest tities of mass, length, and time are used. Distance (length)
to radiologic physics are the derived quantities of velocity, and time are derived from the use of acceleration; remember
acceleration, force, momentum, work, and power. To calcu- that acceleration is based on velocity. Notice how each of the
late these derived quantities, fundamental quantities and in derived quantities can be traced back to one or more funda-
some cases other derived quantities are used. mental quantities.
Example: What is the force necessary to move a 50-kg cart
at a rate of 2 m/s2?
CRITICAL CONCEPT 1-3 Answer: F 5 50 3 2 5 100 N
Units of Measure Momentum is equal to the mass of the object multiplied
by its velocity. The formula is p 5 mv, in which p is momen-
Units of measure are agreed-on standards that give meaning
tum, m is mass, and v is velocity. Its unit of measure is
to specified quantities. Whether the British system or SI is
being used, the values and units must be understood by all
kilograms-meters per second (kg-m/s). Again, mass, length,
parties concerned. The fundamental quantities can be com- and time are used. Length (distance) and time are derived
bined mathematically to create derived and special quantities from the use of velocity.
for more specific applications. Example: What is the momentum of an object with a mass
of 15 kg traveling at a velocity of 5 m/s?
Answer: p 5 15 3 5 5 75 kg-m/s
Velocity is equal to distance traveled, divided by the time Work is an expression of the force applied to an object
necessary to cover that distance. The formula is v 5 d/t, and multiplied by the distance across which it is applied. The
its unit of measure (quantity) is meters per second (m/s). To formula is work 5 Fd, and the unit of measure is the joule
determine this derived quantity (velocity), the fundamental (J). The fundamental quantities of mass, length, and time are
quantities of length and time are used. used. Mass and time are derived from the use of force.
Example: What is the velocity of a baseball that travels Example: What is the work done if a force of 10 N is ap-
20 meters in 2 seconds? plied to a cart across a distance of 20 meters?
Answer: 20/2 5 10 m/s Answer: 10 3 20 5 200 J
Power is equal to work divided by time during which work
MATH APPLICATION 1-1 is done. The formula is P 5 work/t, and the unit of measure
is watts (W). The fundamental quantities of mass, length, and
Velocity is a measure of speed. In radiologic sciences, x-rays
time are used to find power. Mass and length are derived
have a constant velocity equal to the speed of light, or 3 3
from the use of work.
108 m/s. This value is used throughout the study of radiologic
physics. Example: What is the power consumed if 100 J of work is
performed in 60 seconds?
Answer: P 5 100/60 5 1.67 W
Acceleration is found by subtracting the initial velocity of Inertia is the property of an object with mass that resists a
an object from its final velocity and dividing that value by the change in its state of motion. In fact, mass is a measure of the
time used. The formula is a 5 (vf 2 vo) / t in which vf is the amount of inertia that a body possesses. Inertia applies to
final velocity, vo is the original velocity, and t is time. The unit objects in motion and objects at rest. In the 17th century, Sir
of measure is meters per second squared (m/s2). Here, too, Isaac Newton first described the principle of inertia, which
the fundamental quantities of length and time are used. Dis- came to be known as “Newton’s first law of motion.” This law
tance (length) is derived from the use of the derived quantity states that an object at rest will stay at rest unless acted on by
of velocity. an external force. An object in motion will remain in motion
Example: What is the acceleration of a baseball if the ini- at the same velocity and in the same direction unless acted on
tial velocity is 0, the final velocity is 10 m/s, and the time of by an external force. Inertia is solely the property of mass,
travel is 2 seconds? and all objects with mass have inertia. Objects in motion have
Answer: (10 2 0)/2 5 5 m/s2 the additional characteristic of momentum. As noted previ-
ously, momentum is the product of mass and the velocity at
which the mass is moving.
MATH APPLICATION 1-2 Energy is simply the ability to do work. It has two states,
which are referred to as potential energy and kinetic energy.
Acceleration represents changes in velocity. In the radiologic
Potential energy is energy in a stored state. It has the ability
sciences, acceleration of electrons within the x-ray tube is
to do work by virtue of state or position. A battery sitting on
necessary for x-ray production.
a shelf has potential energy in a stored state. Kinetic energy is
 CHAPTER 1  Introduction to the Imaging Sciences 7

energy being expended. In other words, it is in the act of To convert roentgens to coulombs/kilogram multiply the
doing work. The energy in a battery that is running an elec- roentgen value by 2.58 3 1024 (0.000258).
tronic device is being expended and is thus in a kinetic state. Example: What is the SI equivalent of 5 R?
Energy exists in a variety of forms such as electromagnetic Answer: 5 3 0.000258 5 0.00129 C/kg or 1.29 3 1023 C/kg
(the form of energy with which radiologic science is most The rad is used to quantify the biologic effects of radiation
concerned), electrical, chemical, and thermal. Electromag- on humans and animals. It is a unit of absorbed dose. It gives
netic energy is a form of energy that exists as an electric and measure to the amount of energy deposited by ionizing
magnetic disturbance in space. Electrical energy is a form radiation in any “target” (tissues, objects, etc.), not just air.
that is created by the flow of electricity. Chemical energy is a One rad is the equivalent of 100 ergs/g. An erg is a unit of
form that exists through chemical reactions. Thermal energy energy equal to 1027 joules. Therefore, 100 ergs/g means
is a form of energy that exists because of atomic and molecu- that 1025 joules of energy are transferred per gram of mass.
lar motion. In the production of a radiographic image, one is The gray is the SI equivalent, and the relationship between
able to trace the transformation of energy from one form to the two is:
another to create the image.
1rad 5 1022 Gy (0.01 Gy)
Practically everything can be categorized as matter, energy,
or both. Albert Einstein’s famous formula, E 5 MC2, is an To convert rad to Gray multiply the rad value by 0.01.
expression of the relationship between matter and energy. In Example: What is the SI equivalent of 25 rad?
this formula E is energy (expressed in joules); M is mass (the Answer: 25 3 0.01 5 0.25 Gy
quantity of matter contained in an object); and C represents The rem is used to quantify occupational exposure or dose
a constant, in this case the speed of light. What this equation equivalent. This unit specifically addresses the different bio-
shows us is that matter can be transformed into energy and logic effects of different types of ionizing radiation to which
energy can be transformed into matter. a radiation worker may be exposed. The SI equivalent is the
Now we move to the special radiologic quantities. These sievert and the relationship between the two is:
quantities are uniquely used to quantify amounts or doses of
1 rem 5 1022 Sv (0.01 Sv)
radiation based on its effects. The standard units are the
roentgen (R), rad, rem, and curie (Ci) (note that rad stands To convert rems to Seiverts multiply the rem value by 0.01.
for radiation absorbed dose and rem stands for radiation Example: What is the SI equivalent of 300 rem?
equivalent man and they have no abbreviation). The SI units Answer: 300 3 0.01 5 3 Sv
are the coulomb/kilogram (C/kg), gray (Gy), sievert (Sv), and The curie is used to quantify radioactivity. This unit is an
the Becquerel (Bq). The SI equivalent for the roentgen is the expression of a quantity of radioactive material, not the
coulomb/kilogram, for the rad it is the gray, for the rem it is effect of the radiation emitted from it. One curie is that
the sievert, and for the curie it is the Becquerel. Each of the quantity of radioactive material in which 3.7 3 1010 atoms
units has specific applications. disintegrate every second. Disintegration or decay is the
process whereby a radioactive atom gives off particles and
CRITICAL CONCEPT 1-4 energy in an effort to regain a stable state. The SI equivalent
Radiologic Units of Measure is the Becquerel, which is quantifying the number of indi-
vidual atoms decaying per second. The relationship between
The radiologic units of measure are uniquely used to quantify the two is:
amounts or doses of radiation based on its effects. Which
unit of measure is applied depends on what is being mea- 1 Ci 5 3.7 3 1010 Bq
sured. The rem, for example, is used specifically for quantify-
ing dose received by radiation workers.
To convert curies to Becquerels multiply the curie value by
3.7 3 1010 (37,000,000,000)
Example: What is the SI equivalent of 4 Ci?
The roentgen is used to quantify radiation intensity. It is Answer: 4 3 37,000,000,000 5 148,000,000,000 or
equal to that quantity of radiation that will produce 2.08 3 109 1.48 3 1011 Bq
ion pairs in a cubic centimeter of air. An ion pair is an electron Radiographers routinely use these radiologic units of
removed from an atom and the atom from which it came. The measure and come to know them well. Radiographers may
two together are an ion pair. The coulomb/kilogram is a mea- not often use general physics units, but they serve as vehicles
sure of the number of electrons liberated by ionization per for understanding what is to come. All play a role in the radi-
kilogram of air. Ionization is the removal of electrons from ography student’s education.
atoms. More precisely, 1 coulomb is the charge associated with
6.24 3 1018 electrons. The roentgen or coulomb/kilogram is THEORY TO PRACTICE 1-1
generally used as a unit of measure for such phenomena as the
output intensity of x-ray equipment or intensity in air. The The radiographer must know and understand the radiologic
relationship between the two is: units of measure because such things as dosimetry reports,
medical physicists’ reports, x-ray equipment performance
specifications, and so on all use these units of measure.
1R 5 2.58 3 1024 C/kg
8 CHAPTER 1  Introduction to the Imaging Sciences

The x-ray tube, collimator, and tube stand can be dis-

RADIOGRAPHIC EQUIPMENT cussed together as the tube head assembly. The x-ray tube is a
Generally, radiographic equipment may be classified as mo- special diode (two electrodes) tube that converts electrical
bile or permanently installed. Mobile equipment, as its name energy into x-rays (and produces heat as a byproduct). The
implies, is a unit on wheels that can be taken to the patient’s positive electrode is called the anode, and the negative elec-
bedside, the emergency department, surgery, or wherever it trode is called the cathode. The tube is oriented so that gener-
may be needed. Mobile equipment is discussed in detail later ally the anode is over the head of the table and the cathode is
in this textbook. over the foot. When facing the x-ray tube assembly, the anode
It is helpful to understand the basic layout of an x-ray suite is typically on the radiographer’s left and the cathode is on
before delving into the principles of x-rays and x-ray produc- the right. See Figure 1-8.
tion. Permanently installed equipment refers to units that Because both heat and x-rays are produced, the tube is
are fixed in place in a particular room specifically designed encased in a special tube housing. This housing is made of
for the purpose and are not intended to be mobile. Lead metal and has a special mounting bracket for the x-ray tube
shielding (or lead equivalent) is used in the walls, doors, and and high-voltage receptacles to deliver electricity to the x-ray
floors, and other design features are implemented to restrict tube. The housing is also filled with oil that surrounds the
the radiation produced to the confines of that room. Perma- x-ray tube to help dissipate the heat produced. Cooling
nently installed does not mean that it can never be removed, fans are also built into the housing to help dissipate heat
of course, just that it cannot be wheeled to another location. (Figure 1-8).
Normally, when new equipment is purchased, the old unit The collimator is a box-shaped device attached to the bot-
must be uninstalled and the new unit installed. The room is tom of the housing (Figure 1-8). The collimator serves to
generally out of use for a week or so while the process takes restrict the x-ray beam to the area of interest of the body and
place, and the radiology manager must plan for this down- to help localize the beam to that area. To restrict the beam,
time in the work schedule. For the most part, such equipment the collimator is fitted with two pairs of lead shutters. Two
is found in the radiology department, but permanently in- buttons on the face of the collimator adjust these shutters.
stalled equipment (radiographic rooms) may also be found One button controls the shutters that adjust the width of the
in large emergency departments, special surgery suites, out- beam, and the other button controls the shutters that adjust
patient centers, and free-standing imaging centers. the length of the beam.
Permanently installed equipment consists of the tube, The collimator also contains a light source, a mirror, and
collimator, table, control console, tube stand, and wall unit. a clear plastic covering over the bottom with crosshairs im-
Bear in mind that all of these components are discussed spe- printed on it. The mirror reflects the light source through the
cifically at the appropriate place in this textbook. A general plastic and casts a shadow of the crosshairs onto the patient.
overview is provided here, as is a discussion of equipment The shutters adjust the size of the light field, which represents
manipulation. the radiation field that will be produced. The light field and

Housing
High-voltage
receptacle

X-ray tube

Port between housing

and collimator Collimator

Light source Mirror

Shutters (one
of each pair)

Plastic bottom covering

with cross hairs
FIG 1-8  ​Tube Head Assembly. Housing, x-ray tube, and collimator components.
 CHAPTER 1  Introduction to the Imaging Sciences 9

crosshairs show the radiographer the dimensions of the x-ray A slight modification to this is the floor-wall mount, in which
field and where it will enter the patient’s body. If this tube the other point of attachment is a wall rail rather than a ceil-
head assembly is mishandled, the collimator mirror can, ing attachment. Both variations add a second point of attach-
like a car’s rearview mirror, be bumped out of adjustment. ment, which adds stability. The choice is merely a matter of
Periodically, a quality-control test, called a radiation field/ determining which system is easier or more feasible to install.
light field congruence test, is conducted to check this mirror. Both have the same limitations in movement as the floor
The tube stand or tube mount is the portion of the tube mount and are best suited to the same type of environment
head assembly that gives mobility to the x-ray tube; this af- and workload as the floor mount.
fords the radiographer the flexibility to image from a variety The overhead tube assembly (ceiling mount) is the most
of angles and the ability to accommodate the patient’s condi- widely used in the hospital setting and the most versatile in
tion. There are three basic configurations of the tube stand: design (Figure 1-9, B). With this design, two rails are mounted
the floor mount, the floor-ceiling (or floor-wall) mount, and on the ceiling running along the long axis of the room. To
the overhead tube assembly (sometimes called ceiling mount) this is attached an overhead tube crane. This device moves
(Figure 1-9). the length of the room (with the long axis of the table) along
The floor mount consists of a horizontal track (rail) the rails. The crane itself allows the tube to move side to side
mounted on the floor parallel to the long axis of the table, a (the width of the room and table) as well as to telescope up
vertical piece that rides on the rail, and an arm to which the and down (toward the table), rotate about its axis, and roll
x-ray tube is attached. The vertical piece allows for move- horizontally to point toward a wall. It is often necessary to
ment along the length of the table (by riding on the horizon- perform cross-table examinations and examinations requir-
tal track) and rotation about its axis. The arm that holds the ing the tube to be angled in relation to the body part being
x-ray tube moves up and down along the vertical piece and examined. This design allows for maximum flexibility and
telescopes in and out across the width of the table. Finally, the movement of the tube to do this.
tube also rotates about the axis of the arm to allow angulation The modern table for a general radiography room permits
of the tube. This type of assembly is fairly limited in its height adjustment so that the patient can easily get on and off
application and generally is best suited to low-volume the table and so that the radiographer can place the table at a
workloads and basic examinations. comfortable work height (Figure 1-9, B). It also has a four-
The floor-ceiling mount is a variation of the floor mount way floating top with electromagnetic locks. The locks release
(Figure 1-9, A). It works basically the same, but the second with a foot pedal (not shown), and the table top then floats
point of attachment for the vertical piece adds stability. easily in any direction for ease in patient positioning. Just

A B
FIG 1-9  ​Tube Mount Variations. A, A floor–ceiling mount. Note the rails along the floor and
ceiling. B, An overhead tube assembly with ceiling-only rails and a telescoping tube crane. This is
the most versatile of such designs.
10 CHAPTER 1  Introduction to the Imaging Sciences

under the table top is a Bucky assembly. This device has a CRITICAL CONCEPT 1-5
tray and locks to hold the image receptor in place and a grid
ALARA Principle
positioned between the patient and image receptor to reduce
scatter radiation in the remnant beam (x-ray beam exiting It is the radiographer’s responsibility to minimize radiation
the patient) before it exposes the receptor. The grid is dis- dose to the patient, oneself, and others in accordance with
cussed fully in a later chapter. In direct-capture digital equip- the As Low As Reasonably Achievable (ALARA) Principle.
ment, the Bucky assembly is different in that the receptor is
built into the assembly, but its location is the same.
A variation of this table, used with fluoroscopy equip- It is often easier to learn and remember subject matter
ment, has a chain drive and motor to move the tabletop side when one understands the rationale and need to do so. In this
to side and head to foot. It also has a mechanism to tilt the case, as previously stated, it is the radiographer’s responsibil-
table 30 degrees toward the head and 90 degrees toward the ity to limit radiation dose to the patient, oneself, and others,
feet. This allows the radiographer to place the patient in and it is a violation of the American Registry of Radiologic
the Trendelenburg position (head down) or in a standing Technologists/ American Society of Radiologic Technologists
position. In these positions it would jeopardize patient safety (ARRT/ASRT) Code of Ethics (and in many cases state licen-
to release the table to float freely. It would also be very sure laws) to do otherwise. This should not be taken as a
difficult to manually tilt the table. In both instances a negative motivator for the reader but rather a moral and
chain-driven top allows for controlled, motor-assisted move- professional obligation.
ments. The fluoroscope is discussed in a later chapter. The ARRT certifies individuals (on passing the certifying
The wall unit consists of a vertical rail assembly affixed to examination) as competent to be entry-level radiographers
the wall and floor and a vertical Bucky assembly. The rail and maintains a registry of individuals who maintain that
allows for adjustment of the height of the vertical Bucky. The competence through continuing education and recertifica-
vertical Bucky is the same as the horizontal Bucky in the table tion. As a part of this process they have a Standards of
and serves the same purpose. The wall unit allows the radiog- Ethics document that consists of two parts: Code of Ethics
rapher to easily perform an upright examination. and Rules of Ethics. Item number 7 of the current docu-
Finally, the control panel provides the radiographer with ment (ARRT 2013) deals most directly with radiation pro-
control of all the parameters necessary to produce a diagnos- tection. It specifically states that the radiographer is to
tic image. The radiographer uses the control panel to select demonstrate “expertise in minimizing radiation exposure to
the kilovoltage and milliamperage that is applied to the x-ray the patient, self, and other members of the healthcare team.”
tube to produce x-rays. There are other automated functions With this obligation established, how does one minimize
available to the radiographer, such as the anatomic program, radiation dose?
the focal spot, the automatic exposure control, and Bucky
selection, as well as details of kilovoltage and milliamperage CRITICAL CONCEPT 1-6
selection. These are discussed later in the text. For now, re- ARRT/ASRT Code of Ethics
member that these features of the control panel allow the
Established principles of professional conduct that articulate
radiographer to modify and fine-tune exposure parameters
the radiographer’s responsibility to minimize radiation expo-
to obtain the best image. From a physics standpoint, note that sure to the patient, self, and other members of the health
these factors literally control the electricity applied to the x- care team.
ray tube to produce x-rays. There is nothing magical about
the process. It is a simple manipulation of electricity.
Central to minimizing radiation dose to oneself and oth-
THE FUNDAMENTALS OF RADIATION ers are the cardinal principles of shielding, time, and distance.
Shielding broadly refers to the use of radiopaque materials
PROTECTION (which x-rays do NOT pass through easily) to greatly reduce
The following is by no means a comprehensive study of radia- radiation exposure to areas of the patient not essential to the
tion protection, which is a major portion of another course exam being performed, to radiographers during exams, and
you will take. Because the timing of the introduction of subject others. Lead-impregnated materials are a common example.
matter varies among radiography programs, what follows is Leaded/rubber sheets of varying sizes may be laid directly on
intended as an introduction to guiding radiation protection the patient to shield radiosensitive areas. One example of this
principles. A central message throughout this textbook is the is gonadal shields. These are specifically shaped lead materials
radiographer’s responsibility to minimize radiation dose to the that are placed directly over the gonadal area to minimize
patient, oneself, and others in accordance with the As Low As radiation dose to these radiosensitive areas. They must be
Reasonably Achievable (ALARA) Principle. If this is the begin- carefully and precisely placed so as not to interfere with
ning of your radiography journey, this material will serve as a the image and anatomic area of interest. They should be used
foundation to guide you in this effort as you begin practice. If on all patients within reproductive age and when it will
you are well started in your studies, this material will serve to not interfere with the primary imaging objective of the ex-
reinforce and refresh previously learned material. amination being performed. Lead aprons may be worn by the
 CHAPTER 1  Introduction to the Imaging Sciences 11

radiographer or other health care workers when it is neces- Another important tool in radiation protection is the lim-
sary to be in close proximity to the patient during an expo- iting of the field of x-ray exposure, essentially beam restric-
sure. Thyroid shields are also commonly used in conjunction tion. The primary tool for beam restriction, the collimator,
with lead aprons during fluoroscopic exams by those per- was described earlier in this chapter. This device, by limiting
sonnel who remain in the room. This collar wraps around the area of exposure, limits the radiation dose to the patient.
the neck and fastens in the back to shield the entire front That is, the smaller the area of x-ray exposure, the lower the
portion of the neck. Leaded curtains may drape from the total dose to the patient. When we discuss radiation interac-
fluoroscopy tower to provide a barrier between the fluoros- tions in the body, we are talking about x-ray photons inter-
copist and the x-ray beam during fluoroscopic exams. The acting with atoms of tissue. The greater the volume of tissue
walls of the radiographic suite contain lead or lead equiva- we expose, the greater the opportunity for such interactions
lent (other materials thick enough to provide radiopaque to occur. With these interactions the photon’s energy will
properties equivalent to those of lead) to limit exposure to either be totally absorbed (which contributes to patient dose)
the immediate area of the radiologic exam. Primary barriers or be scattered (which may contribute to dose to radiogra-
are those to which the x-ray beam is routinely directed such phers or others if in the immediate area). See Chapter 7 for a
as the floor beneath the x-ray table and the wall behind the full discussion of x-ray interactions with matter. For the pur-
upright Bucky. Primary barriers are 1/16 inch of lead or lead pose of this discussion, know that we must consider the total
equivalent placed in the wall or floor where the primary volume of tissue we expose to the x-ray beam and limit it to
beam is directed. Secondary barriers are the others such as only that necessary to produce a high-quality image. It
the wall separating the control panel from the room and the should be noted that this is not accomplished by placing lead
ceiling. Secondary barriers are 1/32 inch of lead or lead masks (sheets of lead) beside the patient for the purpose of
equivalent placed in the wall, door, or other area that may limiting exposure to an area of the image receptor. Such a
receive scatter or leakage radiation exposure. The general measure, while improving image quality, does nothing to re-
rule of thumb is always to maximize shielding (use as often duce radiation dose to the patient.
as possible).
Time refers broadly to the duration of exposure to CRITICAL CONCEPT 1-8
ionizing radiation and the time spent in a health care
Beam Restriction
environment where exposure to ionizing radiation is ac-
cumulated. This may include the length of exposure and Limiting the size of x-ray exposure field reduces the volume
number of times the patient is exposed for a radiologic of tissue irradiated and limits the radiation dose to the
exam or the time a radiographer spends in a fluoroscopy patient.
suite (or any procedure involving fluoroscopy). Whether
one is referring to the patient, the radiographer, or other Next among our “tools” of radiation protection are the
health care workers, the general rule of thumb is always to primary controls of the x-ray beam kilovoltage peak (kVp)
minimize time (limit length of time exposed to ionizing and milliampere seconds (mAs). These are the factors se-
radiation). lected by the radiographer to produce an x-ray beam of a
Distance refers to the space between oneself and the given quality (penetrating power) controlled by kVp and
source of ionizing radiation. The reason that distance is im- quantity (number of photons) ultimately controlled by mAs.
portant is simple: the intensity (quantity) of radiation dimin- See Chapter 10 for a complete discussion of these factors. For
ishes over distance. This is an application of the inverse the purposes of radiation protection, these factors control the
square law discussed in detail in the next chapter. Suffice it to nature of the x-ray beam the patient is exposed to. KVp con-
say here that as one increases the distance from an ionizing trols the penetrating power of the x-ray beam produced.
radiation source, the intensity of that source decreases sig- If the photons in the beam do not have sufficient energy
nificantly. This principle is applied mostly to radiographers to penetrate the anatomic part, the entire x-ray beam will
and others to maintain a safe distance from the source of ra- contribute to patient dose. It is true that some absorption is
diation during exposure. The general rule of thumb is always necessary to differentiate among anatomic structures in
to maximize distance (maintain safe distance from source the image; otherwise, it would be uniformly light or clear
during exposure). (everything absorbed) or uniformly dark (everything pene-
trated). But the radiographer can use this concept to his/her
advantage. By increasing the kVp in a controlled manner, the
CRITICAL CONCEPT 1-7 radiographer can ensure that more photons in a given x-ray
Cardinal Principles for Minimizing Radiation Dose beam have the energy to penetrate the anatomic part. In
so doing more will penetrate the part and contribute to the
Time: Limit the amount of time exposed to ionizing radiation. image and fewer photons overall will be needed to produce
Distance: Maintain a safe distance from source of ionizing the image. This follows the 15% rule (see Chapter 10 for a
radiation exposure.
complete discussion). The 15% rule states that, by increasing
Shielding: Maximize the use of shielding from ionizing radia-
the kVp by 15%, we can reduce the mAs by one half and still
tion exposure.
maintain image quality. There are limitations to this that you
12 CHAPTER 1  Introduction to the Imaging Sciences

will learn about later, but with respect to radiation protec- unknowingly order the same thing. To be sure, there are in-
tion, by using this method we cut in half the quantity of stances when patient condition changes rapidly and it is
radiation we expose the patient to. With digital imaging necessary to perform the same exam a number of times in
this rule may be applied once and in some cases twice before succession. But it is okay to double-check an order or stop
significantly altering image quality. mAs ultimately controls and question. To knowingly duplicate an exam because it is
the quantity of x-ray photons produced. As you will see less time consuming than stopping to question is an obvious
later, kVp has a strong influence on this but in general mAs ethical violation. The radiographer must recognize and ac-
represents quantity. cept his/her role as a patient advocate and do what is neces-
In the days of film/screen imaging, the previous discussion sary to avoid unnecessary duplication of exams. Think of
would have sufficed with respect to radiation protection, but each duplicate exam as a doubling of the radiation dose that
digital imaging has introduced a new challenge. Digital imag- would otherwise have been needed (the initial exam is a nor-
ing systems are very forgiving in terms of selection of techni- mal dose and the duplicate exam unnecessarily doubles that
cal factors. In the days of film, the use of an mAs value too dose). Taking the time to check whether a patient has already
high for the anatomic part would have resulted in a very dark, had a radiographic examination is a protection measure
nondiagnostic image. With digital imaging the system will that can significantly reduce the level of radiation dose to the
automatically rescale the image, making the overall appear- patient and others.
ance diagnostic again. It is true that using “extra” radiation in
some cases makes for a better image. However, when one
considers the detail needed, the extra radiation dose is not CRITICAL CONCEPT 1-10
worth the improved quality. We must always strike a balance Avoid Duplicate Exams
between radiation dose and image quality considering the The radiographer must recognize and accept his/her role
anatomic part being imaged. as a patient advocate and do what is necessary to avoid
You will see the following statement here and again in later unnecessary duplication of exams.
chapters, but it bears repeating: The idea that excessive mAs
can be used to avoid repeating the examination due to expo-
sure factors is flawed logic and a violation of the ARRT/ASRT Screening for pregnancy is another important task
Code of Ethics. Although the computer of a digital system to minimize unnecessary exposure to a developing fetus.
can rescale and adjust for overexposure, it does not change Routine or elective radiographic exams should be limited to
the fact that the patient received a higher-than-necessary the 10 days following the onset of menstruation to avoid
dose of radiation. The combination of kVp and mAs is fertile times or times when the woman may be pregnant.
selected based on a number of considerations, including When it is necessary to perform a radiographic exam on a
the anatomic part being examined, patient age, condition, pregnant patient, shielding materials and precise collimation
pathology, etc., and should be ideally suited to the circum- (as previously discussed) should be used to minimize radia-
stance to minimize radiation dose while producing an image tion dose to the fetus. Be sure to follow clinical site policy for
of adequate quality. Again, Chapter 10 is dedicated to the pregnancy screening.
selection of kVp and mAs based on these and other imaging Last, as a developing radiographer, good work habits and
considerations. skills are not yet developed. Use sufficient time and concen-
tration to “get it right the first time.” This also holds true after
CRITICAL CONCEPT 1-9 graduation. Radiography is a practice where being a “creature
of habit”—well, being a “creature of GOOD habits”—is a
Primary Exposure Factors
good thing. Develop a mental checklist for radiographic pro-
The combination of kVp and mAs is selected based on a cedures and perform them the same way every time. In so
number of considerations including the anatomic part being doing you minimize the number of mistakes involving the
examined, patient age, condition, pathology, etc., and should details of the task and, in the process, avoid unnecessary
be ideally suited to the circumstance to minimize radiation
radiation dose to the patient and others.
dose while producing a quality image.

CRITICAL CONCEPT 1-11

Finally, there are a number of daily “workflow” tasks and
processes that address radiation protection. A major one for Screening for Pregnancy
which the radiographer serves as a front-line advocate for the Screening for pregnancy is another important task to mini-
patient is the avoidance of duplication of exams. This means mize unnecessary exposure to a developing fetus. Routine or
preventing the patient from having the same exam twice due elective radiographic exams should be limited to the 10 days
to an error. With so much computerization and automation, following the onset of menstruation to avoid fertile times or
as well as the increased use of team approaches to patient times when the woman may be pregnant. When it is neces-
sary to perform a radiographic exam on a pregnant patient,
care, it is easy to duplicate an order (accidentally order
shielding materials and precise collimation should be used to
the same radiographic exam more than once). It is also easy
minimize radiation dose to the fetus.
for two different physicians involved in a patient’s care to
 CHAPTER 1  Introduction to the Imaging Sciences 13

SUMMARY
• Dr. Roentgen’s early academic career was not without Although different brands may vary somewhat in design,
challenges. He persevered, and on November 8, 1895, like different makes of an automobile, they each function
while experimenting with a Crookes cathode ray tube, basically the same and, regardless of design, serve the same
discovered x-rays. purpose. The details of each component are discussed in
• Both the medical community and the general public were later chapters.
captivated by the prospects of this discovery, and a wide • The cardinal principles of radiation protection are shield-
range of uses were attempted. Through trial and error and ing, time, and distance. Generally, the radiographer should
unfortunate injuries and deaths, the dangerous effects of strive to maximize shielding, minimize time of exposure,
x-rays were also recognized. and maximize distance from the source of exposure.
• Units of measure are agreed-on standards that give value • Limiting the field of exposure and proper selection of kVp
to specific quantities and are understood by a society. and mAs values for the anatomic area being imaged are
These units of measure are the fundamental quantities of very important radiation protection/radiation dose mini-
mass, length, and time. From these fundamental quanti- mization tools at the radiographer’s disposal.
ties, the derived quantities of velocity, acceleration, force, • Serving as a patient advocate and paying attention to daily
momentum, work, and power are made. A special set of workflow as it relates to patient exposure is an important
radiologic quantities are also used, giving measure to dose, function of the radiographer.
dose equivalent, exposure, and radioactivity. This chapter provides a general foundation for the re-
• Definitions and calculations for the quantities are provided mainder of this text. The basic physics and radiologic physics
in this chapter and should be understood before moving on. introduced here provide a common language and foundation
• Generally, radiographic equipment may be classified as on which to build further understanding of the application
mobile or permanently installed. Mobile equipment refers to and manipulation of electricity to produce x-rays. Through-
a unit on wheels that can be taken to the patient’s bedside, out this text, connections between the physics of radiologic
the emergency department, surgery, or other locations as science and the imaging and clinical applications are high-
needed. Permanently installed equipment refers to units that lighted. Some links are from physics to imaging or clinical
are fixed in place in a particular room specifically designed applications and vice versa. These help students understand
for the purpose and are not intended to be mobile. these subjects with greater depth and apply information and
• Permanently installed equipment consists of the tube, col- lessons as appropriate.
limator, table, control console, tube stand, and wall unit.

CRITICAL THINKING QUESTIONS

1. A patient is very concerned about the radiation dose she 2. The ARRT/ASRT provides the professional code of ethics
will receive during an exam you are about to perform. that the radiographer must abide by. What is the radiogra-
How would you explain the radiation dose she will receive pher’s moral and ethical responsibility to patients to
in lay terms and relate it to something she will under- minimize radiation dose?
stand? What steps would you take to limit radiation dose,
and how would you explain those to this patient?

REVIEW QUESTIONS
1. Which of the following is the date of the discovery of 3. According to the basic principles of radiation protection,
x-rays? a radiographer should minimize:
a. November 5, 1885 a. shielding.
b. November 5, 1895 b. patient protection.
c. November 8, 1885 c. distance.
d. November 8, 1895 d. time.
2. A radiographer’s dosimetry report is expressed in: 4. Anything that occupies space and has shape or form is:
a. mRad. a. matter.
b. mRem. b. mass.
c. mR. c. weight.
d. mCi. d. energy.
Continued
14 CHAPTER 1  Introduction to the Imaging Sciences

R E V I E W Q U E S T I O N S — cont’d
5. Which of the following is that radiation intensity that will 8. X-ray exams of the lower abdomen and pelvis of women
produce 2.08 3 109 ion pairs in 1 cm3 of air? in reproductive years should be limited to:
a. R a. the time before menstruation.
b. Rad b. the 10 days prior to the onset of menstruation.
c. Rem c. the 10 days following the onset of menstruation.
d. Ci d. 15 days before or after the onset of menstruation.
6. What is the work done if 35 N of force is applied to move 9. What is the power used if 2000 J of work is applied for
a patient 0.5 m? 5 seconds?
a. 35.5 J a. 400 W
b. 34.5 J b. 10,000 W
c. 17.5 J c. 2005 W
d. 70 J d. 1995 W
7. The curie is an expression of: 10. What is the velocity of a car if it travels 1000 meters in
a. quality of radioactive material. 4 seconds?
b. intensity of radioactive material. a. 1004 m/s
c. absorption of radioactive material. b. 250 m/s
d. quantity of radioactive material. c. 1996 m/s
d. 4000 m/s
 SECTION I
Principles of Radiation Physics

15
 2
Structure of the Atom

OUTLINE
Introduction Classification and Bonding
Basic Atomic Structure Classification
Historical Overview Bonding
Modern Theory Summary

OBJECTIVES
• Discuss atomic theory. • Explain classifications of the atom.
• Describe the nature and structure of the atom. • Describe the principal types of atomic bonding.
• Identify the constituents of the atom and the characteristics
of each.

KEY TERMS
atom covalent bond molecule
atomic mass number electron neutron
atomic number electron shell nucleus
binding energy element proton
compound ionic bond

INTRODUCTION behave as a result of this structure is presented. Diligent study

The focus of this chapter is on the structure and nature of the of this material is recommended because it is an important
atom. Students may wonder why such detailed study of the component of the radiographer’s overall knowledge base.
atom is necessary for education and training in radiographic
imaging. The following bullet points address this necessity: BASIC ATOMIC STRUCTURE
• First, the interactions in the x-ray tube that produce x-rays
occur at the atomic level, and the nature of the x-ray pho- Historical Overview
ton produced depends on how an electron interacts with Although it is believed that some basic ideas of atomism or
an atom. atomic theory predate Leucippus, his name most often is
• Second, the interactions between the x-ray photons and associated with the earliest atomic theory. His ideas were
the human body also occur at the atomic level, determin- rather vague, and it is his student and follower, Democritus
ing both the radiation dose delivered and how the body of Abdera, who provided one of the most detailed and elabo-
part will be imaged. rate theories and is credited with expanding on and formal-
• Third, the interactions between the x-ray photons exiting izing the earliest atomic theory. Democritus lived from about
the patient to produce the image interact at the atomic 460 BC to about 370 BC. The name atom comes from the
level of the image receptor to generate the final image. Greek word atomos, meaning “indivisible.” Democritus hy-
• Finally, other areas of study in the radiologic sciences also pothesized that all things were made of tiny, indivisible struc-
require a working knowledge of the atom. So it is best to tures called atoms. Figure 2-1 illustrates early Greek theory
develop a strong foundation at the outset. of atoms. Democritus believed that these atoms were inde-
The chapter begins with a brief history of the development of structible and differed in their size, shape, and structure. He
atomic theory that chronologically traces the progression of theorized that the nature of the object depended on its atoms.
human understanding of the atom. This is followed by a dis- For example, sweet things are made of smooth atoms and
cussion of basic atomic structure. Finally, the classification of bitter things of sharp atoms. Solids consist of small, pointy
elements based on atomic structure and on how elements atoms, liquids of large, round atoms, and so on. Such ideas
16
 CHAPTER 2  Structure of the Atom 17

periodic table, which demonstrates that elements, arranged

W in order of increasing atomic mass, have similar chemical
ld

et
Co
properties.
AIR The next significant advancement in atomic theory came
with Joseph John “J.J.” Thomson’s discovery of the electron.

ry

H
D ot
This discovery resulted from the scientific community’s fasci-
W W nation with the cathode ray tube, the very fascination that led
ld et ld

et
Co
Co

Dr. Roentgen to his discovery of x-rays. Thomson was studying

FIRE EARTH the well-known glowing stream that is visible when an electric
current is passed through the cathode ray tube. This glowing
ry

ry
H

H
D ot D ot
stream was familiar to scientists, but no one knew what it was.
W Thomson discovered that the glowing stream was attracted to
ld
et
Co

a positively charged electrode. Through his investigation of this

WATER phenomenon, he theorized that these glowing particles were
actually negatively charged pieces of atoms (later named elec-
ry

D ot
trons). Based on his understanding, he described the atom as a
positively charged sphere with negatively charged electrons
FIG 2-1  Early Greek Theory of the Atom. embedded in it, much like the raisins in a plum pudding—
hence its name: the “plum pudding model.” See Figure 2-3.
and theories were debated and carried forward for another Thomson’s theory was further advanced by one of his
2000 years. students, Ernest Rutherford. Marie and Pierre Curie had
The English chemist John Dalton in the early 1800s recently discovered radioactivity, and Henri Becquerel, radio-
developed a sound atomic theory based not on philosophical active rays. Rutherford was conducting scattering experi-
speculation but on scientific evidence. His recognition that ments by bombarding a very thin sheet of gold with alpha
elements combined in definite proportions to form com- particles. Alpha particles are made up of two protons and two
pounds led to questions about why this happened. This in- neutrons (basically the nucleus of a helium atom) and have a
quiry led in turn to his atomic theory. Figure 2-2 is a photo positive charge. He placed a zinc sulfide screen in a ring
of Dalton’s original wooden models of the atom. To explain around the gold sheet and observed the experiment with a
the phenomenon, he theorized that all elements were com- movable microscope (Figure 2-4). He observed that most
posed of tiny indivisible and indestructible particles called particles passed straight through the sheet, but some were
atoms. These atoms were unique to each element in their deflected at varying angles from slight to 180 degrees back
size and mass. From this he theorized that compounds were along the path they had traveled. To Rutherford, this sug-
formed by molecules and molecules by fixed ratios of each gested that there were tiny spaces, or holes, at the atomic
type of constituent atom, resulting in a predictable mass. level. This space allowed most of the particles to pass through,
Finally, his theory stated that a chemical reaction was a rear- but some particles hit parts of the atoms. Such an idea con-
rangement of atoms. His theory is now more than 200 years tradicted his teacher’s model and, based on his experiments,
old but remains fundamentally valid. We know now that we he proposed a new, rather different model of the atom.
can destroy the atom in a nuclear reaction, but his basic His model resembled a tiny version of our solar system. He
ideas were correct. Later Dmitri Mendeleev advanced
Dalton’s work by organizing the known elements into the

Electrons

FIG 2-2  Dalton’s Atom Model. Dalton’s wooden models Sphere of positive charge
of the atom.  (Reprinted with permission Science Museum FIG 2-3  Thomson Model. Sometimes called the “plum
[London]). pudding” model.
18 SECTION I  Principles of Radiation Physics

Alpha particles
Scattered alpha
particles

Nonscattered
alpha particles
Alpha particle
source

Gold foil
Scintillation
screen

FIG 2-4  Rutherford’s Experiment. Ernest Rutherford’s scattering experiment setup.

described a positively charged and very dense nucleus with tiny (Figure 2-6). The proton is one component of the nucleus. It
electrons orbiting it in defined paths. This model explained has one unit of positive electrical charge and a mass of 1.673 3
how some of the alpha particles could pass right through the 10227 kg. The neutron is the other component of the nucleus;
gold sheet (between the nuclei of the atoms and missing the it has no electrical charge and a mass of 1.675 3 10227 kg. The
orbiting electrons) whereas others were deflected (repelled by primary difference between protons and neutrons is that pro-
the strong, positively charged nucleus). His version was a radi- tons have a positive electrical charge. An easy way to remember
cally new idea, but it did not explain a couple of physical prin- the difference is to think of the pro in proton, which suggests
ciples of nature. The 20th-century Danish physicist Niels Bohr “positive,” whereas the word neutron sounds like “neutral.” The
refined Rutherford’s work, bringing us to the theory and neutron is in fact neutral; it has no electrical charge. Protons
model of the atom with which we are most familiar. and neutrons compose the majority of the mass of an atom.
The electron is the third principal part of the atom. It has one
Modern Theory unit of negative electrical charge and a mass of 9.109 3 10231
The atom is considered the basic building block of matter. kg. Compared with the mass of a nucleus, an electron has very
Bohr’s theory describes the atom as having three fundamental little mass, yet each electron is moving extremely fast in its
components: electrons, neutrons, and protons (Figure 2-5). orbit, and thus it has significant kinetic energy.
These particles are generally referred to as the fundamental
particles. The quantity of each is unique to the matter or ele- CRITICAL CONCEPT 2-1
ment it composes. That is, a hydrogen atom is different from Atomic Structure
lead, which is different from tungsten, and so on. In radiology
The atom is composed of three fundamental particles: pro-
we select elements for use because of their atomic structure
tons, neutrons, and electrons. The nucleus is central to the
and how they interact with x-rays. Today the quantum theory,
atom and is made up of protons and neutrons (collectively
which is based on mathematics and wave properties, more called nucleons). The electrons orbit the nucleus in defined
accurately describes the atom, but for radiologic science energy bands or shells.
purposes the following discussion suffices.
The atom has a nucleus made up of protons and neutrons Structure of atom
(collectively called nucleons); orbiting that nucleus are elec-
trons in defined energy levels and distances from that nucleus
Proton

Neutron

Electron

Nucleus
FIG 2-6  Parts of the Atom. The atom is made up of protons
and neutrons in the nucleus orbited by electrons in defined
FIG 2-5  Bohr Atom. The Bohr model of the atom. energy levels.
 CHAPTER 2  Structure of the Atom 19

Electrical charge is a characteristic of matter, whether it is masses would be greater. That is because some mass is con-
a subatomic particle, an atom, or a large object. Remember verted to energy (recall Einstein’s famous equation E5mc2)
that each proton has one unit of positive charge and each to hold the nucleus together. Binding energy is also a measure
electron has one unit of negative charge (neutrons are neu- of the amount of energy necessary to split an atom (break it
tral; they have no charge). If an atom has an equal number of apart). If a particle strikes the nucleus with energy equal to
protons and electrons, it has no net charge (the positives and the nucleus’s binding energy, the atom could break apart.
negatives are equal and cancel each other out, making it elec- This force is referred to as nuclear binding energy and is ex-
trically neutral). If this balance is disrupted, the atom’s charge pressed in megaelectron-volts (MeV).
becomes positive if there are more protons, or negative if Electrons orbit the nucleus at very high velocities. The
there are more electrons. Because the protons are generally force of attraction between the negatively charged electrons
very strongly bound in the nucleus, the cause of the electrical and positively charged protons keeps the electrons in orbit.
change (acquisition of a net charge) usually involves the gain Just as neutrons and protons are held together in the nucleus
or loss of electrons. If the atom gains an extra electron, the by nuclear binding energy, the electrons are held in their or-
negative charges will outnumber the positives and the atom bits by electron-binding energy. This electron-binding energy
will have a net negative charge, which is called a negative ion, depends on several factors, including how close the electron
or anion. If the atom loses an electron, the positive charges is to the nucleus and how many protons are in the atom. The
will outnumber the negative charges and the atom will have closer the electron is to the nucleus, the stronger is its binding
a net positive charge, which is called a positive ion, or cation. energy (expressed in electron-volts [eV]).
Both nuclear binding energy and electron binding energy
are key determinates of x-ray production. There are two types
CRITICAL CONCEPT 2-2 of atomic interactions in the x-ray tube that produce x-rays,
Atomic Charge characteristic and bremsstrahlung. Both are discussed in de-
Within each atom, each proton has one unit of positive charge, tail in Chapter 6. Because it relates to the present discussion,
each electron has one unit of negative charge, and neutrons note that characteristic interactions involve the removal
have no charge. of orbital electrons from atoms. The penetrating strength
(energy) of the x-ray photon produced depends on the differ-
ence in electron-binding energies of the electron shells in-
The nucleus is held together by a strong nuclear force, volved. Bremsstrahlung interactions involve attraction to the
creating a binding energy. This energy creates a very strong nucleus of the atom, and the penetrating strength (energy)
attraction in the nucleus that overcomes even the natural of the x-ray photon produced depends on nuclear binding
tendency for like charges to repel (a law of electrostatics: like energy. (The beginning pages of Chapter 6 explain x-ray pro-
charges repel each other, opposites attract). This is what duction in relation to atomic structure, and it may be helpful
holds the protons and neutrons together to form the nucleus to read this material at this point and also review it later in
of the atom. The mass of the nucleus is always less than the your studies).
sum of the masses of nucleons that make up the nucleus. This The following description of electron orbit completes the
difference in mass is called the mass defect and it represents discussion of the structure of the atom. Electrons do not all
the energy necessary to hold the nucleus together. That is, if occupy the same orbit at the same distance from the nucleus.
one added the masses of all of the protons and neutrons of a An atom has defined energy levels, each at a different distance
particular atom together (atomic mass) and then compared from the nucleus. These energy levels are called electron
it to the mass of the nucleus itself, the sum of the individual shells and describe a sphere around the nucleus (Figure 2-7).

Second shell

First shell

Hydrogen

Lithium Lithium
3 electrons in 2 shells
FIG 2-7  Electron Shells. Atoms have defined energy levels, called electron shells, that describe
spheres around the nucleus.
20 SECTION I  Principles of Radiation Physics

Electrons orbit three dimensionally around the nucleus. The outermost shells of atoms may or may not have a full
They are not simply orbiting the nucleus in a single plane complement of electrons. Although shells can hold a certain
(although in many discussions of radiologic science we number of electrons, they are not necessarily full. Except for the
illustrate them this way for simplicity). first (K) shell, a maximum of 8 electrons can exist in the outer-
Each electron shell of an atom is lettered beginning with K most shell of any atom (octet rule). Some inner shells may hold
nearest to the nucleus and moving outward with L, M, N, O, more than 8 electrons. For example, the M shell can contain
P, and so on. Generally, these shells fill from the K shell out- 18 electrons; if there are more electrons present, they will be in
ward, with the outermost shells not necessarily filling com- an N shell. If M is the outermost shell, however, it can hold a
pletely, depending on the stability and nature of the atom. maximum of only 8 electrons. It is important to note that the
Each shell has a limit to the number of electrons that it can outermost shell may hold fewer, but no more than 8 electrons.
hold. The first shell can hold only two electrons. If an atom Keep the following in mind regarding atomic structure as
has three electrons, two electrons will occupy the K shell and you continue your studies. Think of atoms as archery targets
one the L shell. An easy way to determine the maximum with the nucleus as the bulls-eye and the electron shells as the
number of electrons that will fit in an electron shell is the rings. Whether we are discussing atomic interactions in the
formula 2n2, in which n is the shell’s number (K becomes 1, x-ray tube to produce x-rays or interactions between human
L becomes 2, M becomes 3, and so on). For example, for the tissue atoms and x-ray photons, atoms represent “targets” for
K shell n 5 1, so the number of electrons that will fit is 2, interactions. There is a greater opportunity for interactions
because 1 squared is 1 and 1 3 2 5 2 (2 3 12 5 2). For the L with very large, complex atoms because their nucleus is larger
shell, n 5 2, 2 squared is 4, and 2 3 4 5 8, so the number and there are more electron shells and electrons in orbit
of electrons that will fit is 8 (2 3 22 5 8). For the M shell, around the nucleus (more complex atoms are physically
n 5 3, 3 squared is 9, and 2 3 9 5 18, so the number of elec- larger in size) (Figure 2-8). There is a lesser opportunity for
trons that will fit is 18 (2 3 32 5 18). interactions with very small and less complex atoms because
the nucleus is smaller and there are fewer shells and electrons
CRITICAL CONCEPT 2-3 in orbit around the nucleus (less complex atoms are physi-
Binding Energy cally smaller in size). Continuing with the archery target
analogy, it would be easier for an archer to hit a target that is
The K shell has the greatest electron-binding energy. Binding 3 feet in diameter than one that is 3 inches in diameter. Of
energy decreases with each subsequent shell. The maximum course, binding energies and photon energies are critical
number of electrons that may occupy each shell can be found
parts of this interaction equation, but one also has to con-
by using the formula 2n2, in which n represents the shell num-
sider the fact that the greater the complexity of the atom, the
ber, beginning with the K shell as 1.
greater the opportunity for interactions to occur.

e
e
e e e e e
e e
e e e
e e
e e
e e e
e e e e
e e e
e e e e
e
e e
e e
e e e 74P e e e 1P
110N
e e
e e

e e e e
e e e Hydrogen
e e e e
e e e
e e
e e
e e e
e e
e e e e e
e
e

Tungsten
FIG 2-8  Atom Complexity. Comparison of the complexity and size of a hydrogen atom versus
a tungsten atom.
 CHAPTER 2  Structure of the Atom 21

atoms have the same number of protons and neutrons but

CLASSIFICATION AND BONDING with different amounts of energy within their nuclei. Isomers
Before discussing classification and bonding, a few defini- have the same atomic number and same atomic mass
tions must be understood: atomic number, atomic mass number but vary in the amount of energy within the nuclei
number, elements, and compounds. The atomic number of because of differences in how the protons and neutrons are
an atom refers to the number of protons it contains in its arranged.
nucleus. (Remember that in a stable atom the number of
electrons is equal to the number of protons, so the atomic CRITICAL CONCEPT 2-4
number indicates the number of electrons.) The atomic mass The Isos
number is the number of protons and neutrons an atom has
The isos are a way of classifying elements based on the
in its nucleus. Elements are the simplest forms of substances
number of protons, neutrons, and electrons in each of their
that compose matter. Each element is made up of one unique
constituent atoms. The second-to-last letter in the name of
type of atom with an unchanging number of protons. The each may be used as a prompt for what stays the same.
number of atoms that form a molecule of an element varies.
Ninety-two different elements exist in the natural world, and
almost two dozen others have been created artificially. Famil- So what stays the same with isos? The names of these
iar elements include oxygen, carbon, and chlorine. Two or variants—isotope, isotone, isobar, and isomer—can serve as an
more atoms bonded together form a molecule. Most natu- easy way to remember their characteristics. The second-to-
rally occurring elements exist independently in nature—that last letter in the name of each suggests which characteristic
is, in a pure form not combined with other elements. For stays the same. In isotope, the p reminds you that the number
example, iron, zinc, nickel, oxygen, carbon, hydrogen, and so of protons stays the same. In isotone, the n reminds you
on all exist as pure elements. But when you look at the world that the number of neutrons stays the same. In isobar, the a
around you, most of what you see is in the form of chemical reminds you that the atomic mass number is the same (total
compounds, which are combinations of elements bonded number of neutrons and protons). In isomer, the e reminds
together. For example, the most common substance on the you that everything (that is, all the fundamental particles
earth’s surface is water, which is a compound of two atoms of of the atoms) remains the same (but with different amounts
hydrogen and one atom of oxygen. of energy).
In chemical shorthand the chemical symbol is an abbrevia- Apply the definitions to the following examples:
1 2 131 132 7 7 99m
tion of the element, such as H for hydrogen. The superscript 1H, and 1 H; 53 I and 54 Xe; 3 Li and 4 Be; and Tc
number that appears with it is the atomic mass number, and The first two, 11H, and 21H, are isotopes of hydrogen (note
the subscript number below it is the atomic number. It that they have the same atomic number and a different
appears in the format illustrated in Figure 2-9. atomic mass number). The next two, 131 132
53 I and 54 Xe, are iso-
tones. (Note that the isotone has the same number of neu-
Classification trons and a different number of protons. The number of
We now move to what are sometimes called the isos. This neutrons is found by subtracting the atomic number from
refers to isotopes, isotones, isobars, and isomers and is a way the atomic mass number.) The next two, 73 Li and 74 Be, are
of classifying elemental relationships based on the number of isobars (same atomic mass number, different atomic num-
protons, neutrons, and electrons in their constituent atoms. ber). Finally, 99mTc is an isomer. As indicated by the super-
An isotope refers to elements whose atoms have the same script m, which stands for “metastable,” it will decay to a
number of protons but a different number of neutrons. An stable form of technetium.
isotone refers to elements whose atoms have the same number Another means of classifying elements is according to the
of neutrons but a different number of protons. An isobar re- periodic table, as in Figure 2-10. The periodic table is orga-
fers to elements whose atoms have a different number of nized by periods and groups. There are seven periods ar-
protons but the same total number of protons and neutrons ranged as rows of the table and eight groups arranged as
(atomic mass number). An isomer refers to elements whose columns of the table. Elements in each period and group have
certain characteristics.
Atoms in each period have the same number of electron
shells, and the number of shells increases as one moves from
Atomic mass the top row (period 1) to the bottom row (period 7). This
number means that the atoms of the element become increasingly
Chemical larger and more complex.
symbol Atoms in each group have the same number of electrons
in the outermost shell. The number of electrons in the outer-
most shell increases as one moves from left (group 1) to right
(group 8) on the table.
Atomic number The periodic table is not perfectly uniform. In the middle
FIG 2-9  Chemical Shorthand. Format for chemical shorthand. of the chart are a number of elements that do not easily fit
 22

hydrogen helium
1 2
Key:
H He
1.0079 element name 4.0026
lithium beryllium
atomic number boron carbon nitrogen oxygen fluorine neon
3 4 Symbol 5 6 7 8 9 10
Li Be atomic weight (mean relative mass) B C N O F Ne
6.941 9.0122 10.811 12.011 14.007 15.999 18.998 20.180
sodium magnesium aluminium silicon phosphorus sulfur chlorine argon
11 12 13 14 15 16 17 18
Na Mg Al Si P S Cl Ar
22.990 24.305 26.982 28.085 30.974 32.065 35.453 39.948
potassium calcium scandium titanium vanadium chromium mangenese iron cobalt nickel copper zinc gallium germanium arsenic selenium bromine krypton
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
K Ca Sc Ti V Cr Mn Fe Co Ni Cu Zn Ga Ge As Se Br Kr
39.098 40.078 44.956 47.867 50.942 51.996 54.938 55.845 58.933 58.693 63.546 65.39 69.723 72.61 74.922 78.96 79.904 83.80
rubidium strontium yttrium zirconium niobium molybdenum technetium ruthenium rhodium palladium silver cadmium indium tin antimony tellurium iodine xenon
37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Rb Sr Y Zr Nb Mo Tc Ru Rh Pd Ag Cd In Sn Sb Te I Xe
85.468 87.62 88.906 91.224 92.906 95.94 (98) 101.07 102.91 106.42 107.87 112.41 114.82 118.71 121.76 127.60 126.90 131.29
caesium barium lutetium hafnium tantalum tungstun rhenium osmium iridium platinum gold mercury Thallium lead bismuth polonium astatine radon
55 56 57-70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86
Cs Ba Lu Hf Ta W Re Os Ir Pt Au Hg Tl Pb Bi Po At Rn
132.905 137.327 174.97 178.49 180.95 183.84 186.21 190.23 192.22 195.084 196.97 200.59 204.38 207.2 208.98 (209) (210) (222)
francium radium lawrencium rutherfordium dubnium seaborgium bohrium hassium meitnerium ununnillium unununium ununbium ununquadium
87 88 89-102 103 104 105 106 107 108 109 110 111 112 114
Fr Ra Lr Rf Db Sg Bh Hs Mt Uun Uuu Uub Uuq
SECTION I  Principles of Radiation Physics

(223) (226) (262) (261) (262) (266) (264) (269) (276) (271) (272) (277) (289)

lanthanum cerium praseodymium neodymium promethium samarium europium gadolinium terbium dysprosium holmium erbium thulium ytterbium
57 58 59 60 61 62 63 64 65 66 67 68 69 70
*lanthanoids La Ce Pr Nd Pm Sm Eu Gd Tb Dy Ho Er Tm Yb
138.91 140.116 140.90 144.24 (145) 150.36 151.96 157.26 158.93 162.50 164.93 167.26 168.93 173.04
actinium thorium protactinium uranium neptunium plutonium americium curium berkelium californium einsteinium fermium mendelevium nobelium
89 90 91 92 93 94 95 96 97 98 99 100 101 102
**actinoids Ac Th Pa U Np Pu Am Cm Bk Cf Es Fm Md No
(227) 232.04 231.04 238.03 (237) (244) (243) (247) (247) (251) (252) (257) (258) (259)

FIG 2-10  Periodic Table. Note that on the periodic table each element is abbreviated with a
chemical symbol. The superscript number with the symbol is the atomic number and the bottom
number is the elemental mass. The elemental mass is the characteristic mass of an element
determined by the relative abundance of the constituent atoms and their respective masses.
 CHAPTER 2  Structure of the Atom 23

into the eight groups. In these elements, called the transitional

metals, inner electron shells are being filled. These elements
have some characteristics different from other elements.
There are additional elements that do not readily fit into
Atoms
the eight groups. They are the two series of inner transitional
metals, which are not shown at all on a simplified version of
the periodic table. The elements with the atomic numbers
57 to 71 and 89 to 103 are the inner transitional metals. They
generally have special qualities; many are radioactive. Na Cl

Bonding Electron transfer

To this point atoms have been discussed as individual entities, +1 1

but as the building blocks of matter, it is the chemical bonds
between atoms that allow complex matter (such as living tis-
sue) to exist. As already mentioned, a molecule is formed Ions
when two or more atoms join together chemically. Some ele-
ments naturally exist as molecules (e.g., H2). A compound is
a molecule that contains at least two different elements. Thus
all compounds are molecules, but not all molecules are com-
Na Cl
pounds. There are two primary ways atoms bond to form
molecules and subsequently more complex structures. One Electrostatic attraction
type of bond is called the ionic bond, and the other is called
a covalent bond.
Ionic bonding is based on the attraction of opposing
charges. Recall that generally atoms are electrically neutral: that
Ionic
is, each has the same number of protons (positive electrical bond
charges) and electrons (negative electrical charges). When in
the presence of other atoms, however, some atoms have a ten-
dency to give up electrons, whereas others have the tendency to
gain electrons. An atom that gives up an electron (a cation) has
NaCl
a net positive electrical charge. An atom that gains an electron
(an anion) has a net negative electrical charge. In an ionic FIG 2-11  Ionic Bonding. Note that one atom gives up an
bond, one of the atoms gives up an electron and the other electron, becoming positively charged, and the other takes on
takes the extra electron; the difference in their electrical charge an electron, becoming negatively charged; the opposing
charges attract the two atoms together.
attracts and bonds the two together. See Figure 2-11.
Covalent bonding is based on two atoms sharing electrons
that then orbit both nuclei. Recall that as the electron shells of
atoms fill, they do so from the one nearest the nucleus out-
ward, and the outermost shells are not always full. In a covalent
bond, an outermost electron from one atom begins to orbit the
nucleus of another adjacent atom in addition to its original
nucleus. Think of this electron as creating a figure eight as it
orbits first one nucleus, then the other. See Figure 2-12.
H H

CRITICAL CONCEPT 2-5

Bonding
There are two ways in which atoms bond to form molecules.
Ionic bonds occur when one atom gives up an electron and
becomes positively charged and another atom takes on that
electron, acquiring a negative charge. It is the difference in
charge that bonds the two together. In a covalent bond, two
atoms share electrons that then orbit both nuclei, completing
the outermost shell of each.
H H
The bonding of various atoms to form molecules permits FIG 2-12  Covalent Bonding. Note in the lower illustration
the highly complex matter about us to exist. the figure-eight orbital path of the shared electron.
24 SECTION I  Principles of Radiation Physics

SUMMARY
• The basic ideas of atomism or atomic theory most often charge, electrons have one unit of negative charge, and
are ascribed to Leucippus. However, his student and fol- neutrons have no charge.
lower, Democritus of Abdera, is credited with formalizing • The atom is held together by a strong nuclear force (nuclear
and elaborating on the earliest atomic theory. binding energy) and by electrostatic attraction between the
• In the early 1800s John Dalton proposed an atomic theory nucleus and orbiting electrons (electron-binding energy).
based on scientific investigation that remains fundamen- • The isos—isotopes, isobars, isotones, and isomers—are a
tally sound today. The work of Thomson, Rutherford, and way of classifying elements based on the number of pro-
Bohr furthered Dalton’s atomic theory, giving us the solid tons, neutrons, and electrons in their constituent atoms.
understanding we have today. • There are two ways in which atoms chemically bond to
• The atom is the basic building block of matter and con- form molecules. Ionic bonds occur when two atoms of
sists of three fundamental particles: protons and neutrons, opposite charge are held together by their mutual attrac-
which compose the nucleus, and electrons, which orbit tion. In a covalent bond two atoms share electrons that then
around the nucleus. Protons have one unit of positive orbit both nuclei, completing the outermost shell of each.

CRITICAL THINKING QUESTIONS

1. How does atomic structure complexity affect x-ray inter- 2. Describe the atom in terms of its physical organization,
actions in the human body and patient dose? electrical charge (if present and under what circum-
stance), binding energy, and bonding nature.

REVIEW QUESTIONS
1 . Which of the following is considered a nucleon? 7. What is the maximum number of electrons that will
a. proton occupy the outermost shell of an atom?
b. electron a. 2
c. alpha particle b. 8
d. beta particle c. 18
2. What is the maximum number of electrons permitted in d. 32
the M-shell? 8. The maximum number of electrons that can occupy the
a. 8 P shell is:
b. 18 a. 8.
c. 32 b. 32.
d. 50 c. 72.
3. How many protons does 131
53 I have? d. 98.
a. 131 9. Atoms that bind together due to their opposite charges
b. 53 form:
c. 78 a. covalent bonds.
d. 184 b. convalescent bonds.
4. How many nucleons are in (39
19K)? c. ionic bonds.
a. 39 d. nonionic bonds.
b. 19 10. The horizontal periods of the periodic table contain
c. 20 elements with:
d. 58 a. the same number of electron shells.
5. 132 131
54 Xe and 53 I are: b. the same number of electrons.
a. isomers. c. the same chemical properties.
b. isotopes. d. the same number of protons.
c. isobars.
d. isotones.
6. 130 131
53 I and 53 I are:
a. isotopes.
b. isobars.
c. isotones.
d. isomers.
 3
Electromagnetic and
Particulate Radiation

OUTLINE
Introduction Particulate Radiation
Electromagnetic Radiation Summary
Nature and Characteristics
X-rays and Gamma Rays
The Rest of the Spectrum

OBJECTIVES
• Describe the nature of the electromagnetic spectrum. • Calculate the wavelength or frequency of electromagnetic
• Discuss the energy, wavelength, and frequency of each radiation.
member of the electromagnetic spectrum and how these • Differentiate between x-rays and gamma rays and the rest
characteristics affect its behavior in interacting with of the electromagnetic spectrum.
matter. • Identify concepts regarding the electromagnetic
• Explain the relationship between energy and frequency spectrum important for the radiographer.
of electromagnetic radiation. • Describe the nature of particulate radiation.
• Explain wave-particle duality as it applies to the • Differentiate between electromagnetic and particulate
electromagnetic spectrum. radiation.

KEY TERMS
alpha particles infrared light radiowaves
beta particles inverse square law radioactivity
electromagnetic radiation ionization ultraviolet light
electromagnetic spectrum microwaves visible light
frequency particulate radiation wavelength
gamma rays photon x-rays
hertz (Hz) Planck’s constant

INTRODUCTION that only high-energy radiation (x-rays and gamma rays) has
This chapter introduces the nature of electromagnetic and the ability to ionize matter. This property is explained in this
particulate radiation. Students may wonder why it is neces- chapter. More specifically, the radiographer should be able to
sary for the radiographer to understand the entire spectrum explain to a patient the nature of ionizing radiation as well as
of radiation. This question can be answered both broadly any risks and benefits and should be an advocate for the
and specifically. In general, it is the radiographer’s role to be patient in such discussions with other professionals. He or
familiar with the different types of radiation to which pa- she should also understand the nature of radiation well
tients may be exposed and to be able to answer questions and enough to safely use it for medical imaging purposes. With
educate patients. The radiographer should consider him or this rationale in mind, the electromagnetic spectrum is dis-
herself as a resource for the public and should be able to dis- cussed first, followed by a discussion of particulate radiation.
pel any myths or misconceptions about medical imaging in
general. Both ends of the electromagnetic spectrum are used ELECTROMAGNETIC RADIATION
in medical imaging. Radiowaves are used in conjunction
with a magnetic field in magnetic resonance imaging (MRI) Nature And Characteristics
to create images of the body. X-rays and gamma rays are In the latter half of the 19th century, the physicist James
used for imaging in radiology and nuclear medicine, respec- Maxwell developed his electromagnetic theory, significantly
tively. One difference between the “ends” of the spectrum is advancing the world of physics. In this theory he explained
25
26 SECTION I  Principles of Radiation Physics

that all electromagnetic radiation is very similar in that from 102 to 1024 hertz (Hz). Wavelength and frequency are
it has no mass, carries energy in waves as electric and mag- discussed shortly. The ranges of energy, frequency, and wave-
netic disturbances in space, and travels at the speed of light length of the electromagnetic spectrum are continuous—that
(Figure 3-1). His work is considered by many to be one of the is, one constituent blends into the next (Figure 3-2).
greatest advances of physics. Electromagnetic radiation may
be defined as “an electric and magnetic disturbance traveling CRITICAL CONCEPT 3-1
through space at the speed of light.” The electromagnetic
spectrum is a way of ordering or grouping the different elec- The Nature of Electromagnetic Radiation
tromagnetic radiations. All of the members of the electro- All electromagnetic radiations have the same nature in that
magnetic spectrum have the same velocity (the speed of light they are electric and magnetic disturbances traveling through
or 3 3 108 m/s) and vary only in their energy, wavelength, space. They all have the same velocity—the speed of light—
and frequency. The members of the electromagnetic spectrum and vary only in their energy, wavelength, and frequency.
from lowest energy to highest are radiowaves, microwaves,
infrared light, visible light, ultraviolet light, x-rays, and
gamma rays. The wavelengths of the electromagnetic spectrum Electromagnetic radiation is a form of energy that origi-
range from 106 to10216 meters (m) and the frequencies range nates from the atom. That is, electromagnetic radiations are

Axis of electrical field

Axis of magnetic field

Direction of
electromagnetic
radiation

FIG 3-1  Electromagnetic Radiation. Electromagnetic radiation is energy traveling at the speed
of light in waves as an electric and magnetic disturbance in space.

Energy in eV

10–10 10–5 100 105 1010

Visible light

Infrared X-rays

Radiowaves Microwaves Ultraviolet Gamma rays

105 1010 1015 1020

Frequency (Hertz)
FIG 3-2  Electromagnetic Spectrum. The electromagnetic spectrum energy, frequency, and
wavelength ranges are continuous, with energies from 10212 to 1010 eV.
 CHAPTER 3  Electromagnetic and Particulate Radiation 27

emitted when changes in atoms occur, such as when electrons Wavelength

undergo orbital transitions or atomic nuclei emit excess
energy to regain stability. Unlike mechanical energy, which
requires an object or matter to act through, electromagnetic Amplitude
energy can exist apart from matter and can travel through a
vacuum. For example, sound is a form of mechanical energy.
The sound from a speaker vibrates molecules of air adjacent Frequency
to the speaker, which then pass the vibration to other nearby FIG 3-3  Electromagnetic Wave Measures. An electromag-
molecules until they reach the listener’s ear. In the absence of netic wave may be described by its wavelength (distance
the intervening air molecules, no sound would reach the ear. from one peak to the next), amplitude (maximum height of a
With electromagnetic radiation, it is the energy itself that is wave), or its frequency (the number of waves that pass a
vibrating as a combination of electric and magnetic fields; it given point per second).
is pure energy. In fact, energy and frequency of electromag-
netic radiation are related mathematically. The energy of
electromagnetic radiation can be calculated by the following very small wavelengths in the electromagnetic spectrum,
formula: the actual measure is typically in exponential form (e.g.,
10211 m). Frequency is generally expressed in hertz (Hz).
E 5 hf
One hertz is defined as one cycle per second. Long-wave AM
In this formula, E is energy, h is Planck’s constant (equal radiowaves have frequencies from 500 to 1600 kilohertz
to 4.135 3 10215 eV sec; 6.626 3 10234 J sec), and f is the (kHz), or 0.5 to 1.6 megahertz (MHz). One kilohertz is
frequency of the photon. The energy is measured in electron 1000 cycles per second; 1 megahertz is 1,000,000 cycles per
volts (eV). The physicist Max Planck first described the direct second. Shorter FM radiowaves have frequencies in the
proportionality between energy and frequency; that is, as the hundreds of megahertz. As with electromagnetic radiation
frequency increases, so does the energy. Planck theorized that wavelengths, frequencies are also very large or very small
electromagnetic radiation can only exist as “packets” of en- and are generally expressed in exponential form. Electro-
ergy, later called photons. The constant, h, which is named for magnetic radiation with very short wavelengths, such as
Planck, is a mathematical value used to calculate photon en- x-rays, has frequencies measured in million-trillions of
ergies based on frequency. The energy of the electromagnetic hertz (e.g., 1019 Hz).
spectrum ranges from 10212 to 1010 eV. The basic formula for calculating wavelength or frequency
is velocity 5 frequency 3 wavelength (v 5 f l). This formula
is simplified when applied to electromagnetic radiation be-
CRITICAL CONCEPT 3-2
cause the velocity of the spectrum is the same for all. So we
Difference Between Electromagnetic and replace v with c (the constant symbol for the speed of light:
Mechanical Energy 3 3 108 m/s), and our formula becomes c 5 f l. When
Electromagnetic energy differs from mechanical energy in solving for frequency, this formula becomes f 5 c/l; this
that it does not require a medium in which to travel. Rather, is simply a mathematical rearrangement to isolate the unknown
the energy itself vibrates. value. When solving for wavelength, the formula becomes
l 5 c/f—again, just to isolate the unknown value.

Electromagnetic radiation exhibits properties of a wave or

a particle depending on its energy and in some cases its envi- MATH APPLICATION 3-1
ronment. This phenomenon is called wave-particle duality, The speed of light is a known value and is used in other
which is essentially the idea that there are two equally correct formulas encountered in studies of radiologic science. It is
ways to describe electromagnetic radiation. Conceptually we commonly represented by the letter c, and its value is equal
can talk about electromagnetic radiation based on its wave to 3 3 108 m/s.
characteristics of velocity, amplitude, wavelength, and fre-
quency. As previously stated, the velocity for all electromag-
netic radiation is the same: 3 3 108 m/s. The amplitude refers MATH APPLICATION 3-2
to the maximum height of a wave. Wavelength is a measure of To find the frequency of electromagnetic radiation, divide the
the distance from the peak of one wave to the peak of the next speed of light by the wavelength measure:
wave. Frequency refers to the number of waves that pass a
given point per second (Figure 3-3). f 5 c/l
Because all electromagnetic radiation travels at the same For example, what is the frequency of electromagnetic radia-
velocity, the relationship between wavelength and frequency tion if the wavelength is 1 3 10–11 m? The problem is set up
is inverse. That is, the longer the wavelength, the lower the like this:
frequency, and vice versa. Wavelength is generally expressed f 5 c/l 5 3 3 108 m/s/1 3 10211 m 5 3 3 1019 Hz
in meters (m). Because we are dealing with very large to
28 SECTION I  Principles of Radiation Physics

MATH APPLICATION 3-3 value. As you continue in your studies, you will have many
x-ray problems with which to practice, so in keeping with
To find the wavelength of electromagnetic radiation, divide Figure 3-4 let’s continue with a light source example. If a light
the speed of light by the frequency measure: source has an output of 1000 lumens at 2 meters, what will
l 5 c/f the intensity be at 4 meters? Inserting the values into the
inverse square law formula we get:
What is the wavelength of electromagnetic radiation if the
frequency is 1.5 3 1012 Hz? The problem is set up like this: 1000/I2 5 42/22
l 5 c/f 5 3 3 108 m/s/1.5 3 1012 Hz 5 2 3 1024 m 1000/I2 5 16/4
1000/I2 5 4
I2 51000/4 5 250 lumens
Electromagnetic radiation can also be characterized by
how it interacts with matter. When discussed in this way, elec- CRITICAL CONCEPT 3-3
tromagnetic radiation may exhibit more characteristics of Wave-Particle Duality
particles, depending on its energy. An individual particle or
Electromagnetic radiation exhibits properties of both a parti-
photon of electromagnetic radiation has an energy given by
cle and a wave, depending on its energy and environment.
the Planck formula presented earlier. Higher-energy photons
Higher-energy electromagnetic radiation tends to exhibit
(e.g., x-rays and gamma rays) act more like particles, whereas more particle characteristics and lower-energy electromag-
lower-energy radiation (e.g., radiowaves and microwaves) act netic radiation tends to exhibit more wave characteristics.
more like waves.
The intensity of electromagnetic radiation diminishes
over distance. This should be a familiar observation with MAKE THE IMAGING CONNECTION 3-1
sources of light or perhaps a campfire. This is an application
Chapter 10
of the inverse square law: the intensity of electromagnetic
radiation diminishes by a factor of the square of the distance The inverse square law is also used to calculate the change
from the source. This concept is illustrated with a light source in the intensity (quantity) of radiation reaching the image
in Figure 3-4 and is important to medical imaging as the receptor with changes in distance.
reader will see in chapters 6 and 10. The formula is:

I1 (D2 )2 X-rays And Gamma Rays

5 X-rays and gamma rays have characteristics of both waves and
I2 (D1)2
particles, but because of their high energy, they exhibit more
If the formula is applied to a light source, “I” represents particulate characteristics than those at the other end of the
luminosity (measured in lumens or candela) and “D” repre- electromagnetic spectrum. They do exhibit the wave charac-
sents distance. If applied to x-rays, the “I” represents Roentgens teristic of transmission. But they can also burn the skin, and
(R) (or milliRoentgens [mR]), which is a measure of radia- their intensity varies according to the inverse square law, both
tion intensity (with “D” again representing distance. The of which are particulate characteristics. One additional par-
calculation is the same and involves solving for the unknown ticulate characteristic unique to the highest two members of
the electromagnetic spectrum (x-rays and gamma rays) is the
4m
ability to ionize matter. When a photon possesses sufficient
energy, it can remove electrons from the orbit of atoms during
interactions. This removal of an electron from an atom is
3m
called ionization. The atom and the electron that was re-
moved from it are called an ion pair. Ionization is the charac-
2m
teristic of x-rays and gamma rays that make them dangerous
in general and harmful to the patient if misused. When tissue
1m atoms are ionized, they can damage molecules and deoxyribo-
nucleic acid (DNA), and cause chemical changes in cells.

CRITICAL CONCEPT 3-4

Ability to Ionize Matter
1 cm2 The highest-energy members of the electromagnetic spec-
4 cm2
trum, x-rays and gamma rays, have the ability to ionize matter.
9 cm2
16 cm2 This is an extremely important differentiating characteristic in
that this characteristic can cause biologic changes and harm
FIG 3-4  Inverse Square Law. Illustration of the inverse to human tissues.
square law using grid pattern from a source.
 CHAPTER 3  Electromagnetic and Particulate Radiation 29

What differentiates x-rays from gamma rays is that each TABLE 3-1  Summary of Electromagnetic
originates from a different energy source. Gamma rays origi- Spectrum
nate in the nuclei of atoms and represent the excess energy
Electromagnetic Ionize
the atom is giving off to reach a stable state. X-rays originate
Radiation Common Use Matter?
through interactions between electrons and atoms. X-rays are
Radiowaves Broadcasting of music, MRI No
produced when fast-moving electrons within the x-ray tube
Microwaves Cell phone signals, micro- No
strike the atoms of the metal in its target. This subject is dis-
wave ovens
cussed in greater detail in later chapters. Infrared light Communication between No
electronic devices
The Rest of the Spectrum Visible light The part of the spectrum No
Readers should now understand the nature of x-rays and the human eye perceives
gamma rays. This section discusses the rest of the spectrum. as colors
As mentioned earlier, radiographers do encounter the other Ultraviolet light Tanning beds No
members of the electromagnetic spectrum and should be X-rays Medical imaging, radiation Yes
able to explain the difference to patients. therapy
The low end of the energy spectrum begins with radio- Gamma rays Nuclear medicine imaging, Yes
radiation therapy
waves. One common use of radiowaves (aside from trans-
mitting our favorite music to our radios) is in magnetic MRI, Magnetic resonance imaging.
resonance imaging (MRI). The basic principle of opera-
tion of MRI hinges on the fact that the nuclei of hydrogen
atoms are magnetic: when placed in a strong magnetic visible spectrum together. Therefore, an object perceived as
field, the nuclei will absorb and reemit radiowaves of a white is reflecting all of the wavelengths of light at once.
particular frequency. Through sophisticated processing When we see a particular color, the object is absorbing all of
of these emitted radiowaves, images can be constructed. the wavelengths of light except the one we see. The color
Because human tissue contains large amounts of hydrogen black represents absorption of all of the color wavelengths.
(in molecules of water, fat, etc.), a substantial signal is The visible spectrum is a very tiny portion of the electromag-
observed. It is important to note that radiowaves do not netic spectrum and, again, visible light does not ionize atoms.
ionize atoms. Ultraviolet light has energies approaching those of x-rays
Microwaves are used routinely to transmit cell phone sig- and gamma rays. Ultraviolet light–emitting bulbs are used in
nals and heat food. Microwave towers can be seen across the tanning beds because it is that part of sunlight that causes
landscape, and microwaves generally provide a reliable signal. darkening of the skin (or burning if exposure is excessive).
In microwave ovens, a microwave generator is used to create Ultraviolet light can be harmful, and routine exposure has
microwaves (electromagnetic waves at a frequency of about been demonstrated to cause skin cancer. Ultraviolet light
2500 MHz) that are directed at the food. Microwaves hit the stimulates melanin production in skin cells, causing the dark-
atoms of the food, giving them excess energy. This energy ening of or damage to the melanocytes, resulting in cancer,
causes “vibration” of the atoms and molecules. The atoms but it does not ionize the atoms.
release this excess energy as heat, which increases the tem- All of these are members of the electromagnetic spectrum,
perature of the food to the point of cooking or warming but each behaves differently depending on its energy, and
it. Microwave ovens work because microwaves are readily none has the ability to ionize matter. See Table 3-1 for a sum-
absorbed by water, sugars, and fats, but not by glass or plastic. mary of the electromagnetic spectrum.
Metals reflect microwaves and prevent them from being ab-
sorbed by the food, and could damage the generator (which THEORY TO PRACTICE 3-1
is why metals cannot be used in microwave ovens). Although
microwaves can cause heating of tissues, they do not ionize The radiographer should be able to explain the electromagnetic
atoms. spectrum to patients or others for the purpose of education and
reassurance during examinations.
Infrared light is a low-energy, electromagnetic radiation
just above microwaves. It is sometimes used to “beam” infor-
mation between electronic devices. For example, the signal
sent from the television remote to change channels or set-
PARTICULATE RADIATION
tings on the television is infrared light. It may also be used to Particulate radiation—alpha particles and beta particles—
send information between portable electronic devices, such is important to know and understand because, like x-rays and
as between cell phones, between cell phones and computers, gamma rays, alpha and beta particles have the energy to ion-
or between personal digital assistants and computers. Again, ize matter. Particulate radiation is more often dealt with in
infrared light does not ionize atoms. nuclear medicine or radiation therapy. But imaging profes-
Visible light is likely the most familiar member of the sionals are obliged to understand its nature to fulfill their role
electromagnetic spectrum. It represents the colors visible to as a source of information and an advocate for patients and
the human eye. White light consists of all of the colors of the the public.
30 SECTION I  Principles of Radiation Physics

CRITICAL CONCEPT 3-5 Neutron

The Nature of Particulate Radiation
Particulate radiation—alpha and beta particles—are physical Proton
particles originating from radioactive atoms with the ability to
ionize matter, much like x-rays and gamma rays.

To understand particulate radiation, one must first under-

stand radioactivity. Radioactivity is a general term for the Nucleus
process by which an atom with excess energy in its nucleus
Alpha particle
emits particles and energy to regain stability. This process of
a radioactive element giving off excess energy and particles to FIG 3-5  Alpha Particle. An alpha particle is composed of two
regain stability is known as radioactive decay. Elements that protons and two neutrons, the same makeup of the nucleus
of a helium atom.
are composed of atoms with unstable nuclei are said to be
radioactive. Some radioactive elements, such as radium and
uranium, exist in nature, whereas others, such as technetium,
Beta particle
are artificially produced for various purposes. (Technetium is (electron)
produced for nuclear medicine studies). A radioactive sub-
stance does not suddenly decay all at once. Decay is a process
that may last minutes or billions of years. One term used to
describe the rate at which a radioactive substance decays is
half-life. A half-life is the length of time it takes for half the
remaining atoms in a quantity of a particular radioactive ele-
ment to decay. The half-life of radium 226, for example, is
1620 years. Half the unstable atoms are left after that time,
and half of that amount (or one fourth) is left after another
1620 years, and so on. Half-lives are used to measure radioac-
tivity because that is how radioactive substances happen to
decay. Chapter 1 noted that the unit of measure for radioac- FIG 3-6  Beta Particle. A beta particle is an electron that is
emitted from an unstable nucleus; it does not originate from
tive decay is the curie (or Becquerel). The electromagnetic
one of the electron shells.
photons emitted in this process (gamma rays) have already
been discussed. That leaves the two common particles: alpha
and beta.
An alpha particle is actually two protons bound to two particle picks up the two electrons, it becomes a neutral
neutrons (the same makeup of the nucleus of a helium atom; helium atom.
Figure 3-5). Alpha particles have a net positive charge, two A beta particle is an electron that is emitted from an
protons giving a charge of plus two. For example, uranium unstable nucleus; it does not originate in an electron shell
238 is naturally radioactive. Each uranium atom has 92 pro- (Figure 3-6). A beta particle is much lighter and smaller than
tons and 146 neutrons. When it decays and emits an alpha an alpha particle, and thus can penetrate light materials.
particle, uranium then has 90 protons and 144 neutrons and Betas have a much larger range and may ionize many atoms
becomes an atom of the element thorium. Alpha particles do along their path. They may have a positive or negative charge.
not travel very far because they are relatively large and cannot The negatively charged beta particle differs from an electron
penetrate most objects. Even in passing through air, they only in that it originated in the nucleus of the atom, not an
quickly pick up electrons that are attracted to their net posi- orbital shell. The positively charged beta particle is called a
tive charge and become helium atoms. A helium atom has positron. When beta particles are stopped by collisions with
two protons, two neutrons, and two electrons. When an alpha other atoms, they join with atoms, just as electrons do.

SUMMARY
• Radiographers serve as advocates for patients and re- members of the electromagnetic spectrum vary only in
sources of information regarding the nature, benefits, and their energy, wavelength, and frequency.
risks of the use of radiation. They should understand elec- • Electromagnetic energy differs from mechanical energy in
tromagnetic and particulate radiation and safely use the that it does not require a medium in which to travel.
ionizing forms for medical imaging. • Electromagnetic radiation exhibits properties of both a
• Electromagnetic radiation is an electric and magnetic dis- particle and a wave depending on its energy and environ-
turbance traveling through space at the speed of light. The ment. Higher-energy electromagnetic radiation tends to
 CHAPTER 3  Electromagnetic and Particulate Radiation 31

S U M M A R Y — cont’d
exhibit more particle characteristics than lower-energy spectrum and be able to explain such differences to the
electromagnetic radiation. public.
• The wavelength or frequency of electromagnetic radiation • Particulate radiation includes alpha and beta particles,
may be calculated using the following formula: c 5 f l. which originate from radioactive nuclei and have the abil-
• The crucial difference between x-rays and gamma rays and ity to ionize matter.
the rest of the electromagnetic spectrum is that these two • Particulate radiation is emitted from radioactive nuclei
members have the ability to ionize matter. through decay, the process by which radioactive nuclei
• Radiographers should be aware of the nature and charac- emit excess particles and energy in an effort to regain
teristics of all of the members of the electromagnetic stability.

CRITICAL THINKING QUESTIONS

1. A patient states that he works around microwave and inform him of the risks versus benefits of the
ovens every day and is concerned about the additional exam?
radiation from the exam you are about to perform. 2. Using your understanding of electromagnetic energy and
How would you explain the electromagnetic spectrum its properties, explain why health care providers continue
(difference in microwaves versus x-rays) to him to struggle with the safe use of x-rays.

REVIEW QUESTIONS
1. As the frequency of electromagnetic radiation decreases, 6. A photon has a wavelength of 3 3 10212 m. What is its
wavelength will: frequency?
a. increase. a. 3 3 1024 Hz
b. decrease. b. 3 3 1020 Hz
c. remain the same. c. 1 3 1024 Hz
d. frequency and wavelength are unrelated d. 1 3 1020 Hz
2. Which of the following members of the electromagnetic 7. Which of the following do not originate from an unstable
spectrum has the ability to ionize matter? nucleus?
a. Radiowaves a. Alpha particles
b. X-rays b. Beta particles
c. Microwaves c. X-rays
d. Ultraviolet light d. Gamma rays
3. Which of the following is not within the wavelength range 8. How much activity will remain in a dose of 20 mCI 99mTC
of electromagnetic radiation? after 24 hours? (The physical half-life of 99mTc is 6 hours.)
a. 10224 a. 5 mCi
b. 10212 b. 10 mCi
c. 107 c. 0.05 mCi

d. 10216 d. 1.25 mCi
4. Which member of the electromagnetic spectrum has the 9. The intensity of a source at 15 inches is 10 R. What will
longest wavelength? the intensity be at 45 inches?
a. Microwaves a. 1.11 R
b. Visible light b. 0.74 R
c. Radiowaves c. 90 R
d. X-rays d. 304 R
5. A diagnostic x-ray photon has a frequency of 2.42 3 1019 10. The intensity of a source is 25 R at 40 inches. What will
Hz. What is its wavelength? the intensity be at 20 inches?
a. 12.4 3 10211m a. 6.25 R
b. 12.4 3 1027m b. 62.5 R
c. 1.24 3 10211 m c. 100 R
d. 1.24 3 1027m d. 1000 R
 4
The X-ray Circuit

OUTLINE
Introduction Generators, Motors, and Transformers
Nature of Electricity General X-ray Circuit
Electric Potential, Current, and Resistance Primary Circuit
Conductors, Insulators, and Electronic Devices Secondary Circuit
Electromagnetism and Electromagnetic Induction Filament Circuit
Magnetism Principles of Circuit Operation
Electromagnetism Summary

OBJECTIVES
• Discuss the nature of electricity in terms of electrostatics • Explain electromagnetic induction (both mutual induc-
and electrodynamics. tion and self-induction).
• Explain electric potential, current, and resistance. • Describe basic generators, motors, and transformers.
• Describe conductors and insulators and give examples • Identify the components of the x-ray circuit as being in
of each. the primary, secondary, or filament circuits.
• Identify electronic devices important to the understanding • Explain the role and function of each major part of the
of the x-ray circuit. x-ray circuit.
• Demonstrate a basic understanding of magnetism. • Explain the basic principles of operation of the x-ray
• Explain electromagnetism. circuit from incoming power to x-ray production.

KEY TERMS
alternating current (AC) electromagnetic induction magnetism
automatic exposure control (AEC) electromagnetism motors
conductor electrostatics primary circuit
current filament circuit resistance
direct current (DC) generators secondary circuit
electric potential grounding transformers
electrodynamics insulator

likely to stay in the air very long. The safety of the passengers
INTRODUCTION aboard that aircraft rests with the training and knowledge of
This chapter provides a concise overview of the nature of elec- that pilot. Similarly, the radiographer is responsible for the
tricity, electrical devices, and the basics of x-ray circuitry and safety of the patient; the radiation dose that patient receives
principles of operation. It is true that many types of x-ray depends on the radiographer’s understanding and safe opera-
equipment are automated (Figure 4-1). However, a radiogra- tion of the x-ray machine. The concepts presented here are
pher is not someone who merely “pushes buttons.” Rather, he or important to the radiographer because they ground his or her
she has an understanding of the principles of x-ray production practice in a fundamental understanding of what is happening
and has mastered the art of producing quality images with each time he or she operates the x-ray machine. By understand-
minimal radiation exposure to the patient. To reach this level of ing what happens within the x-ray machine with each selection
mastery, the radiographer must understand the basic elements made at the operating console, the radiographer is able to use
of the x-ray machine and the steps in the process. Consider a the machine with maximum efficiency and minimal radiation
pilot who flies a modern jet. A pilot untrained for that aircraft exposure to the patient. The knowledgeable radiographer is also
may be able to get it off the ground and flying, but without able to make adjustments in exposure technique with variations
some understanding of the jet’s instrumentation he or she is not in machines and daily operation.
32
 CHAPTER 4  The X-ray Circuit 33

The electrostatic force between two charges is directly

proportional to the product of their quantities and inversely
proportional to the square of the distance between them (also
known as Coulomb’s law).
Electric charges reside only on the external surface of
conductors.
The concentration of charges on a curved surface of a
conductor is greatest where the curvature is greatest.
Only negative charges (electrons) are free to move in solid
conductors.
In electrostatics, electrification of objects occurs when
they gain either a net positive or a net negative charge. An
object may be electrified in three ways: by friction, by contact,
or by induction. The classic physics experiment involving
rubbing a rubber rod with fur is an example of electrification
by friction. Once charged, the rod can be discharged by plac-
ing it in contact with a conductor. This is an example of
electrification by contact. Electrification by induction is the
process by which an uncharged metallic object experiences a
shift of electrons when brought into the electric field of a
charged object. Induction occurs as a result of the interaction
of the electric fields around two objects that are not in con-
tact with each other. This is very useful in the design of the
FIG 4-1  X-ray Machine Control Panel. Touch-screen control x-ray tube, as is discussed in Chapter 5.
panel of a typical radiographic unit. Electrodynamics describes electrical charges in motion.
This movement is associated with “electricity,” and it is the
intended meaning for all further discussions of electricity in
this text. For electric current to move, an electric potential
NATURE OF ELECTRICITY must exist. Electric potential is the ability to do work because
The nature of electricity may be understood through a dis- of a separation of charges. If one has an abundance of elec-
cussion of electrostatics and electrodynamics. Electrostatics trons at one end of a wire and an abundance of positive
is the study of stationary electric charges, and electrodynam- charges at the other end (separation of charges), electrons
ics is the study of electric charges in motion. The latter is will flow from abundance to deficiency.
most often considered as “electricity.” A few fundamental
concepts must first be discussed. THEORY TO PRACTICE 4-1
Electric charge is a property of matter. The smallest
units of charge exist with the electron and the proton. Elec- By design, the x-ray tube creates a separation of charges, and
trons have one unit of negative charge and protons have the exposure factors the radiographer selects on the control
panel determine the number of electrons that will flow and
one unit of positive charge. Electrical charges are measured
the magnitude of their attraction to the positive side
in the systeme internationale (SI) unit “coulomb.” One
coulomb is equal to the electrical charge of 6.25 3 1018
electrons. A measure of electrons is used because electricity
most often results from their movement. Except in decay- CRITICAL CONCEPT 4-1
ing radioactive elements, protons are generally fixed in Nature of Electricity
their position inside the nucleus of the atom. Electrons, on The smallest units of charge rest with the proton and the
the other hand, are relatively free to move about, depend- electron. However, only electrons are free to move in solid
ing on the material. Some materials, such as copper and conductors. Therefore “electricity” is most often associated
gold, have a very large number of free electrons, making with the flow of electrons.
them good conductors of electricity. Glass and plastic, on
the other hand, have very few free electrons, making them
good insulators. This is discussed in greater detail later in ELECTRIC POTENTIAL, CURRENT,
this chapter.
Although an understanding of the laws of electrostatics
AND RESISTANCE
is not the primary focus of this chapter, it is helpful in un- Electric potential, current, and resistance are expressions of
derstanding the nature of electricity. There are five general different phenomena surrounding electricity. Electric poten-
principles of electrostatics. They are as follows: tial is the ability to do work because of a separation of
Like charges repel and unlike charges attract. charges. Current is an expression of the flow of electrons in a
34 SECTION I  Principles of Radiation Physics

conductor. Finally, resistance is that property of an element in defined as “1 coulomb flowing by a given point in 1 second.”
a circuit that resists or impedes the flow of electricity. Reflecting its relationship to the definition of volt (discussed
It should be noted that there is nothing magical about the previously), it may also be defined as “the amount of current
production of x-rays; it is simply the manipulation of elec- flowing with an electric potential of 1 volt in a circuit with a
tricity. Of course significant engineering and technological resistance of 1 ohm.” For electric current to flow, there must
knowledge is required to design and manufacture the equip- be a potential difference between two electrodes and a suit-
ment, but, when viewed at its most basic level, x-ray produc- able medium through which it can travel. With regard to
tion is again, achieved through the manipulation of electric- potential difference, electrons flow from abundance to defi-
ity. In fact, the units of measure for electric potential (the volt) ciency and will continue to do so as long as that difference
and current (the ampere) are the factors selected on the oper- exists. Electricity behaves differently depending on the me-
ating console of the x-ray machine to produce x-rays. They are dium through which it travels. Suitable media are conductors
expressed in thousands and thousandths, respectively, but and those resisting electric current flow are insulators. Both
they are electrical terms and are not exclusive to radiology. types of media are important to the production of x-rays.
Two in particular, vacuums and metallic conductors, are of
CRITICAL CONCEPT 4-2 particular usefulness in x-ray production. In a vacuum tube,
electrons tend to jump the gap between oppositely charged
Expressions of Electrical Phenomena
electrodes. This is part of the environment that exists inside
Electric potential, current, and resistance are expressions of an x-ray tube. With metallic conductors, electrons from the
different phenomena surrounding electricity. Electric poten- conductor’s atoms will move out of the valence shell to a
tial is the ability to do work because of a separation of higher energy level just beyond, called the conduction band,
charges. Current is an expression of the flow of electrons in where they are free to drift along the external surface of the
a conductor. Resistance is that property of an element in a
conductor (refer to Chapter 2 for a discussion of atomic
circuit that resists or impedes the flow of electricity.
structure). Copper is particularly useful as a conductor and is
commonly used as such in electronic devices. Other metals
Electric potential is measured in volts, named for the Ital- with this characteristic are used extensively in x-ray machine
ian physicist Volta who invented the battery. A volt may be and x-ray tube design.
defined as “the potential difference that will maintain a cur- The two types of current, direct current (DC) and alter-
rent of 1 ampere in a circuit with a resistance of 1 ohm” nating current (AC), are also important to x-ray production
(amperes and ohms are discussed next). It is the expression and should be understood before moving on. DC is a type of
of the difference in electric potential between two points. The current that flows in only one direction. A battery is a good
volt is also equal to the amount of work in joules that can be example: It has a positive and a negative electrode, and, when
done per unit of charge. (Refer to Chapter 1 for a review of placed in an electrical circuit, electrons flow from the nega-
the definition and calculation of work.) A volt is the ratio of tive terminal to the positive terminal (current flows in the
joules to coulombs (volt 5 joules/coulombs). For example, a opposite direction, a topic clarified later). AC is current that
battery that uses 6 joules of energy to move 1 coulomb of changes direction in cycles as the electric potential of the
charge is a 6-volt battery. source changes (the negative and positive “terminals,” if you
Again, one of the exposure factors selected on the control will, alternate). In the United States the electricity that flows
panel of the x-ray machine is kilovoltage peak (kVp). The into homes alternates at 60 cycles per second. This is ex-
role of kVp within the machine and in image production is pressed as a frequency of 60 Hz (see Chapter 3 for a definition
discussed later in this text. For now, note that the radiogra- and discussion of hertz). Both AC and DC are used in basic
pher is literally selecting the thousands of volts that will be x-ray production.
applied to the x-ray tube to produce x-rays. An understand-
ing of this unit of measure and the concepts presented here CRITICAL CONCEPT 4-3
are vital to the competent and safe operation of the x-ray
Types of Current
machine.
There are two types of electric current. DC is a type that
MAKE THE IMAGING CONNECTION 4-1 flows in only one direction (from positive to negative, oppo-
site the direction of electron flow). AC is a type that changes
Chapters 9 and 10 direction in cycles as the electric potential of the source
Kilovoltage peak influences many areas of imaging. Among changes (the negative and positive or polarity changes). In
other things, it determines how the beam penetrates the the United States, electricity alternates at 60 cycles per
body part, controls contrast in the film image, and influences second.
contrast in the digital image.

Resistance is measured in ohms, named for the physicist

Current is measured in amperes, named for André-Marie Georg Simon Ohm who discovered the inverse relationship
Ampere, a French physicist who made significant contribu- between current and resistance. The ohm may be defined as
tions to the study of electrodynamics. The ampere may be “the electrical resistance equal to the resistance between two
 CHAPTER 4  The X-ray Circuit 35

points along a conductor that produces a current of 1 ampere Such materials are insulators. Insulators have virtually no
when a potential difference of 1 volt is applied.” Ohm’s law free electrons and, as such, are very poor conductors of elec-
states that the potential difference (voltage) across the total tricity. But it is this very property that makes them particu-
circuit or any part of that circuit is equal to the current (am- larly useful in containing the flow of electricity. Covering a
peres) multiplied by the resistance. It is expressed by the copper wire with rubber or plastic “insulates” the wire and
formula V 5 IR, in which V is voltage, I is current, and R is restricts the flow of electricity to the copper wire; such is the
resistance. case with an electric cord (extension cord). Glass, ceramic,
and wood are also good insulators. This combination of con-
ductors and insulators is prevalent in daily life.
CRITICAL CONCEPT 4-4 In between these extremes are semiconductors. These ma-
Relationship of Voltage, Current, and Resistance terials will conduct electricity but not as well as conductors,
The relationship among voltage, current, and resistance may and they will insulate but not as well as insulators. Silicon,
be expressed through Ohm’s law, which states that the germanium, and diamond are examples of semiconductors.
potential difference (voltage) across the total circuit or any Semiconductor properties are very useful and widely used in
part of that circuit is equal to the current (amperes) multiplied electronics.
by the resistance (ohms) (V 5 IR).
CRITICAL CONCEPT 4-5
Conductors and Insulators
Resistance is that property of a circuit element that im-
pedes the flow of electricity. The amount of resistance of a Conductors are materials with an abundance of free elec-
particular conductor depends on four things: material, trons that allow a relatively free flow of electricity, whereas
insulators have virtually no free electrons and are therefore
length, cross-sectional area, and temperature.
very poor conductors of electricity.
Material: Some materials allow a free flow of current be-
cause they have an abundance of free electrons whereas other
materials have tremendous resistance because they have vir- An electric circuit is a closed pathway composed of wires
tually no free electrons. and circuit elements through which electricity may flow. This
Length: Resistance is directly proportional to the length of pathway for electricity must be closed (complete) for electric-
the conductor; that is, a long conductor has more resistance ity to flow. This is what is meant by a closed circuit. In contrast,
than a short one. an open circuit is one in which the pathway is broken, such as
Cross-sectional area: A conductor with a large cross-sec- when a switch is turned off. Turning off a switch opens the
tional area has a lower resistance than one with a small cross- pathway, and turning on a switch closes the pathway. The ele-
sectional area because there is a greater external surface area ments of a circuit may be arranged in series (called a series
on which electrons can travel. circuit), in parallel (called a parallel circuit), or a combination
Temperature: With metallic conductors, the resistance (called series-parallel). A series circuit is one in which the
becomes greater as the temperature of the conductor rises. circuit elements are wired along a single conductor. A parallel
Although resistance may sound like a hindrance to the x- circuit is one in which the circuit elements “bridge” or branch
ray production process, it is quite useful and is an important across a conductor. The calculation of voltage, current, and
part of the process of x-ray production. resistance differ between the two, and the rules for each are
summarized in Box 4-1. An x-ray circuit is a complex version
CONDUCTORS, INSULATORS, that has different voltages and currents flowing through dif-
ferent sections.
AND ELECTRONIC DEVICES The term electronic devices may mean a number of things
Conduction and insulation are properties of elements and depending on context. Music players, cell phones, video gam-
materials used in daily life. As previously stated, conductors ing systems, televisions, and so on are all referred to as elec-
are those materials with an abundance of free electrons that tronic devices. This same definition can be applied to many
allow a relatively free flow of electricity. Although any such devices used in health care. An understanding of seven elec-
material conducts electricity, metals are typically used to tronic devices—battery, capacitor, diode, protective devices
serve this purpose. Copper typifies a conductive material. Its (fuses and circuit breakers), resistor or rheostat, switch, and
valence electrons are relatively free and will readily move to transformer—facilitates understanding of the x-ray circuit.
the conduction band, allowing a free flow of electricity. Gold A battery is a device that produces electrons through
is also a good conductor, but is considerably more expensive a chemical reaction, stores an electric charge for the long
because it is a precious metal and is not widely used for this term, and provides an electric potential. A capacitor is like
purpose. Water is also a good conductor of electricity because a battery in that it stores an electric charge, but it works
of the mineral impurities it often contains. very differently in that it cannot produce new electrons and
In contrast, most nonmetallic elements are made up of stores the charge only temporarily. A diode (e.g., solid-state
atoms with tightly bound electrons and do not conduct elec- rectifier) is a “one-way valve” device that allows electrons to
tricity well even when attracted by a potential difference. flow in one direction only. Protective devices, such as fuses
36 SECTION I  Principles of Radiation Physics

BOX 4-1  Rules for Calculating Voltage, TABLE 4-1  Common Circuit Devices
Current, and Resistance Based on Circuit Device Use Symbol
Type Battery Produces electrons
Rules for Series Circuits through a chemical re-
Total voltage is equal to total current 3 total resistance. action, stores an elec-
VT 5 ITRT tric charge long term,
Resistance is equal to the sum of the individual resistances. and provides an electric
RT 5 R1 1 R2 1 R3 potential.
Current is equal throughout the circuit. IT 5 I1 5 I2 5 I3 Capacitor Temporarily stores an
Voltage is equal to the sum of the individual voltages. VT 5 V1 electric charge.
1 V2 1 V3 Diode A “one-way valve” de-
vice; allows electrons
Rules for Parallel Circuits to flow in only one
Total voltage is equal to the total current 3 the total resis- direction.
tance. VT 5 ITRT Protective Emergency devices that Fuse
Total current is equal to the sum of the individual currents. IT devices break or open the cir-
5 I1 1 I2 1 I3 (fuses, cuit if there is a sudden
Voltage is equal throughout the circuit. VT 5 V1 5 V2 5 V3 circuit surge of electricity to Circuit breaker
Total resistance is inversely proportional to the sum of the breakers) the circuit or device.
reciprocals of each individual resistance. 1/RT 5 1/R1 1
1/R2 1 1/R3
Resistor (and Inhibits the flow of elec- Resistor
rheostat) trons, thereby precisely
regulating the flow of Rheostat
and circuit breakers, act as emergency devices that “break” electricity through that
or open the circuit if there is a sudden surge of electricity part of the circuit
to the circuit or device. This act of opening the circuit pro- where it is placed.
tects the other circuit elements and the device as a whole. A rheostat is simply
A fuse is simply a section of special wire usually encased in an adjustable or vari-
able form of resistor.
glass that quickly melts if the current flow rises excessively,
Switch A device that opens a
thus opening the circuit. A circuit breaker acts in the same
circuit (breaks the
manner as a fuse. If the current flow rises excessively, the pathway).
circuit breaker’s internal switch is tripped (opened), stop- Transformer A device that can in-
ping the flow of electricity. A resistor is a device designed crease or decrease
to inhibit the flow of electrons, thereby precisely regulating voltage by a predeter-
the flow of electricity through that part of the circuit where mined amount.
it is placed. A rheostat is simply an adjustable or variable
form of resistor. A switch is a device that opens a circuit
(breaks the pathway). Finally, a transformer is a device
that can increase or decrease voltage by a predetermined
amount. CRITICAL CONCEPT 4-6
Table 4-1 provides a summary of these devices and the Grounding
symbols of each.
Grounding is a process of neutralizing a charged object by
A term you may see in relation to circuits and electricity is
placing it in contact with the earth. Positively charged objects
grounding. Grounding, a process of connecting the electrical take electrons from the earth until neutral, and negatively
device to the earth via a conductor, is a protective measure. charged objects give up electrons to the earth until neutral.
The earth is essentially an infinite reservoir of electrons. Any
charged object can be neutralized if it is grounded. Positively
charged objects take on electrons from the earth, and nega-
tively charged objects give up electrons to the earth until ELECTROMAGNETISM
neutral. Inside electrical equipment, the grounding wire con- AND ELECTROMAGNETIC INDUCTION
nects to metal parts that are not a part of the circuit, such as
the housing. If a “live” wire happens to touch the housing, the Magnetism
current is conducted away by the grounding wire. This “short Electricity and magnetism are two different parts of the same
circuit” into the ground wire trips the circuit breaker, shut- phenomenon known as electromagnetism. Magnetism may
ting off the electricity to the circuit. With these concepts and be defined as “the ability of a material to attract iron, cobalt,
components in mind, electromagnetism and electromagnetic or nickel.” The magnetic properties of cobalt and nickel as-
induction can now be discussed. sume their pure form. The U.S. nickel coin does not exhibit
 CHAPTER 4  The X-ray Circuit 37

strong magnetic properties because it contains only 25% weakly repelled by magnetic fields, paramagnetic materials
nickel; the rest is copper. Iron is relatively abundant and is (e.g., platinum, gadolinium, and aluminum) are weakly
used extensively in the creation of magnets and magnetic attracted to magnetic fields, and ferromagnetic materials
fields. (e.g., iron, cobalt, and nickel) are strongly attracted to mag-
The nature of magnetic materials is such that the orbital netic materials.
electrons of their atoms spin in predominately one direction.
Such atoms create tiny magnets called magnetic dipoles. Electromagnetism
When these dipoles, or “atomic magnets,” form groups of With an understanding of electricity and magnetism, they
similarly aligned atoms, they create magnetic domains. These can be discussed together as electromagnetism. As previ-
domains exist in magnetic materials but are not “coordi- ously stated, electricity and magnetism are two parts of the
nated” with each other. When such magnetic materials are same basic force. That is, any flow of electrons, whether in
placed in a strong magnetic field, the domains align with the space or in a conductor, is surrounded by a magnetic field.
external field, which organizes them and “magnetizes” the Likewise, a moving magnetic field can create an electric
material, creating a magnet. current.
A magnetic field consists of lines of force in space called
flux and has three basic characteristics. First, the lines of flux
travel from the south pole to the north pole inside the magnet CRITICAL CONCEPT 4-7
and from the north pole to the south pole outside the magnet, Electromagnetism
creating elliptical loops (Figure 4-2). Second, lines of flux in Electricity and magnetism are two parts of the same basic
the same direction repel each other, and lines of flux in the force. That is, any flow of electrons, whether in space or in a
opposite direction attract each other. Third, magnetic fields conductor, is surrounded by a magnetic field. Likewise, a
are distorted by magnetic materials and are unaffected by moving magnetic field can create an electric current.
nonmagnetic materials. There are three laws of magnetism
that may promote an understanding of electromagnetism.
The first law is that every magnet has a north and south pole. The principle of electromagnetism was first identified by
The second law states that like poles repel each other and op- the Danish physicist Hans Oersted when he discovered that
posite poles attract each other. The third law states that the needle of a compass is deflected when placed near a con-
the force of attraction or repulsion varies directly with the ductor carrying electric current. It was later discovered that
strength of the poles and inversely with the square of the the magnetic field surrounding the conductor could be in-
distance between them. The strength of the magnetic field is tensified by fashioning it into a coil (called a solenoid) and
measured in the SI unit tesla (T), named for the American intensified further by adding an iron core to the coil (called
physicist Nikola Tesla. Magnetic resonance imaging (MRI) an electromagnet). Shortly after Oersted’s discovery, British
units used for medical imaging are referred to by their mag- scientist Michael Faraday found that moving a conductor
netic field strength and operate with fields from 0.5 to 5 T (such as copper wire) through a magnetic field induces an
(5 T is currently experimental). electric current in that conductor. This phenomenon is called
Just as materials can be classified as conductors or insula- electromagnetic induction. Fashioning the conductor into a
tors, they may also be classified by their magnetic properties. coil and passing it through the magnetic field increases the
There are four categories: Nonmagnetic materials (e.g., glass, induced voltage, and this voltage increases with an increasing
wood, and plastic) are not attracted to magnetic fields at all, number of coils. Increasing the strength of the magnetic field
diamagnetic materials (e.g., water, mercury, and gold) are or the speed with which the conductor is passed through the
magnetic field also increases the induced voltage.

CRITICAL CONCEPT 4-8

Electromagnetic Induction
Current may be induced to flow in a conductor by moving
that conductor through a magnetic field or by placing the
conductor in a moving magnetic field.
S N

Two forms of electromagnetic induction are used in the

operation of the x-ray machine: mutual induction and self-
induction. Mutual induction is the induction of electricity in
a secondary coil by a moving magnetic field (Figure 4-3).
The coil on the left in Figure 4-3 is connected on an AC
FIG 4-2  Magnetic Flux. A magnetic field consists of lines of source. As previously discussed, a magnetic field is associated
force in space called flux. with the flow of electricity, and AC switches direction of flow
38 SECTION I  Principles of Radiation Physics

this case, that action is the changing magnetic field. Returning

to the example of the primary coil illustrated in Figure 4-3, the
magnetic field is created in this coil and expands outward
from the center of the coil. As it does so, it “cuts” through the
turns of the coil. This act of “cutting” creates a current within
the same conductor that opposes the original (Lenz’s law).
Using DC, this phenomenon is short-lived because the mag-
netic field reaches maximum strength and the cutting action
stops. But with AC, this process repeats with each change of
direction. The result is a fluctuating magnetic field cutting
back and forth through a single coil, inducing a constant
secondary current that opposes the original. This process is
called self-induction and is used in the x-ray circuit in the
A B autotransformer design (discussed shortly).
FIG 4-3  Mutual Induction. Coil A is the primary coil con-
nected to an AC power source. Coil B is the secondary coil,
Generators, Motors, and Transformers
and as the fluctuating magnetic field from A moves back and Electromagnetism and electromagnetic induction have many
forth through the turns of B, a secondary current is induced. applications in electrical equipment. Of particular interest in
understanding the x-ray circuit are the electric generators,
electric motors, and transformers. Each is described briefly
in cycles. Each time AC switches direction, the associated here and is then placed in context in the discussion of the
magnetic field also changes. That is, the north and south x-ray circuit.
poles of the magnetic field are directionally oriented to the Electric generators are devices that convert some form of
current flow, and when the current changes direction, the mechanical energy into electrical energy. Examples are the
previous magnetic field dies away and a new one is created force of water through a dam; steam, which is created by burn-
that is opposite in orientation and properly oriented to the ing some type of fuel, turning a turbine; or the wind turning a
new current flow direction. The important part of this phe- windmill turbine. In its simplest form, rotating a loop of wire
nomenon is that a “moving” magnetic field is created. The in a magnetic field induces a current in that loop through elec-
previous field collapses and a new one expands, then current tromagnetic induction. Remember: When the loop cuts the
changes direction again and the process starts over. When this magnetic flux lines, a current is induced (Figure 4-4).
moving magnetic field is placed near a secondary coil (the The more complex design uses coils of wire forming
coil on the right in Figure 4-3), electricity is induced to flow an armature that is rotated in a magnetic field by some me-
in that coil. This is also AC because it, too, switches with the chanical means.
changing magnetic fields. Electric motors are devices that convert electrical energy
Self-induction is a bit more complex, requiring an under- to mechanical energy through electromagnetic induction.
standing of Lenz’s law, which states that an induced current In a simple motor an armature is placed in an external mag-
flows in a direction that opposes the action that induced it. In netic field and the armature is supplied with AC. As discussed

Mechanical input
Electrical output

Rotating loop

Magnet
FIG 4-4  Generator. As the loop is rotated in the magnetic field, a current is induced in the loop.
 CHAPTER 4  The X-ray Circuit 39

previously, every flow of current has an associated magnetic The relation of voltage to current in a transformer is:
field. This magnetic field associated with the armature is ori-
Is/Ip 5 Vp/Vs
ented such that the north pole is next to the north pole of the
external field and the south pole is next to the external south This is an inverse relationship.
pole. Because like poles repel, the armature flips to orient it- Example: if a transformer has an input voltage of 110, an
self to the external field. At the same instant that the two input current of 5 amps, and an output voltage of 550, what
magnetic fields align, the AC current changes direction. A is the output current?
new magnetic field is created in the armature, which, again, is Answer: Is/5 5 110/550; Is 5 110/550 3 5; Is 5 1
not aligned to the external field, and the armature rotates Note that these expressions assume ideal circumstances in
again. This process is continuous, converting electrical energy a transformer and do not take into account eddy current loss
to mechanical energy. A more sophisticated variation of this (heat loss in the core) or hysteresis loss (loss because the volt-
design, called the induction motor, is discussed with the x-ray age is applied in a nonlinear fashion to the core), but they
tube in Chapter 5.Transformers are devices used to increase suffice for the sake of understanding their role in the x-ray
or decrease voltage (or current) through electromagnetic in- circuit. In some instances, a transformer may be used to in-
duction. They are named for their effect on voltage. A step-up crease or decrease voltage, and in others, it may be used to
transformer is one that increases voltage, and a step-down increase or decrease current. Both uses occur in the x-ray cir-
transformer is one that decreases voltage. It should be noted cuit. The example presented with the explanation of electro-
here that the change in voltage and current is an inverse rela- magnetic mutual induction (see Figure 4-3) is the simplest
tionship. As voltage is increased, current decreases, and vice transformer design, consisting of two coils placed next to each
versa. This relationship is expressed using the transformer other with one connected to an AC source. When AC is flow-
laws for voltage and current as follows where V 5 voltage; ing through the primary coil, it has an associated “fluctuating”
I 5 current; N 5 number of turns in the coil; s 5 secondary magnetic field. This collapsing and expanding magnetic field
coil; p 5 primary coil. induces electricity in the secondary coil. The difference in the
Transformer Law for Voltage is: voltage induced in the secondary coil depends on the ratio of
the number of turns of wire in the two coils. For example, if
Vs/Vp 5 Ns/Np
there are twice as many turns in the secondary coil as in the
This is a direct relationship. primary, the voltage in the secondary coil is twice that of the
Example: If a transformer has 10 turns in the primary, 50 primary coil. If there are half as many turns in the secondary
turns in the secondary and 110 volt is applied, what is the coil, the voltage is half that in the primary coil. Much more
output voltage? sophisticated designs are used in x-ray equipment such as
Answer: Vs/110 5 50/10; Vs 5 5 3 110; Vs 5 550 closed-core and shell-type transformers that incorporate a
Transformer Law for Current is: ferromagnetic core to maximize efficiency (Figure 4-5).
Is/Ip 5 Np/Ns
CRITICAL CONCEPT 4-9
This is an inverse relationship.
Example: If a transformer has 10 turns in the primary, 50 Inverse Relationship of Current and Voltage
turns in the secondary, and 5 amps is applied, what is the The change in voltage or current through a transformer is an
output current? inverse relationship: If voltage is increased, current decreases
Answer: Is/5 5 10/50; Is 5 5 3 0.2; Is 5 1 and vice versa.

Iron Core

Primary Secondary Primary Secondary

coil coil coil coil
Closed-core transformer Shell-type transformer
FIG 4-5  Transformer Types. The basic design of a closed-core and shell-type transformer. The
iron cores of each increases magnetic field strength and transformer efficiency.
40 SECTION I  Principles of Radiation Physics

FIG 4-6  Autotransformer. An autotransformer (orange) and its orientation to the rest of the x-ray
circuit.

One final type of transformer important to the x-ray The filament circuit consists of a rheostat, a step-down trans-
machine is the autotransformer. This transformer operates former, and the filaments.
on the principle of self-induction, as described earlier. This
transformer has only one coil of wire around a central Primary Circuit
magnetic core (not to be confused with the shell type, Figure 4-8 is a labeled version of the basic x-ray circuit. Be-
which has two coils of wire). This coil is used as both ginning in the primary circuit, the main power switch is
the primary and secondary coil. The outside wires are simply an on–off switch for the unit and is connected to the
attached at different points along the coil, and the induced power supply of the facility. Because the incoming power is
voltage varies, depending on where the connections are not a consistent 220 volts, a line compensator is also used.
made (Figure 4-6). This device is usually wired to the autotransformer and auto-
matically adjusts the power supplied to the x-ray machine to
precisely 220 volts. The circuit breakers are included in the
GENERAL X-RAY CIRCUIT primary circuit to protect against short circuits and electric
Figure 4-7 is a general drawing of an x-ray circuit. This is a shock. The autotransformer (see Figure 4-8) is an adjustable
greatly simplified version, but it is sufficient to understand transformer controlled by the kilovoltage peak selector on the
the principles of operation of the x-ray machine. The x-ray operating console. When the radiographer selects a kVp
circuit may be divided into three sections: the primary cir- setting, he or she is controlling this transformer. As stated
cuit, the secondary circuit, and the filament circuit. Each earlier, this transformer operates on the principle of self-
section has specific components and roles to play. The pri- induction. When the radiographer selects a kVp setting, he or
mary circuit consists of the main power switch (connected to she determines the number of turns on the secondary side
the incoming power supply), circuit breakers, the autotrans- to be included in the circuit element and with it the output
former, the timer circuit, and the primary side of the step-up voltage. Because of its function, the autotransformer is some-
transformer. The secondary circuit consists of the secondary times called the kVp selector. Its primary purpose is to pro-
side of the step-up transformer, the milliampere meter, a vide a voltage that will be increased by the step-up transformer
rectifier bank, and the x-ray tube (except for the filaments). to produce the kilovoltage selected at the operating console.
 CHAPTER 4  The X-ray Circuit 41

X-ray circuit

Secondary
circuit

Primary
circuit

Filament circuit

FIG 4-7  Basic X-ray Circuit. The primary circuit is indicated in orange, the secondary circuit is
in blue, and the filament circuit is in purple.

CRITICAL CONCEPT 4-10 a very sophisticated and accurate timer that is the most
The Autotransformer widely used today. This timer is based on the time it takes to
charge a capacitor through a variable resistor. Once the ca-
The radiographer controls the autotransformer through the
pacitor receives its preprogrammed charge, it terminates the
kVp selector on the operating console, and through this,
directly determines the voltage applied to the x-ray tube to
exposure. The time it takes to charge this capacitor to its
produce x-rays. preprogrammed level is controlled by the variable resistor.
To achieve a 1-second exposure, the resistance is increased
so that it takes longer to charge the capacitor (including
The step-up transformer (Figure 4-8) is used to increase inherent electrical delays, the total time is 1 second). To
the voltage from the autotransformer to the kilovoltage achieve a 1-millisecond exposure, there is virtually no resis-
necessary for x-ray production. This transformer is the di- tance; the capacitor charges very quickly and the timer ter-
viding line between the primary and secondary circuits. The minates the exposure. This is one application for a resistor
primary coil is in the primary circuit, and the secondary coil in the x-ray circuit. The mAs timer is a variation of the elec-
is in the secondary circuit (hence the names). Unlike the tronic timer, but it monitors the current passing through
autotransformer, this transformer is not adjustable and in- the x-ray tube and terminates the exposure when the de-
creases the voltage from the autotransformer by a fixed sired mAs is reached. Because of the way it functions, this
amount. The timer circuit (exposure timer) is located in timer is located in the secondary circuit instead of the pri-
this section because it is easier to control (turn on and off) mary circuit.
a low voltage than a very high one. There are several varia- Serving the same role as a timer is the automatic exposure
tions of the exposure timer. The first variation is a synchro- control (AEC) device. This device operates somewhat differ-
nous timer, which is based on a synchronous motor. The ently from the others in that it uses the patient’s body part of
motor is designed to turn a shaft at precisely 60 revolutions interest as the variable in determining when to terminate
per second. This shaft turns a disk, which is connected to exposure. The AEC uses a device called an ionization cham-
on-off switches, through reduction gears. The exposure ber. This is a radiolucent device placed between the patient
time selected determines the reduction gear used and there- and the image receptor. When x-rays interact with this cham-
fore the time it takes the disk to move from the on switch to ber, its atoms are ionized (electrons removed), creating an
the off switch. The second variation, the electronic timer, is electric charge. This charge becomes a signal that terminates
42 SECTION I  Principles of Radiation Physics

X-ray circuit

Exposure timer Step-up

transformer
Rectifiers

Circuit breaker

Primary Secondary X-ray tube

Incoming circuit circuit
power supply

kVp meter

Main power
switch

Rheostat

Filament
circuit

Autotransformer

Step-down
transformer
FIG 4-8  Parts of the X-ray Circuit. Labeled version of a basic x-ray circuit.

the exposure. The AEC can be adjusted (calibrated) so that it takes longer for enough x-rays to exit the larger abdomen
more or less of a charge is needed before the signal to ter- to create the signal in the chamber.
minate exposure is sent. AEC calibration is performed by
installation personnel by exposing phantoms until the de- At the Console. To this point the radiographer has selected
sired density (image quality factor) is achieved. This the exposure factors (kVp and mAs) among other parameters
amount of exposure varies with the image receptor, and the and pressed the exposure button. In the primary circuit this
AEC must be recalibrated if that receptor changes (e.g., results in a voltage being determined by the autotransformer
from one film/screen speed to another or from film/screen and applied to the primary side of the step-up transformer. A
to a cassette-based digital system). Once the AEC is cali- voltage is also selected from the autotransformer and applied
brated, the patient becomes the variable. As x-rays exit the to the filament circuit. With the voltage and current selected
patient on the way to the image receptor, they pass through and traveling, the stage is set for the rest of the circuit.
the ionization chamber, causing ionization. Once the pre-
programmed magnitude of electric charge is reached, the
exposure is terminated. The length of the exposure is then MAKE THE IMAGING CONNECTION 4-2
determined by the thickness and density of the area of the Chapter 13
patient placed over the ionization chamber. For example,
AEC controls only the quantity of radiation reaching the im-
an infant abdomen and an adult abdomen could be placed
age receptor and therefore has no effect on other image
over the ionization chamber and, although both are abdo- characteristics such as contrast. The radiographer must still
mens, the exposure time is very different because of the select kVp and in many cases mA.
differences in tissue thickness of the two patients. That is,
 CHAPTER 4  The X-ray Circuit 43

Solid-state rectifier (P-N junction)

Anode Anode
P P

Does not
Conducts
conduct

N N

Cathode Cathode

FIG 4-9  Solid-State Rectifier. Solid-state rectifier showing its conduction and nonconduction
phases. Note the change in polarity in each half of the illustration.

CRITICAL CONCEPT 4-11 move toward and across the p-n junction, allowing current to
flow. When the AC cycle reverses, and the p-type crystal re-
Automatic Exposure Control
ceives the negative charge and the n-type crystal receives the
The AEC is a device that serves to terminate exposure (like positive charge, the solid-state diode will not conduct. This is
a timer). It consists of an ionization chamber that is placed because the traps and electrons “stay at home” (do not move to
between the patient and image receptor. As the radiation ex- the junction) and no current is conducted (Figure 4-9).
its the patient and passes through the chamber, ionization To be used most effectively, rectifiers are arranged in pairs
occurs. When sufficient ionization occurs in the chamber, a
so that the AC cycle has an open “path” from each direction.
signal is sent to terminate exposure. The thickness and den-
The symbol for the solid-state rectifier is the same as that
sity of the body part of interest becomes the “timer” variable.
for the diode in general: Using this symbol, current flow is
with the direction of the arrow and electron flow is against
the arrow of the symbol. It is possible to use only two recti-
Secondary Circuit fiers, but this suppresses (wastes) the negative half of the cycle
The secondary circuit begins with the rest of the step-up trans- only and simply serves to protect the x-ray tube during that
former. The role of the step-up transformer was presented phase. One half of the AC cycle flows through the x-ray tube
previously. The milliampere meter is simply a device placed in and the other half, which would otherwise flow through the
the secondary circuit that monitors x-ray tube current. The x-ray tube the wrong way, is suppressed (blocked). This type
rectifiers are needed to convert AC to DC and require a more of waveform is called half-wave rectification. Figure 4-10
detailed discussion. In a general x-ray circuit, AC is necessary
for transformers to operate correctly (provide the “moving”
magnetic field). However, to allow the x-ray tube to be exposed
to AC would be disastrous. Within the x-ray tube, current must
always flow from anode to cathode and electrons from cathode
to anode (this process is covered in detail in Chapter 5). To
achieve this, rectifiers are used.
The rectifier commonly used in today’s x-ray circuit is a Alternating current
solid-state rectifier. This device is made of two semiconducting
crystals. One is a p-type crystal and the other is an n-type crys-
tal. The p-type crystal has an abundance of “electron traps,”
whereas the n-type has an abundance of freely moving elec-
trons. These two crystals are joined to form a solid-state diode.
When a positive charge is placed on the p-type crystal and
a negative charge is placed on the n-type crystal, the solid-state Half-wave rectification
diode will conduct electricity. To do this, both the traps from FIG 4-10  Rectification of Alternating Current. Alternating
the p-type crystal and the electrons from the n-type crystal current and half-wave rectification waveforms.
44 SECTION I  Principles of Radiation Physics

shows AC (top) and what the waveform would look like with selected on the operating console (maximum energy avail-
only two rectifiers (half-wave rectification, bottom). able) to zero. One solution is to use three AC waveforms at
When four rectifiers are used, full-wave rectification is the same time. With a bit of engineering, three waveforms
achieved. Notice the arrangement of the four rectifiers in can be phased or synchronized. Each is generated indepen-
Figure 4-11. They are highlighted to show which two are in dently and then phased so that each one is 120 degrees out of
use with each half of the cycle. With four rectifiers arranged step with the next (i.e., out of step by one third). The result is
in this way, both halves of the AC cycle are used. The resulting a waveform like that shown in Figure 4-13. It would be a ter-
waveform is illustrated in Figure 4-12. Note that we, in effect, rible waste not to rectify this waveform. When we do rectify
“invert” the negative half of the cycle, thereby making use of each one as if they were a single-phase waveform, the x-ray
the entire cycle. Note also that the energy fluctuates from zero tube “sees” a waveform like the one in Figure 4-14. This is
(on the line) to the maximum voltage (peak of wave). This is referred to appropriately as three-phase power. Although this
called ripple and, in the case of single-phase full wave, it is obviously has less ripple than the single-phase waveform, it
100% ripple. Although single-phase, full-wave power is much still has ripple. Depending on the number of rectifiers and
more desirable and certainly less wasteful, this 100% ripple is engineering, it will have anywhere from 13% ripple (three-
a problem because the x-rays vary in energy from the kVp phase 6 pulse) to 3.5% ripple (three-phase 12 pulse). This

Rectifiers

X-ray tube

Secondary
circuit

FIG 4-11  Rectifier Bank. A four-rectifier bank. Note the color coding of the pair that operates
together in each half of the cycle.

Single-phase, full-wave rectification Alternating currents

FIG 4-12  Single-Phase Alternating Current. Single-phase, FIG 4-13  Three Single-Phase Waveforms. Three single-
full-wave waveform. phase waveforms unrectified.
 CHAPTER 4  The X-ray Circuit 45

At the Console. Within the secondary circuit the pressing

of the exposure button has sent a voltage through the step-
up transformer, increasing it to the kilovoltage selected
and indicated on the control console. This kilovoltage is
passed through a series of rectifiers so that it travels
through the x-ray tube correctly to produce x-rays. A large
Three-phase, full-wave rectification positive charge now resides with the anode, and a large
negative charge with the cathode within the x-ray tube. All
FIG 4-14  Three-Phase Waveform. Three single-phase wave-
that is lacking is the source of electrons on which this
forms rectified.
kinetic energy will ride, which brings us to the filament
circuit.

translates into x-rays being produced with anywhere from Filament Circuit
87% to 100% of the kVp selected on the operating console The filament circuit begins with the rheostat (Figure 4-16).
for three-phase 6 pulse to 96.5% to 100% for three-phase This variable resistor is controlled by the mA selector on
12 pulse. the operating console. The milliampere parameter is called
The next evolution in the quest to improve the waveform tube current because it reflects the rate of flow of electrons
is the use of high-frequency generators in place of the stan- passing through the x-ray tube during an exposure. When
dard 60-Hz generators. The standard 60-Hz incoming power the radiographer adjusts milliamperage on the operating
is first fully rectified, then sent through a capacitor bank, console, he or she is adjusting this rheostat, and thus
where it is smoothed. From there it passes through an in- the amount of resistance in the filament circuit, and
verter circuit that “chops” this DC waveform and converts it ultimately the amount of current applied to the filament
to high-frequency AC. This low-voltage, high-frequency AC (called filament current) in the x-ray tube. The higher the
is then passed through a step-up transformer converting it to milliamperage station number, the lower the resistance.
high-voltage AC. It is again passed through rectifiers, where it A 1000-mA station will have very little resistance to the
is again fully rectified, and finally through high-voltage ca- flow of electricity, whereas a 100-mA station will have con-
pacitors, where it is smoothed to provide the x-ray tube with siderable resistance. The goal of the filament circuit is
a near-constant potential voltage waveform. These generators to literally boil electrons out of the filament wire. Nor-
reduce the ripple “seen” by the x-ray tube to less than 1%. mally, a rather large filament current of 5 to 7 amperes is
Figure 4-15 demonstrates the resulting waveform. In general, required to produce a tube current in the range of milliam-
these generators are smaller, lighter, less costly, and offer bet- peres. The thermionically emitted electrons are needed for
ter exposure reproducibility. x-ray production and represent one more step in the ma-
Keep in mind that through all of this, rectifiers—the one- nipulation of electricity. However, in the filament circuit,
way valves—are necessary to route the electricity through the we are boiling these electrons off of a very small wire
x-ray tube correctly. and must precisely control the current that is applied. If
the current is too high, this tiny wire will be damaged or
destroyed.
THEORY TO PRACTICE 4-2
A single-phase machine may require a higher kVp setting
MAKE THE IMAGING CONNECTION 4-3
than a three-phase or high-frequency machine because of the
difference in efficiency, but it does not expose the patient to Chapter 10
a different dose of radiation. The quantity of radiation exposing the patient and ulti-
mately reaching the image receptor is directly related to
the product of milliamperage and exposure time (mAs).
The x-ray tube, with the exception of the filaments, is also Therefore exposure to the image receptor can be increased
a part of this section. Because the x-ray tube head assembly is or decreased by adjusting the amount of radiation by
the subject of Chapter 5, it is addressed in detail there. adjusting the mAs.

CRITICAL CONCEPT 4-12

Milliamperage Selector
The radiographer controls the rheostat through the milliam-
perage selector of the operating console, which directly de-
termines the current that is ultimately applied to the selected
High frequency, full-wave rectification filament and the number of electrons boiled off and available
for x-ray production.
FIG 4-15  High-Frequency Waveform.
46 SECTION I  Principles of Radiation Physics

X-ray circuit

Exposure timer Step-up

transformer
Rectifiers

Circuit breaker

Primary Secondary X-ray tube

Incoming circuit circuit
power supply

kVp meter

Main power
switch

Rheostat

Filament
circuit

Autotransformer

Step-down
transformer
FIG 4-16  Filament Circuit. Components of the filament circuit (purple).

It should be noted that the exposure timer, discussed pre-

viously, works in concert with the rheostat. The rheostat
controls filament temperature and the rate at which electrons
are boiled off of the filament. The timer determines the dura-
tion of this process. Together, they determine the quantity of
electrons boiled off of the filament and available for x-ray
production (this subject is addressed in detail in Chapter 5).
A step-down transformer is used in the filament circuit to
increase the current by reducing the voltage that is applied to
the filament. The purpose of the filament circuit is to control
the degree and duration that the filament is heated, which in
turn controls the number of electrons boiled off that will
ultimately become the tube current. Although the step-down
transformer reduces the voltage that is applied to the fila-
ment, because we are concerned with the current through the FIG 4-17  Filaments. Filaments (small wire coils) within the
filament, we generally talk about the output current of this cathode focusing cup.
transformer rather than voltage. Remember that as voltage
decreases, current increases. filaments is covered later. They are represented on the
The final piece of the filament circuit is the filaments operating console by the “large focal spot” and “small focal
(Figure 4-17). A general-purpose radiographic tube typically spot.” When selecting one of these, the radiographer is liter-
has two filaments. These are tiny coils of wire housed in the ally selecting the filament to be heated and used for that
cathode of the x-ray tube. The design and purpose of the exposure.
 CHAPTER 4  The X-ray Circuit 47

At the Console. Within the filament circuit, when the expo- Once kilovoltage is created, it must be rectified for the x-ray
sure button is pressed, a voltage and current is sent through the tube. Where the x-ray tube is concerned, the electrons must al-
filament circuit. The quantity is precisely controlled by a rheo- ways flow from cathode to anode. Solid-state rectifiers are used
stat to reflect the mA selected and indicated on the control to route electricity through the x-ray tube correctly. The num-
console. A step-down transformer is used to reduce this voltage ber of rectifiers used depends on the circuit type. These “one-
and increase current (recall that this is an inverse relationship, way valves” route current from positive to negative, and elec-
as voltage decreases current increases). This current heats the trons from negative to positive. After passing through the
filament chosen by the radiographer and begins boiling off rectifiers, the electricity creates a large positive charge on the
electrons. The time selected by the radiographer controls anode of the x-ray tube and a large negative charge on the cath-
the duration that the voltage and current in the x-ray tube is ode focusing cup (part of tube that surrounds the filaments).
applied (as described with timers). It is now necessary to return to the autotransformer to cover
the other half of the process. The filament circuit draws electric-
ity from the autotransformer, which then travels to the rheostat.
PRINCIPLES OF CIRCUIT OPERATION The rheostat is a variable resistor controlled by the mA selector
Now that all of the pieces and parts have been covered, it is on the operating console and is tied to the focal spots. The
helpful to walk through the x-ray circuit’s operation from focal-spot selector represents the two filaments in the x-ray
incoming power supply to x-ray tube. The discussion of the tube: one large and one small. When the mA station was se-
events in the x-ray tube is brief here, but they are covered in lected, the appropriate filament was also selected (small for
detail in Chapters 5 and 6. small mA stations and large for large mA stations). The selected
The appropriate place to begin is the operating console. mA station sets the resistance in the filament circuit. From the
Like the controls of an automobile, options and arrange- rheostat, electricity then travels to the step-down transformer.
ment vary, but all have basic options in common. The oper- Recall that we are more concerned with the current output in
ating console offers options for selecting kVp, mA, exposure this case than with the voltage, and as voltage decreases, current
time, and focal spot size. If the unit is equipped with AEC increases. The adjusted current from the step-down trans-
or anatomic programming, those options are also displayed. former then travels directly to the filament located within the
The same is true for Bucky selection if both a table and a focusing cup of the x-ray tube. This current heats the filament
wall Bucky are available. The process begins when the ra- to the point at which electrons are literally boiled off.
diographer selects an exposure technique, which specifies Now the two halves of the process can be joined. A group,
kVp, mA, exposure time, and focal spot. From here it is or cloud, of electrons is created by the filament circuit (heating
easiest to follow the sequence of events in two parts. This of the filament). The kilovoltage applied to the x-ray tube cre-
discussion first follows voltage through the primary and sec- ates a large positive charge on the anode and a large negative
ondary circuits, then follows current through the filament charge on the cathode (focusing cup). The large positive charge
circuit. attracts the electrons boiled off the filament, giving them tre-
The kVp selected adjusts the autotransformer and deter- mendous kinetic energy in the process. Opposites attract, and
mines the number of turns on the secondary side necessary in the short 1- to 3-centimeter gap between cathode and anode
to produce a voltage, through self-induction, that will be sent the electrons from the filament reach speeds of about one-half
to the step-up transformer. The step-up transformer in- the speed of light. The large negative charge on the cathode
creases this voltage by a fixed amount and, through mutual serves to keep the electrons crowded together; otherwise they
induction, produces the kilovoltage selected on the operating would repel each other and scatter throughout the tube. The
console. This transformer represents the transition from the electrons travel across to the anode and interact there to pro-
primary circuit to the secondary circuit. duce x-rays until the timer circuit terminates the process.

SUMMARY
• The smallest units of charge rest with the proton (one unit conductor; and resistance (measured in ohms) is that
of positive charge) and the electron (one unit of negative property of an element in a circuit that resists or impedes
charge). the flow of electricity.
• Only electrons are free to move in solid conductors; “elec- • Electricity behaves differently depending on the medium.
tricity” is most often associated with the flow of electrons. In a vacuum electrons jump the gap between electrodes,
Electrical charge is measured in coulombs. One coulomb and in a metallic conductor electrons move to the conduc-
is equal to 6.25 3 1018 electrons. tion band and flow.
• Electric potential, current, and resistance are expressions • There are two types of electric current. DC is a type that
of different phenomena surrounding electricity. Electric flows in only one direction (from positive to negative,
potential (measured in volts) is the ability to do work be- opposite the direction of electron flow), and AC is a type
cause of a separation of charges; current (measured in that changes direction in cycles as the electric potential of
amperes) is an expression of the flow of electrons in a the source changes (the negative and positive or polarity
Continued
48 SECTION I  Principles of Radiation Physics

S U M M A R Y — cont’d
changes). In the United States the electricity alternates at voltage through self-induction that, when passed through
60 cycles per second. the step-up transformer, becomes the kilovoltage applied
• The relationship between voltage, current, and resistance to the x-ray tube to produce x-rays.
may be expressed through Ohm’s law, which states that the • The exposure timer is generally located in the primary
potential difference (voltage) across the total circuit or any section and the electronic timer is the most sophisticated,
part of that circuit is equal to the current (amperes) mul- most accurate, and most commonly used today.
tiplied by the resistance. • The AEC terminates exposure (like a timer). It consists of
• Resistance of a conductor depends on the material, length an ionization chamber that is placed between the patient
of the conductor, cross-sectional area, and temperature. and image receptor. As the radiation exits the patient
• Conductors are materials with an abundance of free elec- and passes through the chamber, ionization occurs. When
trons that allow a relatively free flow of electricity, whereas sufficient ionization occurs in the chamber, a signal is sent
insulators have virtually no free electrons and therefore to terminate exposure.
are very poor conductors of electricity. • Solid-state rectifier banks are arranged to route current
• Grounding is a process of neutralizing a charged object by through the x-ray tube the same way each time, in
placing it in contact with the earth. effect “converting” AC to DC. This process is called
• Electricity and magnetism are two parts of the same basic rectification.
force. That is, any flow of electrons, whether in space or in • By combining three single-phase waveforms, three-phase
a conductor, is surrounded by a magnetic field. Likewise, a power is created and the percentage of ripple in the wave-
moving magnetic field can create an electric current. form is reduced. Through the use of high-frequency gen-
• Current may be induced to flow in a conductor by moving erators, this ripple is reduced further still.
that conductor through a magnetic field or by placing the • When the radiographer adjusts milliamperage on the op-
conductor in a moving magnetic field. There are two erating console, he or she is adjusting this rheostat, and
forms: mutual induction and self-induction. thus the amount of resistance in the filament circuit, and
• Electric generators are devices that convert mechanical ultimately the amount of current applied to the filament
energy into electrical energy. in the x-ray tube. The higher the mA station number, the
• Electric motors are devices that convert electrical energy lower the resistance.
into mechanical energy. • Following the sequence of events through the primary and
• Transformers are devices that increase or decrease voltage secondary circuits, voltage flows from the autotransformer
(or current) through electromagnetic induction. A step- to the step-up transformer, through the rectifiers, to the
up transformer increases voltage and a step-down trans- x-ray tube. Following the sequence of events through the
former decreases voltage. filament circuit, current flows from the autotransformer
• The x-ray circuit is divided into three main sections: the through the rheostat, to the step-down transformer, and
primary circuit, the secondary circuit, and the filament to the selected filament within the cathode of the x-ray
circuit. tube. Both halves of this sequence happen simultaneously
• The radiographer controls the autotransformer through to set up the environment in the x-ray tube that produces
the kVp selector of the operating console, which creates a x-rays.

CRITICAL THINKING QUESTIONS

1. What are the sequences of events through the primary, 2. How is electricity manipulated and used in an x-ray
secondary, and filament sections of the x-ray circuit when machine to ultimately produce x-rays?
a set of exposure factors are selected?

REVIEW QUESTIONS
1 . An x-ray tube is an example of current flow in a/an: 3 . Which of the following is Coulomb’s law?
a. gas. a. Like charges repel, unlike charges attract.
b. vacuum. b. Electrostatic force between charges is directly propor-
c. metallic conductor. tional to product of quantities and inversely propor-
d. ionic solution. tional to square of distance between them.
2. Which of the following increases or decreases voltage by a c. Electric charges reside only on the external surface of
fixed amount? conductors.
a. capacitor d. Only positive charges can move in solid conductors.
b. rheostat
c. diode
d. transformer
 CHAPTER 4  The X-ray Circuit 49

R E V I E W Q U E S T I O N S — cont’d
4 . A rheostat will: 10. Which of the following allows electrons to flow in only
a. provide electric potential. one direction?
b. vary resistance. a. transformer
c. increase or decrease voltage. b. rheostat
d. provide infinite resistance. c. battery
5. In a metallic conductor: d. diode
a. electrons move on external surface. 11. Which of the following is a unit of measure of current?
b. electrons move internally. a. ampere
c. protons move on external surface. b. volt
d. protons move internally. c. Coulomb
6. Nearly all discussion of electricity deals with the move- d. ohm
ment of: 12. Magnetic flux is:
a. positive charges. a. magnetic material.
b. negative charges. b. groups of smaller magnets.
c. neutrons. c. curved lines of force in space.
d. all of the above. d. the magnetizing of other materials.
7. Which of the following conditions or environments will 13. What is the magnetic classification of materials weakly
provide the least resistance? attracted to magnets?
a. glass material a. nonmagnetic
b. long conductor b. ferromagnetic
c. large cross-sectional area c. paramagnetic
d. high temperature of conductor d. no such classification
8. The potential difference that will maintain a current of 14. The unit of measure for electric potential is:
1 ampere in a circuit with a resistance of 1 ohm is the a. A
definition of: b. V
a. ampere. c. V
b. volt. d. W
c. ohm.
d. coulomb.
9. The removal of electrons from an object by rubbing it
with another is electrification by:
a. contact.
b. friction.
c. induction.
d. grounding.
 5
The X-Ray Tube

OUTLINE
Introduction Cathode
General Tube Construction Principles of Operation
Housing Quality Control and Extending Tube Life
X-ray Tube Summary
Anode

OBJECTIVES
• Describe the construction and purpose of the x-ray tube • Discuss cathode designs and construction.
housing. • Trace the path of electricity through the x-ray circuit and
• Identify the principal parts of the x-ray tube and their x-ray tube, connecting the selections on the operating
purposes. console to the functions within the unit.
• Describe the operation of the principal parts of the • Use tube rating charts, anode cooling charts, and housing
x-ray tube. cooling charts.
• Discuss anode designs and construction. • Employ methods of safe x-ray tube operation and extending
• Explain the line-focus principle. x-ray tube life.
• Explain the anode heel effect.

KEY TERMS
actual focal spot focusing cup rotor
anode heat units (HUs) space charge
anode heel effect induction motor space-charge effect
cathode leakage radiation stator
effective focal spot line-focus principle target window
filament protective housing thermionic emission

INTRODUCTION A thorough discussion of each part of the x-ray tube is

Chapter 1 provided a general discussion of the x-ray tube presented here, including how each selection made at the
head assembly and the function of the major parts of the control panel affects the corresponding part of the x-ray
design. Chapter 4 discussed the components of the x-ray tube. Several procedures and considerations to protect the
circuit and the events that lead to the production of x-rays tube are also presented. Finally, quality-control consider-
in the x-ray tube. This chapter examines the x-ray tube ations to extend the life of the tube are discussed. The safe
itself (Figure 5-1), its general construction, and how it operation and proper maintenance of the x-ray unit rests
works. The sole purpose for manipulating electricity in with the radiographer; appropriate operation and mainte-
an x-ray circuit is to create the environment in the x-ray nance of the x-ray unit stems from the knowledge of how it
tube necessary for x-ray production. The need for the works.
radiographer to understand the x-ray tube is twofold.
First, as was described in Chapter 4, the radiographer must GENERAL TUBE CONSTRUCTION
have a basic understanding of how the tube works to com-
petently and safely formulate exposure techniques and Housing
minimize patient radiation dose. Second, such an under- The general construction of the tube head assembly is dis-
standing is critical to extending the life of the tube and to cussed first. Recall that the x-ray tube is situated in a protective
avoid damaging it. housing that provides solid, stable mechanical support. This
50
 CHAPTER 5  The X-Ray Tube 51

absorb most of the photons traveling in directions other than

toward the patient. The housing design reduces this radiation,
called leakage radiation, to less than 100 mR/hr at a distance
of 1 meter, as required by regulation.
Two notes of caution about the housing are necessary.
First, with extended “on” times, the housing can become
rather hot. This is most likely to occur with fluoroscopic
units, and most permanently installed units have the tube
located under the tabletop, which limits the possibility of
contact. But mobile fluoroscopic units can be easily touched;
caution should be used when they are involved in very long
cases in which heating is considerable. Second, the high-
voltage cables are not “handles.” Some radiographers develop
the bad habit of using them as such, but doing so poses a
FIG 5-1  Photograph of X-ray Tube. A basic rotating anode risk to the radiographer and potential for damage to the
x-ray tube. equipment.

housing is a lead-lined metal structure that also serves as

CRITICAL CONCEPT 5-1
an electrical insulator and thermal cushion for the tube itself
(Figure 5-2). X-ray production is a rather inefficient process, The Protective Housing
and much of the electrical energy that goes into it is converted The housing protects the x-ray tube by serving as an electrical
to heat. The design of the housing incorporates an oil bath and insulator and thermal cushion. The radiographer should take
cooling fans to help dissipate heat away from the tube, protect- care not to touch it after long “on times” and not to use the
ing it from thermal damage. The tube is immersed in the oil high-voltage cables as “handles” for maneuvering the tube.
bath, which draws heat away from the tube. The cooling fans
circulate air around the assembly, which also helps dissipate
heat. Because of the large current and voltage needed to pro- X-ray Tube
duce x-rays, electrical insulation is necessary. Two large electri- Although there are several specialty designs of the x-ray tube,
cal cables enter the housing and are securely attached to the they do have basic components in common. This text focuses
x-ray tube through special high-voltage receptacles. Finally, on the design used for general medical radiography. The
although x-rays are perceived as being produced and traveling general-purpose x-ray tube is an electronic vacuum tube that
in one direction out through the collimator to the patient and consists of an anode, a cathode, and an induction motor all
image receptor, this is not the case. X-rays are produced isotro- encased in a glass or metal enclosure (envelope). Figure 5-3
pically (in all directions), and another role of the housing is to provides a labeled illustration of this design. Recall that the

High-voltage
connector
Leakage
radiation
Lead

Fitting for filters, Window

collimators, etc.

Useful beam
FIG 5-2  X-ray Tube Inside Protective Housing. Protective housing with the x-ray tube situated
inside. The design of the housing serves as an electrical insulator and thermal cushion for the
x-ray tube in addition to being a protective device against physical damage.
 52 SECTION I  Principles of Radiation Physics

Stator Anode stem Tungsten/rhenium is flowing through the x-ray tube and the electrons flowing
anode disk from cathode to anode are a part of that flow of electricity.
Rotor
Some of the electrons interact with the target to produce
x-rays (see Chapter 6), and the rest continue as current flow
through the x-ray circuit. Remember, too, that a tremendous
Anode Cathode amount of heat is also generated during the process. The
anode is designed to dissipate this heat.
There are two designs for the anode. One is the stationary
Glass
anode (Figure 5-4, A). This is basically a tungsten button
envelope embedded in a copper rod. It is called stationary because the
Port
target does not move. Stationary anodes were used in old
Filament in focusing cup
tube designs and may still be found in dental x-ray units or
FIG 5-3  Parts of the X-ray Tube. A cross-sectional view of a
those requiring very small exposure techniques. The primary
basic rotating anode x-ray tube.
disadvantage of this design is that, because the electrons
always hit the same small target area, heat builds up rapidly
and can damage the tube. This problem limits the exposure
anode is the positive end of the tube and the cathode is the technique factors that can be used. This limitation spurred
negative end of the tube. The anode incorporates an anode the development of rotating-anode designs.
target and an induction motor, half of which is inside and The rotating-anode design is used in general-purpose
half of which is outside the protective enclosure; the anode is tubes today (Figure 5-4, B). It consists of a rotating disc made
discussed in detail shortly. The cathode consists of the focus- of molybdenum as a core material coated with tungsten and
ing cup and filament with its supporting wires. mounted on a copper shaft with a molybdenum core. Copper
The main purpose of the enclosure is to maintain a vac-
uum within the tube. Because the production of x-rays in-
volves the interaction between filament electrons and the
anode target, if any air were present, the electrons from the
air would contribute to the electron stream, causing arcing
and damage to the tube. The glass envelope variety is gener-
ally made of borosilicate glass because it is very heat resistant.
However, as these tubes age, vaporized tungsten from the
filament deposits on the inside of the glass (called “sun tan-
ning” because of the bronze discoloration of the glass), which
causes problems with arcing and damage. The metal envelope
variety provides a constant electric potential between the
electron stream from the cathode and the enclosure, thereby
avoiding the arcing problem and extending tube life. Both
enclosure types have a specially designed target window A
for the desired exit point of the x-rays produced. The target
window is fashioned to minimally interfere with (absorb) the
x-rays. It is usually about 5 cm square and is a place on the
enclosure that has been made thinner than the rest. This
thinned section reduces the amount of absorption by the
enclosure.

CRITICAL CONCEPT 5-2

The Enclosure or Envelope
The primary purpose of the glass or metal enclosure of the
x-ray tube is to maintain a vacuum so that electrons from the
air do not contribute to the electron stream, which would
disrupt the x-ray production process and damage the tube. B
FIG 5-4  Anode Types. A is a stationary anode removed from
the glass envelope. Note the silver-colored tungsten button
Anode and the discolored area where electrons interacted with it.
The anode is the positive end of the tube. It provides the B is a rotating anode removed from the glass envelope. The
target for electron interaction to produce x-rays and is an focal track along the edge of the disc and some damage from
electrical and thermal conductor. Remember that electricity extensive use is visible.
 CHAPTER 5  The X-Ray Tube 53

is used as part of the shaft because it has excellent thermal The purpose of rotating the anode is to spread the tremen-
and electrical conductive properties. Molybdenum is used as dous heat produced during x-ray production over a larger
the disc base and core because it has a low thermal conductiv- surface area. Instead of electrons always striking the same
ity, which slows migration of heat into the rotor bearings small surface area (as with stationary anodes), the electrons
(minimizing heat damage) and it is a light but strong alloy, strike only a small part of the total anode surface area at any
making it easier to rotate the anode. The target material one time and that area changes. The focal “spot” becomes a
(coating) is made of tungsten because it has a very high melt- focal “track,” with the rotating anode and the heat build-up
ing point (3400° C, 6152° F) and its thermal conductivity is spread over the focal track circumference rather than on one
almost equal to that of copper. Furthermore, it has a high spot. This greatly increases the heat-load capacity and the
atomic number (74), improving the efficiency of x-ray pro- exposure techniques that can be used.
duction. Rhenium may also be added to the tungsten to in-
crease thermal capacity and tensile strength. The anode is CRITICAL CONCEPT 5-3
rotated using an induction motor. The two major parts of
The Rotating Anode
this motor are the stator and the rotor (see Figure 5-3). The
stator is made up of electromagnets arranged in pairs around The rotating anode is turned using an induction motor that
the rotor. The stator is outside the tube enclosure. The rotor operates through electromagnetic mutual induction. The rota-
is made of an iron core (iron bars embedded in the copper tion of the anode spreads the heat produced during x-ray
production over a larger surface area, greatly increasing the
shaft) surrounded by coils and located in the center of the
thermal and exposure technique capacity of the tube.
stator, but within the enclosure. The rotor does not touch the
stator, nor is it supplied with electric current. It is operated
through mutual induction. The stators are energized in op- Notice in Figure 5-6 that the face of the target is angled.
posing pairs and induce an electric current in the rotor with This makes use of the line-focus principle. The line-focus
an associated magnetic field. This induced field opposes that principle states that by angling the face of the anode target, a
of the stator pair, and the rotor turns to correct that orienta- large actual focal spot size (area actually bombarded with
tion. Just as the two fields align, the next pair of stators is filament electrons) can be maintained and a small effective
energized and again a new electric current and magnetic field focal spot size (the x-ray beam area as seen from the perspec-
is induced, causing the rotor to turn again. This process con- tive of the patient) can be created. The actual focal spot is the
tinues with the energizing of each pair of stators in sequence. area being bombarded by the filament electrons. The size of
The response of the rotor is to continuously turn as the the electron stream depends on the size of the filament. The
induced magnetic fields try to orient with the ever-changing smaller this stream, the greater the heat generated in a small
external fields. Figure 5-5 illustrates this concept. Using an area; therefore, it is desirable to have a larger actual focal
induction motor allows for the rotation of the anode in a spot area. The effective focal spot is the origin of the x-ray
vacuum without engineering a motor into the vacuum. Such beam and is the area as seen from the patient’s perspective.
motors are capable of rotating the anode at speeds of 3400 The smaller this area of origin, the sharper the image will be.
revolutions per minute (rpm) for general-purpose tubes and It is desirable to keep this as small as practical to improve
10,000 rpm for specialty tubes. image quality. When the angle of the target face is less than

Stators
N1 N1

N2 N2
S3 S3

Rotor

S2 N3 S2 N3

S1 S1

First energized Second energized

sequence sequence
Induction motor
FIG 5-5  Induction Motor. The operation of opposing pairs of stators in sequence ultimately
causes rotation of the rotor.
54 SECTION I  Principles of Radiation Physics

Target the angles are optimized for mammography units, angio-

angle graphic units, general radiography units, etc.
15° Although the line-focus principle achieves this goal of
balance between heat area and projected focal spot, it is not
Anode
target
without tradeoffs. When the target angle becomes too small, the
x-ray beam area may not be large enough to fully expose a
14 3 17-inch image receptor at a 40-inch source-to-image recep-
tor distance (SID). Such angle limitations are taken into consid-
Electron stream
eration when the x-ray tube is designed and manufactured.
Additionally the angle causes the intensity of the x-ray beam to
Actual focal be less on the anode side because the “heel” of the target is in
spot size the path of the beam. This means that the x-rays on the anode
side must first penetrate a portion of the target before exiting the
tube. Some do not have the energy to do so and are absorbed
in the target heel, reducing the intensity on the anode side. This
phenomenon is called the anode heel effect (Figure 5-8). Notice
Effective focal in Figure 5-8 the percentage difference in x-ray beam intensity
spot size
from cathode side to anode side. This lowering of intensity on
FIG 5-6  Line-Focus Principle. By angling the face of the target,
the anode side of the beam can cause the image to be “lighter”
a large actual focal spot is maintained to spread heat load and
on that end. This is because there are fewer high-energy x-ray
create a small effective focal spot to improve image detail.
photons on the anode side and not enough penetrate the patient
to expose the image receptor. This is particularly true of film/
45 degrees, the effective focal spot will be smaller than the screen technology, and for some examinations, placing the thin-
actual focal spot. The target angles are 7 to 18 degrees for a ner or less dense portion of the patient’s anatomy under the
general-purpose tube, with 12 degrees being the most com- anode end can partially compensate for this and improve image
mon. The smaller the anode angle, the smaller the effective quality. This is less of an issue with digital technology because
focal spot will be while maintaining a large actual focal spot these systems can record and display many shades of gray, a
area. Again, this means that a large actual focal spot for heat characteristic called dynamic range. Digital systems have a wide
dissipation is maintained, but a small effective focal spot to dynamic range, meaning that they can accurately detect, record,
improve image quality is created. The smaller the effective and display very high and very low x-ray photon intensities. In
focal spot, the sharper the image will be (Figure 5-7). It the case of the anode heel effect, the lower intensities on the
should be noted that anode target angle is determined based anode side will still be detected and accurately displayed on
on the intended use of the tube and is not something the ra- the final image. However, it is still useful for the radiographer to
diographer “selects” at the operating console. For example, be mindful of and understand the anode heel effect.

Target
Target angle
angle
10°
15°

Anode Anode
target target

Electron stream Electron stream

Actual focal
Actual focal spot size
spot size

Effective focal Effective focal

spot size spot size
FIG 5-7  Target Angle and Line-Focus Principle. Two different target angles illustrate the effect
of target angle on effective focal spot size. The smaller the target angle, the smaller the effective
focal spot.
 CHAPTER 5  The X-Ray Tube 55

Focusing
cup

Wire filament for Wire filament for

large focal spot small focal spot

Cathode
FIG 5-9  Cathode. Front view of the cathode focusing cup
with two filaments situated within.
Anode side Cathode side

and does not vaporize easily. Thorium is a radioactive me-

tallic element that is added to increase thermionic emis-
sion (boiling off of electrons) and extend filament life. The
filaments are situated parallel to each other in the focusing
cup and share a common ground wire.

75% Beam 120%

intensity MAKE THE IMAGING CONNECTION 5-1
Chapter 10
FIG 5-8  Anode Heel Effect. The anode heel effect is simply
caused by photons produced on the anode side, which must The filament (focal spot size) only affects recorded detail. The
penetrate the heel of the target before exiting the tube. This smaller the focal spot, the greater the recorded detail in
causes some photons to be weakened and some to be ab- the image.
sorbed. The net effect is a reduced intensity of the beam on
the anode side.
The focusing cup is made of nickel and surrounds each
filament on its back and sides, leaving the front open and fac-
CRITICAL CONCEPT 5-4 ing the anode target. The focusing cup receives a strong nega-
The Line-Focus Principle and Anode Heel Effect tive charge from the secondary circuit that forces the elec-
trons together into a cloud as they are boiled off of the
The rotating anode design uses the line-focus principle, filament. The size, shape, and charge of the focusing cup, as
which means that the target face is angled to create a large
well as how the filaments are designed and placed within it,
actual focal spot for heat dissipation and a small effective
focal spot for improved image quality. But by angling the face,
affect how well it “focuses” the electrons on the target. All of
the “heel” of the target is partially placed in the path of the these things are taken into consideration in the design for
x-ray beam produced, causing absorption and reduced inten- optimum performance. The focusing cup serves its function
sity of the beam on the anode side. through electrostatic repulsion. That is, its negative charge is
greater than the negative charges of the electrons and thus
forces them together. Otherwise, the individual electron-
Cathode negative charges would cause them to repel each other and
The cathode is the negative end of the tube; it provides the scatter as they are boiled off of the filament.
source of electrons needed for x-ray production. The cathode
is made up of the filaments and the focusing cup (Figure 5-9) CRITICAL CONCEPT 5-5
and is connected to two different parts of the x-ray circuit.
Recall that the filaments are connected to the filament circuit The Cathode
and the focusing cup is connected to the secondary circuit. The cathode, the negative end of the x-ray tube, consists of
Most general-purpose tubes have two filaments and are filaments and the focusing cup and provides the source of
referred to as dual-focus tubes. These filaments are repre- electrons necessary for x-ray production.
sented by the large and small focal-spot options on the
operating console. Each filament is a coil of wire usually
7 to 15 mm long and 1 to 2 mm wide. They are usually
PRINCIPLES OF OPERATION
made of tungsten with 1% to 2% thorium added. Here, too, This section begins with a discussion of the operating con-
tungsten is used because it has a very high melting point sole, retraces the steps to the x-ray tube, and then adds the
56 SECTION I  Principles of Radiation Physics

details of x-ray tube operation. At the operating console the The electron cloud is attracted to the anode target because
radiographer selects the desired exposure factors (i.e., kVp, of the huge potential difference. In fact, these filament elec-
mAs, and focal-spot size [on some units focal spot size may trons will reach speeds of about half the speed of light in the
be an automated function]). Whether selection is made short 1 to 3 cm between the focusing cup and anode target.
through anatomic programming or any other form of auto- Because the electron cloud flows from cathode to anode, it is
mation is unimportant for the moment. When the exposure a continuation of the flow of electricity through the x-ray
switch is first pressed, some of the electricity is diverted to the circuit. There is one very important “detour” in this flow of
induction motor of the x-ray tube to bring the rotor up to electrons. As they penetrate the target surface, these filament
speed. (Some radiographers call this “hitting the rotor.”) In- electrons interact with the atoms of tungsten, generating heat
side the x-ray tube, the induction motor turns the anode at and x-rays (Figure 5-10). The two types of interactions that
approximately 3400 rpm (or faster depending on the tube produce x-rays at the atomic level are discussed in detail in
type and purpose) so as to spread the generated heat over a Chapter 6. This chapter continues to follow the effects of this
larger total surface area. At the same time that the rotor is process on the x-ray tube itself.
spinning up, the selected filament is energized until the de-
sired degree of thermionic emission is achieved. Prepping the Quality Control And Extending Tube Life
rotor is the first phase of a two-phase switch. The second Several factors can shorten the life of an x-ray tube or damage
phase actually initiates the x-ray production process. The it. Most have to do with the thermal characteristics of x-ray
process from rotor preparation to exposure lasts only a production and are within the radiographer’s control. In
few seconds, with the actual exposure generally measured in particular, the frequent use of very high or maximum expo-
milliseconds. sure factors, use of lower but very long exposure factors
When the exposure switch is pressed, the voltage from the (maintaining the tube at high temperatures), and overload-
autotransformer (controlled by the kVp selector) passes to ing the filament (prolonged excessive heating caused by prep-
the step-up transformer (or in the case of high-frequency ping the rotor unnecessarily or arcing from filament) are the
generators, to capacitor banks, then inverter circuit, to the major causes of tube failure.
step-up transformer). This voltage (and current) then passes
through a rectifier bank before passing to the anode and cath-
ode of the x-ray tube so that the anode is always positive and
the cathode is always negative. This voltage creates a huge
potential difference between the electrodes. Previously, with
the preparation phase, some power from the autotransformer
was diverted to the filament circuit, where it passes through a
rheostat (controlled by the mA selector) to a step-down
transformer, then to the selected filament (determined on the
control panel) within the cathode focusing cup. This current
heats the filament to a point of incandescence (white hot),
and electrons are literally boiled off of the filament by therm-
Rotating
ionic emission. The focusing cup forms them into a cloud. anode
This cloud is called a space charge. This space charge is self-
limiting. Once the space charge reaches a size commensurate
with the current used, it becomes difficult for additional elec-
trons to be emitted. This self-limiting factor is called the
space-charge effect. The three things needed to produce
x-rays are now present: (1) a large potential difference to give Focusing
kinetic energy to the filament electrons (provided by the kVp Tube cup
current
setting), (2) a vehicle on which kinetic energy can ride
(a quantity of electrons provided by mAs), and (3) a place for
interaction (the target of the anode). Filament

CRITICAL CONCEPT 5-6

Environment for X-ray Production
Three things are needed in the x-ray tube for x-ray production:
a large potential difference to give kinetic energy to filament
electrons (provided by the kVp setting), a vehicle on which FIG 5-10  X-ray Production. In the process of x-ray produc-
kinetic energy can ride (source of electrons provided by tion electrons are boiled off of the filament and are attracted
mAs), and a place for interaction (the anode target). to the anode, where they interact with target atoms produc-
ing heat and x-rays.
 CHAPTER 5  The X-Ray Tube 57

CRITICAL CONCEPT 5-7 prevent exceeding maximum heat loads. These charts are
fairly simple to use and provide a good visual understanding
Major Causes of X-ray Tube Failure
of heat load and thermal capacity. Generic examples and
The major causes of tube failure are the frequent use of very applications of each follow.
high or maximum exposure factors, the use of lower but very The tube rating chart plots three technical factors: kilo-
long exposure factors (maintaining the tube at high tempera- voltage peak, milliamperage, and exposure time. Some charts
tures), and overloading the filament (prolonged excessive have kilovoltage peak as the Y-axis, exposure time as the
heating or arcing from filament).
X-axis, and milliamperage lines as curves on the graph. Oth-
ers have milliamperage as the Y-axis, exposure time as the
X-axis, and kilovoltage peak lines as curves on the graph.
As noted at the beginning of this chapter, built-in meth- Either way, the use is the same (Figure 5-11). In the first type,
ods help dissipate heat (i.e., oil bath and cooling fans). Ad- one uses the kilovoltage peak and exposure time to plot a
ditionally, rotating anodes spread heat over a larger surface point on the graph. If that point is on or above the specified
area, helping with the heat-load problem. The use of heat- milliamperage line, it is unsafe. With the latter example, the
tolerant materials in the construction of the tube also helps milliamperage and time are used to plot a point on the graph.
deal with heat load. Radiational cooling of the anode is also If the point is on or above the specified kilovoltage peak line,
used. That is, the anode “radiates” heat within the tube away the technique is unsafe.
from itself. Therefore, three processes of heat transfer are at For example, using Figure 5-11, A, are settings of 75 kVp,
play: conduction of heat by heat-tolerant materials, radiation 1000 mA, and 0.1 s safe or unsafe? (They are unsafe. When
of heat energy from the anode to the oil bath, and convection the point is plotted, it is on the specified kilovoltage peak
of heat into the room by the cooling fans. Finally, modern line.) Using Figure 5-11, B, are settings of 90 kVp, 100 mA,
x-ray machines have protective circuits built in that prevent and 0.5 s safe or unsafe? (They are safe. When the point is
the use of unsafe exposure techniques and heat overloads of plotted, it is well below the specified kilovoltage peak line.)
the x-ray tube. However, even with all of these safety mea-
sures, the radiographer must understand anode thermal ca-
pacity and keep in mind that the production of x-rays is a CRITICAL CONCEPT 5-8
very inefficient process, with almost 99% of the energy used Tube Rating Charts
being converted to heat. Regardless of the type of tube rating chart, any plotted point
To better understand anode thermal capacity we will use a on the chart that is on or above the given curve line is unsafe.
bit of our history. Prior to the introduction of protective cir-
cuits, rating charts were used to determine if a particular
combination of exposure factors was safe or unsafe for a To better understand how much heat may be produced
given x-ray tube. Similarly, cooling charts were used to deter- during an exposure, students should first be aware of the
mine cooling time needed before continued operation or to concept of heat units (HUs). HUs are a measure of the

150 mA
200
Kilovoltage peak (kVp)

125

150
100

100
75
10.00 rpm
3f 1.0 mm 11
0 50
0.005 0.01 0.1 1 10 20 0.01 0.02 0.05 0.1 0.2 0.5 1 2 5
A Maximum exposure time in seconds B Seconds

1000 mA 700 mA 400 mA 150 kVp 120 kVp 90 kVp

900 mA 600 mA 300 mA 140 kVp 110 kVp 80 kVp
800 mA 500 mA 250 mA 130 kVp 100 kVp 70 kVp
FIG 5-11  Tube Rating Charts. Two versions of tube rating charts. A plots milliamperage lines
and B plots kilovoltage peak lines, but both serve the same purpose.
58 SECTION I  Principles of Radiation Physics

amount of heat stored in a particular device. For the x-ray line: 5 – 2.5 5 2.5.) Using Figure 5-12, B, how long will it
tube, HUs are calculated using the following formula: kVp 3 take the housing to cool from 600,000 HU to 100,000 HU?
mA 3 s 3 c, in which kVp is the kilovoltage selected, mA is (It will take approximately 200 minutes. The 600,000 line
the milliamperage station selected, and s is the exposure time intersects the cooling curve at the 100-minute mark, and
in seconds. The c represents a correction factor and depends the 100,000 HU line intersects the cooling curve at the
on the generator type. Its value is as follows: 300-minute mark: 300 – 100 5 200.)
Single-phase 5 1.0 To extend tube life, simple procedures and guidelines
Three-phase, 6-pulse 5 1.35 should be followed. First, the warm-up steps specific to the
Three-phase, 12-pulse 5 1.41 unit should be followed completely and routinely. This is
High-frequency 5 1.45 akin to warming up a car on a very cold day. Doing so warms
If multiple exposures are made using a given technique, the the engine slowly and prepares it for normal operation.
answer from this formula is multiplied by the number of ex- Similarly, the x-ray tube should be warmed before normal
posures. One can quickly see that heat is a major factor in the operation. Note that newer units may have automatic warm-
damage done to an x-ray tube over thousands of exposures. up protocols. Second, do not prep the rotor excessively. This
Continuing our historical example, the anode and hous- preexposure phase maintains the filament in an energized
ing cooling charts both work the same way. The anode cool- state and thus shortens its useful life. In fact, it is usually pref-
ing chart is used to determine the time it takes for the anode erable to press both the rotor and exposure buttons almost
to cool based on the factors given. The housing cooling chart simultaneously, so that the filament is heated for the mini-
does the same for the tube housing. The Y-axis represents the mum time necessary. The machine will not apply the high
HUs (usually expressed in thousands), and the X-axis repre- voltage until the rotor reaches full operating speed. Third, do
sents time (usually in minutes). The curve that is plotted on not routinely use extremes of exposure factors. Consistently
the graph is the cooling curve representing heat dissipation using single, very high exposure values results in pitting the
over time (Figure 5-12). anode (small areas of melting), which can then cause irregu-
For example, using Figure 5-12, A, how long will it take lar outputs. By the same token, consistently using low but
for the anode to cool from 60,000 HU to 25,000 HU? (It will very long exposures also results in uneven heating and wear.
take approximately 2.5 minutes. The 60,000 line intersects Excessive heating may also cause heat transfer to the bearings
the cooling curve at about the 2.5-minute line, and the of the rotor. This heating can damage the bearings, resulting
25,000 line intersects the cooling curve at about the 5-minute in uneven rotation speed and damage to the tube.

Anode cooling chart Housing cooling chart

120 1300
HRT
110 1200
Max anode cooling
Rate: 40,000 HU/min 1100
100
Housing storage in thousand heat units

1000
90
900
80
(kVp x mA x s x 1.35)

(kVp x mA x s x 1.35)
Thousand heat units

800
70
700
60
600
50
500
40
400
30
300
20 200

10 100

A 0 B 0
0 1 2 3 4 5 6 7 8 0 100 200 300 400
Time in minutes Time in minutes

FIG 5-12  Anode and Housing Cooling Charts. A, the anode cooling chart, and B, the housing
cooling chart, plot cooling time and are used to estimate a cooling time based on accumulated
heat units.
 CHAPTER 5  The X-Ray Tube 59

SUMMARY
• The protective housing of the x-ray tube serves as an elec- • The cathode of the x-ray tube is typically made up of two
trical insulator, a thermal cushion, and a x-ray shield (lead filament coils made of a tungsten-thorium alloy and a sur-
lining) to reduce leakage radiation to less than 100 mR/hr. rounding focusing cup made of nickel. The cathode is
• The glass or metal enclosure of the x-ray tube serves to designed to provide a source of electrons needed for x-ray
maintain a vacuum so that electrons from air do not con- production.
tribute to the electron stream. It also has a target window • Once the radiographer selects the exposure factors on the
made thinner than the rest so as to minimally absorb operating console, electricity is manipulated using various
x-rays as they exit the tube. x-ray circuit components to create the proper environ-
• There are two basic anode designs. The stationary anode ment for x-ray production.
is basically a target embedded in a copper rod and has a • Three things are needed in the x-ray tube for x-ray pro-
very limited heat-load capacity. The rotating anode design duction: a large potential difference to give kinetic energy
is used today and incorporates a rotating target to dissi- to filament electrons (provided by kilovoltage peak set-
pate heat, greatly increasing its heat-load capacity. ting), a vehicle on which kinetic energy can ride (source of
• Copper is used in the construction of the rotating anode electrons provided by milliamperage/second setting), and
because of its thermal and electrical conductivity. Molyb- a place for interaction (the anode target).
denum is used because of its low thermal conductivity and • Several factors can shorten the life of an x-ray tube. Most
tensile strength. Tungsten is used because of its high have to do with the thermal characteristics of x-ray produc-
atomic number and thermal capacity (high melting point). tion, particularly the frequent use of very high exposure
• The rotating anode is turned using an induction motor factors, the use of lower but very long exposure factors, and
that operates through electromagnetic mutual induction. overloading the filament.
The rotor of the induction motor is within the glass or • HUs are a measure of the amount of heat stored in a par-
metal enclosure, and the stators are outside the enclosure ticular device. For the x-ray tube, HUs are calculated using
around the neck of the tube. the following equation: kVp 3 mA 3 s 3 c.
• The rotating anode design uses the line-focus principle, • With anode and housing cooling charts, the Y-axis repre-
which means that the target face is angled to create a large sents the HUs (usually expressed in thousands) and the
actual focal spot for heating and a small effective focal spot X-axis represents time (usually in minutes) and the curve
for improved image quality. But by angling the face, the that is plotted on the graph is the cooling curve represent-
“heel” of the target is partially placed in the path of the ing heat dissipation over time.
x-ray beam produced, causing absorption and reduced • Always follow warm-up and recommended exposure
intensity of the beam on the anode side. guidelines specific to the x-ray machine being used.

CRITICAL THINKING QUESTIONS

1. How does each part of the x-ray tube contribute to maxi- 2. Focusing on x-ray tube operation, explain the effect
mizing x-ray production and extending the life of the of each factor selected at the control console on the x-ray
tube? tube.

REVIEW QUESTIONS
1. Which of the following reduces leakage radiation to NCRP 3 . The x-ray tube is a part of the:
standards? a. x-ray circuit primary.
a. x-ray tube b. x-ray circuit secondary.
b. collimator c. filament circuit.
c. added filtration d. breaker circuit.
d. protective housing 4. A technique of 80 kV, 400 mA, 0.8 seconds is to be used on
2. Which component of the x-ray tube is responsible for a 3-phase, 12-pulse machine. How many heat units are
concentrating the electron cloud? produced with a single exposure?
a. anode a. 25,600
b. filament b. 34,560
c. focusing cup c. 36,096
d. focal track d. 38,100
Continued
60 SECTION I  Principles of Radiation Physics

R E V I E W Q U E S T I O N S — cont’d
5 . The intensity of the x-ray beam is less: 10. The purpose of the line focus principle is to create which
a. in the center of the beam. of the following?
b. at the collimator. a. small actual and effective focal spot size
c. on the cathode side. b. large actual and effective focal spot size
d. on the anode side. c. small actual and large effective focal spot size
6. Causes of tube failure are most often related to which of d. large actual and small effective focal spot size
the following? 11. A technique of 50 kV, 100 mA, 0.1 seconds is to be used
a. electrical characteristics on a 3-phase, 6-pulse machine. How many heat units are
b. mechanical characteristics produced with a single exposure?
c. physical characteristics a. 500
d. thermal characteristics b. 675
7. What metal is added to the filament to increase therm- c. 705
ionic emission and extent tube life? d. 820
a. thorium 12. Using Figure 5-11 A, are the settings of 100 kVp, 600 mA,
b. copper and 1 s safe or unsafe?
c. rhenium 13. Using Figure 5-11 B, are the settings of 90 kVp, 100 mA
d. tungsten and 0.2 s safe or unsafe?
8. A small anode target angle: 14. Using Figure 5-12 A, how long will it take for the anode
a. results in an increase in anode heel effect. to cool from 95,000 HU to 20,000 HU?
b. results in a decrease in anode heel effect. 15. Using Figure 5-12 B, how long will it take for the housing
c. results in an equalization of anode heel effect. to cool from 900,000 HU to 600,000 HU?
d. does not influence anode heel effect.
9. A dual focus tube refers to a tube with:
a. two focal tracks.
b. two filaments.
c. two focusing cups.
d. two targets.
 6
X-Ray Production

OUTLINE
Introduction Properties of the X-ray Beam
Photons (Target Interactions) Beam Quantity
Heat Production Beam Quality
Characteristic Interactions Emission Spectrum
Bremsstrahlung Interactions Summary

OBJECTIVES
• Explain the process of heat production in the • Describe beam quantity and how milliamperage, kilo-
x-ray tube. voltage peak, filtration, and distance affect it.
• Explain the process of characteristic x-ray photon • Describe beam quality and how kilovoltage peak and
production. filtration affect it.
• Explain the process of bremsstrahlung x-ray photon • Explain half-value layer.
production. • Interpret the discrete, continuous, and x-ray emission
• Determine characteristic and bremsstrahlung photon spectrums.
energy. • Explain the effects of milliamperage, kilovoltage peak,
• Describe the principles and use of inherent, added, and filtration, generator type, and target material on the x-ray
compensating filters. emission spectrum.

KEY TERMS
beam quality continuous emission spectrum penetration
beam quantity discrete emission spectrum primary beam
bremsstrahlung (brems) interactions filtration remnant beam
characteristic cascade half-value layer (HVL) x-ray emission spectrum
characteristic interactions inverse square law

INTRODUCTION PHOTONS (TARGET INTERACTIONS)

This chapter examines the anode target interactions at a Figure 6-1 illustrates the inside of the x-ray tube. Exposure
micro level. To this point the focus has been on the use of factors have been selected; electricity has traveled to the
electricity and electrical devices to manipulate the flow of anode, cathode, and filament; and electrons have been
electricity for the purpose of x-ray production. This chapter boiled off of the filament and are streaming across to the
focuses on the interactions in the anode target that result in anode at tremendous speeds. The filament electrons pene-
x-ray photons as well as the properties, characteristics, and trate the face of the target to a depth of approximately
factors that influence the nature of the x-ray beam. The ra- 0.5 mm, interacting with the tungsten target atoms in their
diographer’s actions at the control panel directly determine path. These filament electrons interact with target atoms to
the nature and makeup of the x-ray beam, which (in con- produce x-rays in two ways: characteristic interactions and
junction with patient, image receptor, and processing charac- bremsstrahlung (brems) interactions. It should be noted
teristics) determines image quality. Several complex and that most of the interactions (approximately 99%) do not
overlapping processes result in the radiographic image. The result in x-rays but produce only heat. Keep in mind also
x-ray machine is a tool in this process. An understanding that there are thousands of interactions taking place inside
of this tool is one factor that determines the skill of the the target at once, but for the sake of explanation we focus
radiographer. on a single event in each case. Refer to the first part of
61
62 SECTION I  Principles of Radiation Physics

and only 1% will result in x-ray production either by charac-

teristic or bremsstrahlung interactions.

CRITICAL CONCEPT 6-1

Target Interactions
There are two interactions in the target that produce x-rays:
brems and characteristic. X-rays are produced when filament
electrons interact with target atom electrons or nuclei. Ioniza-
tion of target atom electrons leads to release of characteristic
x-ray photons, whereas interactions with target nuclei pro-
duce brems photons. During a single exposure thousands of
such events take place. However, most of the interactions in
the target result only in heat (approximately 99%).

FIG 6-1  X-ray Tube. A general-purpose x-ray tube.

Characteristic Interactions
Characteristic interactions involve the filament electron and
Chapter 2 for a refresher on the general structure of an orbital electron of a target atom. In general, a filament
the atom. electron enters a target atom and strikes an orbital electron.
If its energy is greater than the binding energy of the orbital
Heat Production electron, it is removed from orbit. Recall from Chapter 2 that
As filament electrons enter the anode target, most interact orbital shells fill from the shell nearest the nucleus outward
with outer shell electrons of the tungsten atoms. They do not and a vacancy in a shell makes the atom unstable. To correct
transfer enough of their kinetic energy to ionize the atom this situation, outer-shell electrons drop to fill inner-shell
but rather just enough to raise them to a higher energy level vacancies. To do so the outer-shell electron must expend
(excitation). This excess energy is immediately given off as some of its potential energy. This energy is given off as a
infrared radiation (heat) as the outer shell electron returns to characteristic x-ray photon (Figure 6-2). Note that when the
normal. As previously stated, there are thousands of interac- first orbital electron drops to fill the vacancy, it in turn leaves
tions occurring in the anode target during a single exposure, another. This second vacancy is also filled by an outer-shell
and 99% are causing recurrent excitation and subsequent electron that again must give up some of its energy, produc-
emission of infrared energy (heat). The end result is that ing another characteristic photon. This process of outer-shell
most of the energy from the filament electrons is lost as heat electrons filling inner-shell vacancies continues down the

Filament
electron

K-shell
L-shell
O-shell N-shell M-shell
Characteristic x-ray photons
FIG 6-2  Characteristic Interaction. A characteristic interaction event. Note that as outer-shell
electrons fill inner-shell vacancies, their excess energy is released as characteristic x-ray photons.
 CHAPTER 6  X-Ray Production 63

line, creating a cascading effect called a characteristic cas- radiographer subtracts the binding energy of the farther shell
cade. Each time an orbital electron moves to a lower orbit, a (shell providing electron) from the closer shell (shell with
characteristic photon is produced. This process is not neces- vacancy).
sarily orderly. If a filament electron removes a K-shell elec- Again, with characteristic interactions, to remove an or-
tron from an atom, the most likely electron to fill the vacancy bital electron, the filament electron must have kinetic energy
is an L shell because of proximity. However, any outer-shell equal to or greater than the binding energy of the electron
electron can fill the K-shell vacancy; it is just not as likely that with which it interacts. If, for example, a filament electron has
an electron beyond the L shell will do so. Notice that the re- 50 keV of kinetic energy and strikes a tungsten K-shell elec-
moval of the orbital electron established the environment for tron (binding energy 5 69.5 keV), it does not have the energy
x-ray production and it is the expending of energy during the to remove it. The result of this type of interaction is heat
cascade that produces characteristic x-rays. production and, as noted earlier, this happens most of the
time. The K-shell electron absorbs the kinetic energy from
CRITICAL CONCEPT 6-2 the filament electron and reemits it as heat energy. This also
Characteristic Interactions happens with any other orbital electron regardless of shell if
the filament electron does not have sufficient energy to re-
Characteristic photons are created when orbital electrons of move it. In such cases the filament electron, having lost all of
target atoms are removed from their shell and outer-shell
its kinetic energy, then drifts away to fill a vacancy in another
electrons fill inner-shell vacancies. To fill the vacancy, the
outer-shell electron releases some of its potential energy as
atom or become part of the current through the tube. If,
a characteristic photon. however, that same filament electron had 100 keV of energy,
it would easily remove the K-shell orbital electron and be
deflected in a new direction. It would still have 30 keV of
Characteristic photons are so called because their energy energy left and with it interact with another atom.
is “characteristic” or dependent on the difference in binding
energy between the shells involved. The electron shells of MATH APPLICATION 6-1
each element have specific binding energies. Table 6-1 pres-
Characteristic Photons
ents binding energies that can be assumed for tungsten. A
tungsten atom has 74 electrons orbiting its nucleus in six dif- To find the energy of a characteristic photon, one must know
ferent shells. The filament electron may interact with any of the shell-binding energies of the element and the shells in-
them, but medical imaging generally focuses on K-shell (in- volved. The filament electron must possess kinetic energy
equal to or greater than the shell-binding energy to remove it
nermost shell) interactions because they are the highest en-
from orbit. The photon energy is then equal to the difference
ergy and the most useful for imaging purposes. Recall from
in the binding energy of the shells involved.
Chapter 2 that each orbital electron is held in orbit by a bind- Example:
ing energy and the closer the orbit, the stronger the bond. A filament electron removes a K-shell electron and an L-shell
K-shell electrons in tungsten have the strongest binding en- electron fills the vacancy:
ergy at 69.5 kiloelectron volt (keV). For a filament electron to K-shell binding energy 5 69.5 keV
remove this orbital electron, it must possess energy equal to L-shell binding energy 5 12.1 keV
or greater than 69.5 keV. For all practical purposes using a 69.5 – 12.1 5 57.4 keV
general purpose x-ray machine, if a radiographer selects a The energy of the K-characteristic photon produced is
kVp less than 70 on the control panel, there will be no pho- 57.4 keV.
This scenario creates a vacancy in the L shell. An M-shell
tons produced from K-shell interactions.
electron fills the L-shell vacancy:
The characteristic photon is named for the shell being
L-shell binding energy 5 12.1 keV
filled in each case. If an outer-shell electron is filling a K-shell, M-shell binding energy 5 2.8 keV
regardless of where that filling electron is coming from, the The energy of the L-characteristic photon produced is
photon produced is called K characteristic. If an electron is 9.3 keV.
filling an L–shell, the resulting photon is called L characteristic, Alternatively, an N-shell might fill the original K-shell vacancy:
and so on. To find the energy of a characteristic photon, the K-shell binding energy 5 69.5 keV
radiographer needs to know the target element (in this case, N-shell binding energy 5 0.6 keV
tungsten) and the shells involved. Using this information, the 69.5 – 0.6 5 68.9 keV
The energy of the K-characteristic photon produced is
68.9 keV.
TABLE 6-1  Binding Energies for Tungsten
K shell 69.5 keV
L shell 12.1 keV Bremsstrahlung Interactions
M shell 2.82 keV The second type of interaction in the target that produces
N shell 0.6 keV
x-rays is a brems interaction. Bremsstrahlung is a German
O shell 0.08 keV
word roughly meaning braking or slowing down radiation,
P shell 0.008 keV
which is exactly what this interaction involves where the
64 SECTION I  Principles of Radiation Physics

filament electron is concerned. In this interaction the fila- The energy of a brems photon can be found by subtract-
ment electron misses all of the orbital electrons and interacts ing the energy that the filament electron leaves the atom
with the nucleus of the target atom. Recall that the electron is with from the energy it had upon entering. For example,
negatively charged and the nucleus (containing all the pro- a filament electron enters an atom with 100 keV of
tons) is positively charged, and there will be a force of attrac- energy, passes very close to the nucleus, and leaves with
tion between the two. The strength of this attraction depends 30 keV of energy. The brems photon produced is 70 keV
on how close the filament electron comes to the nucleus. The (100 keV 2 30 keV 5 70 keV). If that same filament elec-
attraction causes the filament electron to slow down and tron passed at some distance from the nucleus and exited
change direction and, in doing so, lose kinetic energy. This with 80 keV of energy, the brems photon would be 20 keV
energy is released as a brems photon (Figure 6-3). The closer (100 keV – 80 keV 5 20 keV). The average energy of
the filament electron passes to the nucleus, the stronger the a brems photon is one third of the kVp selected at the
attraction. The stronger this attraction, the more energy the control panel.
filament electron loses and the stronger the resultant brems In a tungsten target most of the photons are brems for
photon. Because of this, the brems photon can vary from the two reasons. First, with characteristic interactions, only
maximum kVp selected (filament electron passes very close those involving the K shell are of sufficient energy to be
and loses all its energy) to near zero (filament electron passes useful. All others are too weak to contribute to the radio-
at a distance and loses almost no energy). graphic image and are typically filtered out of the beam by
the 2.5 mm of total filtration (discussed next) that is built
CRITICAL CONCEPT 6-3 into the tube head assembly. Because tungsten has a K-shell
Bremsstrahlung Interactions binding energy of 69.5 keV, only those kilovoltage peak
settings of 70 kVp or greater produce K-characteristic
Brems photons are produced when filament electrons miss photons. All lower settings result in a beam made up
all of the orbital electrons of the target atom and interact with entirely of brems. Second, the filament electron is more
the nucleus. The attraction of the filament electron to the
likely to miss the orbital electrons of the target atom be-
nucleus causes it to slow down and change direction. The
resultant loss of energy is given off as a brems photon.
cause they are in constant motion and the atom is mostly
empty space.

High-energy
Incident bremsstrahlung
electron x-ray photon

Incident
electron

Low-energy
bremsstrahlung
x-ray photon

FIG 6-3  Bremsstrahlung Interaction. A bremsstrahlung (brems) interaction event. Note that
how close the filament electron passes to the nucleus determines the brems photon energy.
Passing very close to the nucleus causes a greater loss of energy, which is released as a
high-energy brems photon.
 CHAPTER 6  X-Ray Production 65

THEORY TO PRACTICE 6-1 CRITICAL CONCEPT 6-4

Knowing that the average energy of brems is one third of the Filtration
kVp selected and that most of the beam is made up of Added and inherent filtration remove low-energy photons
brems, we can predict the average energy of an x-ray beam before they expose the patient and add to radiation dose un-
to be one third of the kVp selected. necessarily. Compensating filters, while requiring an increase
in mAs and therefore radiation dose, offset this by balancing
exposure to the IR and improving image quality.

PROPERTIES OF THE X-RAY BEAM Beam Quantity

Certain properties characterize any given x-ray beam based Beam quantity refers to the total number of x-ray photons in a
on how it was produced and how it behaves in its interac- beam. Beam quantity is affected by mAs, kVp, distance, and
tions with matter. The interactions with matter are covered filtration. The radiographer should associate quantity with ra-
in detail in Chapter 7. The properties that the radiographer diation dose. All other factors remaining constant, an increase
should be familiar with are beam quantity and beam qual- in quantity increases the radiation dose delivered to the patient.
ity, and the defining terms of each. But before we get to Beam quantity is directly proportional to mAs. Because mAs
that, a discussion of filtration is in order. In radiography, controls the number of electrons boiled off of the filament and
filtration refers to the use of a material, usually aluminum available to produce x-rays, it is considered the primary factor
(Al) or aluminum equivalent, to absorb x-ray photons controlling quantity. Doubling the mAs doubles the quantity
from the x-ray beam. This filtration may be in the form (output). When adjustments in quantity are desired, mAs is the
of an inherent, an added, or a compensating filter. In previ- factor adjusted.
ous chapters the collimator (Chapter 1) and x-ray tube Beam quantity varies as the square of the ratio of the
(Chapter 5) were discussed. Filtration is both inherent and change in kVp. If kVp is doubled, the intensity (quantity)
added to this design. Inherent filtration is just that, inher- increases by a factor of four. However, because kVp controls
ent to the tube head assembly (tube and housing). The both the number and energy of x-rays in the beam, a small
target window is the primary contributor to inherent filtra- change in kVp exerts a large effect on exposure to the image
tion and equates to about 0.5 mm Al equivalent. In a gen- receptor. This is why the 15% rule applies when changing
eral radiography tube head assembly, added filtration kVp to affect exposure to the image receptor. A 15% increase
comes in the form of another 2.0 mm Al placed between in kVp is equivalent to doubling the mAs. Beam quantity is
the target window and the top of the collimator. The pur- strongly affected by changes in kVp because kVp gives kinetic
pose of this added filtration is to remove low-energy x-ray energy to the filament electrons. That kinetic energy is con-
photons from the beam before they can expose the patient verted to heat and x-ray photons, and the greater the kinetic
and contribute unnecessarily to radiation dose. So in gen- energy, the greater the chances for x-ray production. It is less
eral-purpose radiography tube head assemblies, a total of desirable to use kVp to change quantity because it influences
2.5 mm Al equivalent filtration is in place to “clean up” the too many other factors (e.g., penetrability and scatter pro-
x-ray beam by removing low-energy photons that would duction) related to image production and is less predictable
not contribute anything useful to the imaging process. The in its imaging effect where quantity is concerned.
combination of inherent and added filtration is referred to Beam quantity varies inversely as the square of the distance.
as total filtration. Compensating filters, as their name im- This is the inverse square law, which states that the intensity of
plies, are used to adjust or “compensate” for variations in a beam is inversely proportional to the square of the distance
patient thickness or density and create a more uniform from the source. The inverse square law is expressed as I1/I2 5
exposure to the image receptor (IR). Many compensating d22/d21. That is, the intensity (quantity) quadruples if the dis-
filter designs are some variation of a wedge shape, with the tance is reduced to one half of its original value. X-ray photons
thin portion of the wedge is placed over the thicker ana- diverge as they travel away from the source, and if the distance
tomic part and the thick part of the wedge is placed over is shorter they do not have the opportunity to diverge as much
the thinner anatomic part. These filters may be designed to and are then concentrated on a smaller area.
attach to the bottom of the collimator or placed adjacent to
or on the anatomic part of interest (Figure 6-4). The use of
compensating filters requires an increase in mAs to main- MAKE THE IMAGING CONNECTION 6-1
tain overall exposure to the IR and is a tradeoff between Chapter 10
increasing patient dose slightly to improve image quality.
As with all of radiography, the benefits of exposing a pa- To best visualize the anatomic area of interest, the mAs set-
tient to ionizing radiation, must outweigh the harm caused ting selected must produce a sufficient amount of radiation
reaching the image receptor, regardless of type. Excessive or
by the exposure. The radiographer must always use sound
insufficient mAs will adversely affect exposure to the image
judgment founded in science when incorporating compen- receptor and affect patient radiation exposure.
sating filters.
66 SECTION I  Principles of Radiation Physics

X-ray tube housing

Collimator
Wedge filter

More photons penetrate

the filter and expose the
thicker area of the foot

Less photons penetrate

the filter and expose the
thinner area of the foot

Boomerang filter

Fewer photons expose IR More photons expose IR

B through soft tissue and air through bony structures
FIG 6-4  Compensating Filters. Compensating filters may attach to the collimator or be placed
adjacent to or on the anatomic area of interest. They serve to filter a portion of the beam to bal-
ance exposure to the IR and improve image quality.

The extent to which use of filtration decreases x-ray quan-

MATH APPLICATION 6-2 tity depends on the thickness and type of filtration material.
Inverse Square Law Filtration absorbs low-energy photons that do not contribute
to the image and would otherwise add to patient radiation
What will the intensity of a beam be at 40 inches if it is 5 R
at 80 inches? dose. Added filtration placed at the collimator serves to
5 R/I2 5 402/802 reduce patient dose by removing such photons. Table 6-2
5/I2 5 1600/6400 presents a summary of the factors affecting beam quantity.
I2 5 5 3 6400/1600
I2 5 20R Beam Quality
If the intensity of a beam is 12 R at 20 inches, at what distance Beam quality refers to the penetrating power of the x-ray
will it be 3 R? beam. Penetration refers to those x-ray photons that are
12/3 5 d22/202 transmitted through the body and reach the image receptor.
12/3 5 d22/400 It is desirable for some of the x-ray photons to penetrate the
12 3 400/3 5 d22
anatomic area of interest, or no image would result. Photons
1600 5 d22
that reach the image receptor create the dark shades of the
40” 5 d2
image; areas where no photons reach result in the light or
 CHAPTER 6  X-Ray Production 67

TABLE 6-2  Factors Affecting Beam is composed of transmitted photons (those exiting the pa-
Quantity tient without having interacted with anatomic structures)
and scattered photons (those that have lost energy and have
Increase In Effect on Quantity been redirected after interacting with anatomic structures).
mAs Increases Both of these are discussed in detail in Chapter 7.
kVp Increases
Distance Decreases
Filtration Decreases EMISSION SPECTRUM
kVp, kilovoltage peak; mAs, milliamperage/second. The emission spectrum graphically illustrates the x-ray beam
(Figure 6-5). As previously discussed, the x-ray beam is the
result of two different anode target interactions. The emis-
clear areas of the image. Both are needed to create the image sion spectrum for each looks different because of the nature
and provide contrast. Beam quality is affected by kVp and of each. Characteristic photons have a discrete emission
filtration and is controlled mainly by adjusting kVp. As kVp spectrum and brems photons have a continuous emission
increases, the beam’s ability to penetrate matter also increases spectrum. We combine the essential parts of each to create
and vice versa. X-ray beams with high energy (from high kVp the x-ray emission spectrum. These graphs are handy visuals
settings) are said to be high-quality, or hard, beams. X-ray of the nature of the beam and are useful for illustrating the
beams with low energy (from low kVp settings) are said to be effects of different influencing factors on them.
low-quality, or soft, beams. The discrete emission spectrum illustrates characteristic
Beam quality is also affected by filtration. Filtration serves x-ray production. The x-axis is the x-ray energy, and the y-
to remove the lower-energy photons, making the average axis is the number of each type of x-ray photon. It is called
energy (quality) higher. Think of this as the instructor drop- discrete because the photon energies are limited to just a few
ping a student’s two lowest test grades. Doing so will increase exact values. Characteristic photons are produced when
the student’s average. Table 6-3 provides a summary of the outer-shell electrons fill inner-shell vacancies in atoms, and
factors affecting beam quality. the energy is determined by the difference in the shells in-
Beam quality is measured by the half-value layer (HVL). volved. Recall that characteristic photons are named for the
HVL is defined as the thickness of absorbing material (alumi- shell being filled. There are a number of bars at each level
num [Al] or aluminum equivalent filtration) necessary to (K, L, M, etc.) representing the energy variations depending
reduce the energy of the beam to one-half its original inten- on the shells involved. For example, there is a bar for K-
sity. It is found by first measuring the intensity of the beam characteristic photons produced when L electrons fill K,
with a radiation detector, then placing aluminum filters of and a bar for when M electrons fill K, and so on. The bars
known thicknesses between the tube and detector until the are at different points along the x-axis according to their
intensity reading is reduced to one-half the original value. energy, but all are K characteristic. The same is true for
Normal HVL of general diagnostic beams is 3 to 5 mm Al. L-characteristic -photons and each of the others. The low-
est-energy bars (those representing the lowest energy inter-
actions) may not be labeled because they are of no diagnos-
CRITICAL CONCEPT 6-5 tic value. The height of the bars relative to the y-axis
Beam Quantity and Quality indicates the number of photons of that type. Figure 6-6
Beam quantity refers to the intensity or number of photons, demonstrates a spectrum for a tungsten target; other target
and beam quality refers to the energy or penetrating power
of a given x-ray beam.

Characteristic
Related to this discussion of quantity and quality are the
Number of x-rays

x-rays
terms primary beam and remnant beam. Primary beam re-
fers to the x-ray beam as it is upon exiting the collimator and
exposing the patient. Remnant beam refers to the x-ray beam Bremsstrahlung
that remains after interaction with the patient and is exiting x-rays
the patient to expose the image receptor. The remnant beam

0 25 50 69 75 100
TABLE 6-3  Factors Affecting Beam Quality
X-ray energy (keV)
Increase In Effect on Quality
kVp Increases FIG 6-5  X-ray Emission Spectrum. The x-ray emission
Filtration Increases spectrum is a graphic representation of the important parts
of an x-ray beam (i.e., brems photons and K-characteristic
kVp, kilovoltage peak. photons). keV, Kiloelectron volt.
68 SECTION I  Principles of Radiation Physics

K x-rays
Number of x-rays

Number of x-rays
L x-rays

0 25 50 75 100
0 25 50 69 75 100
X-ray energy (keV)
X-ray energy (keV)
FIG 6-6  Discrete Emission Spectrum. Discrete emission
spectrum for a tungsten target. keV, Kiloelectron volt. FIG 6-7  Continuous Emission Spectrum. Continuous emis-
sion spectrum for a tungsten target. keV, Kiloelectron volt.

materials are similar, but the energy range on the x-axis is

different. energies of the x-ray beam. It can also be used to reflect the
With tungsten targets, K-characteristic x-rays are of the effects of different factors on the x-ray beam. Changes in the
greatest importance because they contribute to the radio- spectrum with respect to the y-axis indicate changes in quan-
graphic image. Beginning on the right side of the graph, K- tity. Changes in the spectrum with respect to the x-axis
characteristic photons have an energy range of approximately indicate changes in quality. Five factors change the appearance
57 keV (if an L electron fills the K-shell vacancy) to 69 keV (if of the x-ray emission spectrum: mA, kVp, tube filtration, gen-
the O or P shell fills the K-shell vacancy). Then, moving erator type, and target material.
down the x-axis, L-characteristic x-ray energies are plotted. Changes in mA affect beam quantity. All other factors re-
They have an energy range of approximately 9 keV (if an M maining constant, an increase in mA increases the amplitude
shell electron fills the L-shell vacancy) to 12 keV (if an O or of both the continuous and discrete portions of the spec-
P shell electron fills the L-shell vacancy). Beyond L-character- trum. Remember that when mA is increased on the control
istic there is really no point in plotting the energies because panel, more electrons are boiled off of the filament and are
they are so low that they are filtered out of the beam and are available for x-ray production. This increases the quantity of
of no consequence. x-rays produced. Because the kVp setting controls energy,
The continuous emission spectrum illustrates brems x-ray the spectrum does not move along the x-axis with changes
production. Again, the x-axis represents the energy and the in mA, nor does the discrete line move because it is related
y-axis the number of photons. Because brems photons are specifically to the target material (Figure 6-8).
the result of the filament electrons’ attraction to the nucleus,
their energy depends on the strength of this attraction, rang-
ing from just above zero to the maximum kVp selected on the CRITICAL CONCEPT 6-6
control panel. Unlike the finite characteristic photon ener- Milliamperage and Emission Spectrum
gies, brems photons have a range of energy, with most being
Increasing milliamperage increases x-ray beam quantity but
one third of the kVp selected. A graph of brems photons cre-
has no effect on quality and does not change the position of
ates a bell-shaped continuum. The left side of the curve is just
the discrete line.
above zero and the right side of the curve touches the x-axis
at the kVp selected. The peak of the curve is approximately
one third of the kVp indicated. Figure 6-7 illustrates a tung-
sten target spectrum; other target materials are similar, but Changes in kVp affect beam quality and quantity. All
the energy range on the x-axis is different. other factors remaining constant, an increase in kVp in-
To graphically represent the x-ray beam as a whole, we creases the amplitude of both continuous and discrete por-
combine the two spectra (see Figure 6-5). As with the other tions of the spectrum and shifts the right side of the curve to
two graphs, the x-axis represents the energy and the y-axis the right along the x-axis. When kVp is increased at the con-
the quantity of each type of photon. The continuous portion trol panel, a larger potential difference occurs in the x-ray
is used as is because it represents most of the beam. The dis- tube, giving more electrons the kinetic energy to produce x-
crete line is reduced to the highest-energy K-characteristic rays and increasing the kinetic energy overall. The result is
bar. For a tungsten target it is positioned at approximately more photons (quantity), which increases the amplitude of
69 keV. As previously stated, the other discrete lines are omit- the spectrum and higher-energy photons (quality), which
ted because they represent photons that are generally filtered shifts the right side of the curve farther to the right. The dis-
out of the beam and are of no consequence to imaging. The crete line does not move because it is related specifically to
x-ray emission spectrum is used to graphically represent the the target material (Figure 6-9).
 CHAPTER 6  X-Ray Production 69

400 mA 2 mm of Al added
filtration
Number of x-rays

Number of x-rays
200 mA

4 mm of Al
added filtration

0 25 50 75 100
0 25 50 75 100
X-ray energy (keV)
X-ray energy (keV)
FIG 6-10  Additional Tube Filtration. Two emission spectra
FIG 6-8  Change in Milliamperage. Two emission spectra
illustrating the result of an addition of filtration (green curve).
illustrating the result of an increase in mA (purple curve).
Increases in filtration decrease the quantity and increase
Increases in mA increase the quantity of radiation. keV, kilo-
quality of radiation. Al, aluminum; keV, kiloelectron volt.
electron volt; mA, milliampere.

CRITICAL CONCEPT 6-8

Tube Filtration and Emission Spectrum
Number of x-rays

82 kVp An increase in tube filtration causes a decrease in x-ray beam

quantity and an increase in quality, but the discrete line is
unaffected.
72 kVp

Changes in generator type change the x-ray production

0 25 50 75 100 efficiency of the machine. High-frequency units are much
X-ray energy (keV) more efficient in producing x-rays than single-phase units.
This means that with the same amount of electricity (power),
FIG 6-9  Change in Kilovoltage Peak. Two emission spectra
illustrating the result of an increase in kVp (purple curve). In- a high-frequency unit produces more x-rays. In the x-ray
creases in kVp increase the quantity and quality of radiation. emission spectrum, this is represented by an increase in am-
keV, kiloelectron volt; kVp, kilovoltage peak. plitude and average energy. If a generator operates more ef-
ficiently, more filament electrons have the energy to produce
x-rays, increasing quantity (amplitude of the curve). There
are also a greater number of higher-energy photons, increas-
ing the average energy and shifting the peak to the right
CRITICAL CONCEPT 6-7 (Figure 6-11).
Kilovoltage Peak and Emission Spectrum
Increasing kVp increases the x-ray beam quantity and quality
but does not change the position of the discrete line.
High frequency
Number of x-rays

The addition of tube filtration or introducing a more Three phase

efficient filtration material into the tube head assembly re-
moves photons from the beam. All other factors remaining
constant, an increase in tube filtration causes a decrease in
quantity and an increase in quality. The removal of photons Single phase
causes a decrease in quantity reflected by a decrease in ampli-
tude of both the continuous and discrete portions of the
curve. Because it removes more low-energy photons than 0 25 50 75 100
X-ray energy (keV)
high-energy photons, there is a greater decrease on the left
side of the continuous portion and there is a shift in the peak FIG 6-11  Change in Generator Type. Three emission spec-
of the curve to the right. Remember that with the low-energy tra illustrating the result of a change in generator type. Note
photons removed, the average energy is higher. Again, the that as the efficiency of the generator type increases, so
discrete line does not move because it is related specifically to does x-ray quantity given the same amount of electricity
the target material (Figure 6-10). used. keV, kiloelectron volt.
70 SECTION I  Principles of Radiation Physics

TABLE 6-4  Factors Affecting Emission

Gold Z = 79 Spectrum
Tungsten Z = 74 Increase Effect on Effect on
Rhodium (Improvement) in Quantity Quality
Number of x-rays

Molybdenum mA Increases No effect

Z = 42 kVp Increases Increases
Tube filtration Decreases Increases
Generator type Increases Increases
Target material Increase Increases

kVp, kilovoltage peak; mA, milliampere

0 25 50 75 100 representing a bigger “target” for filament electrons to inter-

X-ray energy (keV) act with. This increases the likelihood of interaction and the
FIG 6-12  Change in Target Material. Four emission spectra
number of photons produced. As quantity increases, the
illustrating the effect of changes in target material. Note that number of higher-energy photons increases, as well as the
as the atomic number of the material increases, so does the average energy. In Figure 6-12, the discrete lines represent
average energy and quantity of the x-rays and the position of K-characteristic photons. The energy of these photons de-
the discrete line changes. keV, kiloelectron volt. pends on the K-shell binding energy and which outer shell
fills the vacancy. As the binding energy of the target material
increases, the discrete line shifts to the right. Note that low
CRITICAL CONCEPT 6-9 atomic number targets such as molybdenum and rhodium
are currently used in mammography because their lower K-
Generator Efficiency and Emission Spectrum
characteristic x-rays are better suited to the lower energies
Improving the efficiency of the generator increases x-ray used in that modality. On the other hand, gold is never suit-
beam quantity and quality, but the discrete line is unaffected. able as a target material because of its low melting point and
high cost. Table 6-4 provides a summary of the factors affect-
The general radiographer does not have the ability to ing the emission spectrum.
select the target material used, except in mammography.
Although virtually all radiographic x-ray tubes employ tung-
sten targets, it is instructive to consider how altering the tar- CRITICAL CONCEPT 6-10
get material might affect the emission spectrum. As the Target Material and Emission Spectrum
atomic number (Z number) of the target material goes up, so
Improvement (increasing atomic number) of the target mate-
does the average energy, quantity of photons, and the posi-
rial increases x-ray beam quality and quantity, and shifts the
tion of the discrete line of the spectrum (Figure 6-12). With discrete line to the right.
increases in atomic number, each atom is more complex,

SUMMARY
• When filament electrons interact with atoms of the target, • Brems interactions are the result of filament electrons in-
one of three things happen: characteristic interactions, teracting with the nucleus of a target atom. The filament
brems interactions, and heat production. electron is attracted to the nucleus, which causes it to slow
• Most of the filament electrons entering the target interact down and change direction, resulting in a loss of energy.
with outer-shell electrons of the tungsten atoms but do This loss of energy is given off as a brems photon.
not ionize them; rather, they cause excitation and release • The energy of a brems photon can be found by subtract-
of infrared radiation (heat). ing the energy the electron leaves the atom with from the
• Characteristic interactions involve the removal of orbital energy it had upon entering the atom. The average energy
electrons of target atoms by filament electrons. This va- of brems is equal to one third of the kVp selected on the
cancy makes the atom unstable and outer-shell electrons control panel.
fill inner-shell vacancies, giving up some of their potential • Filtration is used in two forms in radiography. Total filtra-
energy in the process as characteristic photons. tion (inherent plus added) filters are designed into the
• The energy of characteristic photons depends on the shells x-ray tube head assembly to filter low energy photons
involved and is named for the shell being filled. In a tung- from the beam. Compensating filters are used to balance
sten target, the filament electron must have 69.5 keV of exposure to the IR by filtering x-rays from the thinner or
energy or more to remove a K-shell electron. less dense areas of the anatomic area of interest.
 CHAPTER 6  X-Ray Production 71

S U M M A R Y — cont’d
• Beam quantity refers to the total number of x-ray photons equivalent filtration) necessary to reduce the energy of the
in the beam and is affected by mAs, kVp, distance, and beam to one-half its original intensity.”
filtration. • Characteristic photons are graphically represented by a
• Beam quantity is directly proportional to mAs. Doubling discrete emission spectrum and brems by a continuous
the mAs doubles the output. emission spectrum. The two are combined to create
• Beam quantity varies as the square of the change in kVp. the x-ray emission spectrum, which incorporates the
Doubling the kVp increases quantity by a factor of four. K-characteristic line and the continuous curve of
• Beam quantity varies inversely as the square of the dis- brems.
tance (inverse square law). • Five factors will change the appearance of the x-ray emis-
• Beam quality refers to the penetrating power of the beam sion spectrum: mA (changes beam quantity), kVp
and is affected by kVp and filtration. (changes beam quantity and quality), filtration (changes
• Beam quality varies directly with changes in kVp. beam quantity and quality), generator type (changes
• Beam quality is measured by its HVL and is defined as “the quantity and quality), and target material (changes beam
thickness of absorbing material (aluminum or aluminum quantity, quality, and position of discrete line).

CRITICAL THINKING QUESTIONS

1. Describe the x-ray beams produced with 80kVp and 2. How would a radiographer use his/her knowledge of the
40 mAs versus 60 kVp and 160 mAs in terms of factors affecting beam quality and quantity to optimize
bremsstrahlung photon presence, characteristic photon exposure factors to minimize radiation dose and maxi-
presence, beam quantity, and quality. mize image quality?

REVIEW QUESTIONS
1. What is the most likely cause of the change in the emission 2. Which of the following is the most likely cause of the change
spectrum represented by the green line? in the emission spectrum represented by the purple line?

0 25 50 75 100 0 25 50 75 100

a. added filtration a. increase in kVp

b. increase in kVp b. increase in mA
c. increase in mA c. added filtration
d. single phase to three phase d. single phase to three phase
Continued
72 SECTION I  Principles of Radiation Physics

R E V I E W Q U E S T I O N S — cont’d
3. Which of the following is the most likely cause of the 6. A filament electron enters a tungsten target atom with an
change in the emission spectrum represented by the energy of 70 kVp. It interacts first with an L-shell elec-
purple line? tron, then with a K-shell electron. Which of the following
are produced?
1. K-characteristic x-ray photon
2. L-characteristic x-ray photon
3. Heat
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 3 only
d. 1, 2, and 3
7. What is the energy of an x-ray photon produced when an
O-shell electron fills a K-shell vacancy?
0 25 50 75 100 a. 69.42 KeV
b. 69.58 KeV
c. 67.42 KeV
a. added filtration d. 68.58 KeV
b. increase in kVp 8. What is the energy of an x-ray photon produce when an
c. increase in mA L-shell electron fills a K-shell vacancy?
d. single phase to three phase a. 81.9 KeV
4. A filament electron interacts with an outer shell electron b. 65 KeV
of a tungsten but does not remove it. Which of the follow- c. 66.68 KeV
ing is produced? d. 57.4 KeV
a. 50 keV photon 9. What is the energy of an x-ray photon produced when a
b. 70 keV photon M-shell electron fills an L-shell vacancy?
c. heat a. 14.92 KeV
d. brems photon b. 9.28 KeV
5. At what point in the interaction chain of events is a c. 11.5 KeV
characteristic photon produced? d. 57.4 KeV
a. filament electron enters a target atom 10. What is the energy of an x-ray photon produced when an
b. collision of two electrons O-shell electron fills an L-shell vacancy?
c. removal of an orbital electron a. 12.02 KeV
d. outer shell electron filling inner shell vacancy b. 12.18 KeV
c. 11.5 KeV
d. 10.2 KeV
 7
X-Ray Interactions with Matter

OUTLINE
Introduction Pair Production
Classical Interactions Photodisintegration
Compton Interactions Differential Absorption
Photoelectric Interactions Summary

OBJECTIVES
• Explain classical interactions, including production, • Explain photoelectric interactions, including production,
energy, effects on patient dose, and effects on image energy, effects on patient dose, and effects on image quality.
quality. • Explain pair production.
• Explain Compton interactions, including production, • Explain photodisintegration.
energy, effects on patient dose, and effects on image • Relate differential absorption to x-ray beam interactions
quality. with the human body and image formation.

KEY TERMS
absorption main-chain scission photoelectron
classical interaction occupational exposure radiolucent
Compton electron pair production radiopaque
Compton scattering photodisintegration secondary photons
differential absorption photoelectric interaction transmission

INTRODUCTION CRITICAL CONCEPT 7-1

It is helpful for the radiographer to understand the way Understanding X-ray Interactions
x-ray photons interact with matter for two important Interactions between x-ray photons and human tissues deter-
reasons (Figure 7-1). First, it allows the radiographer to mine how anatomic structures are imaged and the patient’s
minimize the physical effects of x-ray photons on the pa- radiation dose.
tient that result in radiation dose and biologic harm.
Second, an understanding of x-ray photon–body tissue
interaction allows the radiographer to better manipulate
how the particular anatomic area of interest appears ra-
CLASSICAL INTERACTIONS
diographically. Minimizing harm to the patient and pro- Classical interactions are also commonly known as coherent
ducing a quality radiographic image are both integral to scattering or Thomson scattering. In this scattering event the
the role and responsibility of the radiographer. X-rays may incident x-ray photon interacts with an orbital electron of a
interact with matter in five different ways, depending on tissue atom and changes direction. In this particular interac-
their energy. This chapter discusses all five, but keep in tion the incident x-ray photon is of a rather low energy (gener-
mind that only the first three occur within the range of ally less than 10 keV). When such low-energy incident photons
energy used in diagnostic radiography. The chapter con- interact with tissue atoms, they are not likely to ionize (remove
cludes with a discussion of differential absorption and orbital electrons from their shell). Instead, the atom absorbs
other terms related to how the x-ray beam interacts in the energy of this x-ray photon, causing excitation of the atom,
general with body tissues. and then immediately releases the energy in a new direction

73
74 SECTION I  Principles of Radiation Physics

COMPTON INTERACTIONS
Compton scattering occurs throughout the diagnostic
range, but generally involves moderate-energy x-ray pho-
tons (e.g., 20-40 keV). In this interaction, an incident x-ray
photon enters a tissue atom, interacts with an orbital elec-
tron (generally a middle- or outer-shell electron), and re-
moves it from its shell. In doing so, the incident photon
loses up to one third of its energy and is usually deflected
in a new direction (Figure 7-3). This interaction does three
things: First, it ionizes the atom, making it unstable. Ion-
ization in the body is significant because the atom is
changed and may bond differently to other atoms, poten-
tially causing biologic damage. If one of the “middle” or-
bital shells is involved, a characteristic cascade (outer-shell
electrons filling inner-shell vacancies and emitting x-ray
photons) also results, creating characteristic photons just
as in the tube target. But here they are called secondary
photons. These secondary photons are x-ray photons, but
of a rather low-energy variety. Such photons generally con-
tribute only to patient dose. Second, the ejected electron,
called a Compton electron, or secondary electron, leaves the
atom with enough energy to go through interactions of its
FIG 7-1  X-ray Interactions. When x-rays interact with the own in adjacent atoms. The type of interaction the Comp-
body, some are absorbed, some are scattered, and some ton electron undergoes depends on the energy it has and
penetrate to expose the image receptor. the type of atom it interacts with. Third, the incident pho-
ton is deflected in a new direction and is now a Compton
(Figure 7-2). Because the energy is reemitted in a new direc- scatter photon. It too, has enough energy to go through
tion, it is now a scatter photon. It is of equal energy to the in- other interactions in the tissues or exit the patient and in-
cident photon but travels in a new direction. Because of its low teract with the image receptor. The problem with Compton
energy, most classical scatter photons are absorbed in the body scatter interacting with the image receptor is that it is not
through other interactions and do not contribute significantly following its original path through the body and strikes the
to the image, but do add slightly to patient dose. image receptor in the wrong area. In so doing, it contrib-
utes no useful information to the image and only results in
CRITICAL CONCEPT 7-2 image fog. Because most scattered photons are still directed
Classical Interactions toward the image receptor and result in image fog, it
is desirable to minimize Compton scattering as much as
Classical interactions do not involve ionization of the atom. possible.
They are scattering events that do not contribute significantly
Compton scattering is one of the most prevalent inter-
to the image but contribute slightly to patient dose.
actions between x-ray photons and the human body in

Scattered
x-ray

Incident x-ray

Classical scattering
FIG 7-2  Classical Interaction. A classical scattering event. Note that no electron is removed; the
atom absorbs the energy and then releases it in a new direction.
 CHAPTER 7  X-Ray Interactions with Matter 75

Ejected electron

Scattered photon
with still less energy

Low-energy
High-energy scattered photon
incident photon

Second Compton
interaction

Ejected electron

First Compton
interaction
FIG 7-3  Compton Interaction. A Compton scattering event. Note that two events are illustrated
stemming from the initial high-energy incident photon.

general diagnostic imaging and is responsible for most of CRITICAL CONCEPT 7-3
the scatter that fogs the image. The probability of Compton
scattering does not depend on the atomic number of atoms Compton Interactions
involved. Compton scattering may occur in both soft tissue Compton interactions are scattering events that ionize the
and bone. The probability of Compton scattering is related atom. They may contribute negatively to the radiographic image
to the energy of the photon. As x-ray photon energy as fog and add to patient and occupational radiation dose.
increases, the probability of that photon penetrating
a given tissue without interaction increases. However,
with this increase in photon energy, the likelihood of
PHOTOELECTRIC INTERACTIONS
Compton interactions relative to photoelectric interactions Photoelectric interactions occur throughout the diagnostic
also increases. range (e.g., 20-120 kVp) and involve inner-shell orbital elec-
Compton scatter photons may travel in any direction trons of tissue atoms. For photoelectric events to occur, the
from their point of scattering. A deflection of zero degrees incident x-ray photon energy must be equal to or greater
means no energy is transferred. Those photons scattered at than the orbital shell binding energy. In these events the inci-
180 degrees represent maximum deflection and energy dent x-ray photon interacts with the inner-shell electron of a
transfer. But keep in mind that the scattered photon still tissue atom and removes it from orbit. In the process, the
retains about two thirds of its energy. This is one reason the incident x-ray photon expends all of its energy and is totally
radiographer should never stand near the patient during absorbed (Figure 7-4). The resulting ejected electron is called
exposure. Some Compton scatter photons exit the patient a photoelectron. The energy transfer between the incident
and would expose the radiographer. This is why shielding photon and inner-shell electron is equal to the incident pho-
(lead aprons, lead gloves, etc.) is necessary during fluoros- ton energy minus the binding energy of the orbital electron.
copy or any procedure in which the radiographer or other This energy transfer constitutes the energy of the photoelec-
health care worker may be near the patient and x-ray tube tron. In soft-tissue atoms, the energy of the photoelectron is
during exposure. It is important for the radiographer to nearly equal to that of the incident x-ray photon because the
remember that Compton scattering is the major source of binding energy of the soft tissue atom is very low and more is
occupational exposure. left over as kinetic energy for the photoelectron. In bone, the
76 SECTION I  Principles of Radiation Physics

Secondary
x-rays

Incident photon

Ejected
photoelectron

FIG 7-4  Photoelectric Interaction. A photoelectric event. Note the total absorption of the inci-
dent photon and the characteristic cascade creating secondary x-rays.

energy of the photoelectron is less because the orbital electron The probability of photoelectric interaction depends on
binding energy of bone atoms is greater and the incident x-ray the energy of the incident photons and the atomic number of
photon has to expend more energy to remove it, leaving less as the tissue atoms with which they interact. For photoelectric
kinetic energy for the photoelectron. In either case, the photo- interactions to occur, the incident x-ray photon energy must
electron has enough kinetic energy to undergo interactions of be greater than or equal to the inner-shell binding energy of
its own before filling a vacancy in another atom elsewhere. the tissue atoms involved. The greatest number of photoelec-
Note that this absorption that constitutes photoelectric tric interactions occurs when the incident x-ray photon en-
interactions contributes significantly to patient dose accrued ergy is equal to or slightly greater than the inner-shell binding
with each diagnostic image. Although some absorption is energy of the tissue atom. As the incident photon energy be-
necessary to create an x-ray image, it is the radiographer’s gins to exceed the inner-shell binding energy of the tissue
responsibility to select technical factors that strike a balance atom, the chances of photoelectric interaction begin to de-
between image quality (absorption and transmission of x-ray cline and the chances increase that it will penetrate the tissue
photons needed to produce a good image) and patient dose. being examined. This function is a cubic relationship. That is,
In photoelectric interactions, as with Compton interac- the probability of a photoelectric event is inversely propor-
tions, the tissue atom is ionized. In the case of photoelectric tional to the third power of the x-ray energy. What this means
interactions, the inner-shell vacancy makes the atom unsta- to the radiographer is that if a kVp range is too high for the
ble; to regain stability a characteristic cascade occurs, produc- anatomic part of interest, less absorption takes place, and
ing secondary x-ray photons. This cascade is the same phe- some absorption is necessary for image formation.
nomenon that occurs with Compton interactions that The probability of photoelectric events is directly propor-
produce secondary photons. Again, these secondary photons tional to the third power of the atomic number of the ab-
are of low energy and are absorbed by the body in other pho- sorber. What this cubic relationship means to the radiogra-
toelectric events. Note that the absorption of these secondary pher is that when he or she makes small changes in the kVp
photons also contributes to patient dose. setting or there are small changes in the atomic number of
the tissue (due to anatomic variations or a pathologic condi-
CRITICAL CONCEPT 7-4 tion), large changes in the probability of photoelectric events
will result. With tissues, the higher the atomic number of the
Photoelectric Interactions tissue atom, the greater the number of photoelectric events.
Photoelectric events result in the total absorption of the inci- Such atoms are more complex; that is, they have more elec-
dent photon. For this to occur, the incident photon energy trons and stronger binding energies and are more likely to
must be equal to or greater than the orbital shell binding en- absorb the incident x-ray photon. This is why bone shows up
ergy. In this process the atom is ionized, a characteristic as lighter shades on the radiographic image. In bone, more
cascade producing secondary photons results, and an ejected photons are absorbed, which means fewer photons are expos-
photoelectron exits the atom with enough energy to undergo
ing the image receptor, resulting in the lighter shades of the
many more interactions.
image.
 CHAPTER 7  X-Ray Interactions with Matter 77

THEORY TO PRACTICE 7-1 electron). If the photon has energy greater than 1.02 MeV, it
is shared between the two as kinetic energy.
If more photoelectric events are needed to make a particular
Both particles travel out of the atom. The electron under-
structure visible on a radiographic image (when, for example,
goes many interactions before coming to rest in another
the tissues to be examined do not have high–atomic number
atoms), contrast agents such as barium or iodine are added.
atom. The positron is an “unnatural particle” and, as such,
These agents have high atomic numbers and thereby in- travels until it strikes an electron, causing an annihilation
crease the number of photoelectric events in these tissues. event. In this annihilation event, the positron and the elec-
Protective shielding is another way of using photoelectric tron it interacts with are destroyed and their energy is con-
interactions. Lead has a very high atomic number and is used verted into two x-ray photons that radiate out of the atom.
as a shielding material because the odds are great that Pair production does not occur in radiography because the
photons will be absorbed by it. energy levels required exceed the range used in diagnostic
x-ray production.

CRITICAL CONCEPT 7-5 PHOTODISINTEGRATION

Photoelectric Probability
The last type of interaction between x-rays and matter is
Photoelectric probability depends on the energy of the inci- called photodisintegration. Photons with extremely high
dent photon and the atomic number of the tissue being irradi- energies of more than 10 MeV may strike the nucleus of
ated. The energy must be equal to or greater than the orbital the atom and make it unstable. In photodisintegration the
shell binding energy, and the greater the atomic number of nucleus of the atom involved regains stability by ejecting a
the tissue atom, the greater the probability of photoelectric
nuclear particle such as a proton, neutron, or alpha particle
interactions.
(Figure 7-6). Like pair production, photodisintegration does
not occur in radiography because the energy levels required
far exceed the kVp range used in diagnostic x-ray production.
PAIR PRODUCTION
Pair production occurs only with very high–energy photons
of 1.02 MeV or greater. The interaction occurs when the in-
DIFFERENTIAL ABSORPTION
cident x-ray photon has enough energy to escape interaction Differential absorption is the difference between the x-ray pho-
with the orbital electrons and interact with the nucleus of tons that are absorbed photoelectrically and those that penetrate
the tissue atom. In this interaction, two particles are pro- the body (Figure 7-7). It is called differential because different
duced: a positron (positively charged electron) and an elec- body structures absorb x-ray photons to different extents. Ana-
tron (Figure 7-5). For these particles to exist, they must tomic structures such as bone are denser and absorb more x-ray
each have energy of 0.51 MeV (the energy equivalent of an photons than structures filled with air such as the lungs.

Electron
Very-high-energy
incident photon

Photon
Positron

Electron Photon
Annihilation
event
Pair production
FIG 7-5  Pair Production. A pair production event. The very high–energy photon interacts with
the nucleus, causing the release of a positron and an electron.
78 SECTION I  Principles of Radiation Physics

Incident x-ray

Nuclear particle

Photodisintegration
FIG 7-6  Photodisintegration. A photodisintegration event. The very high–energy photon inter-
acts with the nucleus, causing the release of a nuclear particle to regain stability.

Primary x-ray photon

X-ray photons that are

absorbed by the part

X-ray photons that

become scatter radiation

Image receptor

X-ray photons that penetrate

the part to help form the image
FIG 7-7  Differential Absorption. X-rays interact with the body in one of three ways: They pen-
etrate to the receptor, scatter in a new direction, or are absorbed in the body.

MAKE THE IMAGING CONNECTION 7-1 When radiographers speak broadly about differential
absorption—how the x-ray beam interacts with the tissues
Chapter 8 of the body—they may speak of transmission versus
The process of image formation is the result of differential absorption. Transmission refers to those x-ray photons that
absorption of the x-ray beam as it interacts with anatomic pass through the body and reach the image receptor. It is
tissue. Differential absorption of the primary beam creates desirable for some of the x-ray photons to pass through the
an image that structurally represents the anatomic area of body area of interest or no image would result. X-ray pho-
interest. tons reaching the image receptor create the dark (less
bright) shades of the image. Absorption refers to those pho-
tons that are attenuated by the body and do not reach
CRITICAL CONCEPT 7-6 the image receptor. Absorption has the opposite effect on
Differential Absorption the image as penetration. Recall that these photons are
absorbed photoelectrically and will not reach the image re-
Differential absorption is the difference between x-ray pho- ceptor. This “lack” of exposure to the image receptor results
tons that are absorbed photoelectrically and those that pen- in the lighter (brighter) shades of the image. It is also desir-
etrate the body. Denser tissue such as bone has greater
able to have some absorption; otherwise, the image would
absorption.
be uniformly dark.
 CHAPTER 7  X-Ray Interactions with Matter 79

Again, absorption depends on the density of body tissues X-rays

through which the x-ray photons are passing. Denser tissue,
such as bone, increases the probability of x-ray photons be-
ing absorbed in photoelectric interactions. The result is that
fewer x-ray photons pass through these areas of the body to Macro-
molecules
reach the image receptor, and those structures appear A
lighter. Body structures that readily absorb x-rays are called
radiopaque. Less dense structures have a much lower prob-
ability of absorption and are said to be radiolucent.
Throughout this chapter x-ray interactions with matter
have been discussed at the atomic level where they occur. It is
important for the radiographer to understand these atomic- B
level interactions, but it is also important to relate these
transfers of energy to a macrolevel where radiation dose and
damage is more apparent. Although this subject will be cov-
ered thoroughly in the radiography student’s radiobiology
course, a brief discussion is offered here to complete the con-
cepts and subject of this chapter.
C
Macromolecules are large molecules made up of thou-
FIG 7-8  Damage to Macromolecules. The three most com-
sands of atoms. When an x-ray photon interacts with one
mon effects of x-ray photon damage to macromolecules are
of these atoms as previously described, the energy transfer A, main-chain scission, B, cross-linking, and C, point lesions.
may manifest as a change to the structure of the macromol-
ecule. The three most common effects are main-chain scis-
sion, cross-linking, and point lesions (Figure 7-8). Main- THEORY TO PRACTICE 7-2
chain scission refers to a breakage of the major structure, It is important to remember that absorption equates to patient
the framework if you will, of the macromolecule itself. dose. Because of the strong inverse dependence of photoelec-
Cross-linking is the result of the formation of “limbs” as a tric absorption on x-ray energy, patient dose increases as kVp
result of irradiation (although these exist naturally in some decreases. When there is too much absorption resulting from
macromolecules) that “stick” to adjacent parts of the mac- a kVp setting that is too low, the patient experiences an in-
romolecule or neighboring molecules, creating unnatural creased radiation dose. Patient dose is a result of the radiation
absorbed by the body, not the radiation that passes through it.
framework. Point lesions are the result of damage to a sin-
gle chemical bond. Think of these as a “wound” to the
macromolecule that may cause a malfunction of the mac- CRITICAL CONCEPT 7-7
romolecule and damage to the cell overall. The most sensi-
Differential Absorption and Clinical Practice
tive of molecules is DNA. Damage similar to that previ-
ously described may occur in DNA as a result of radiation In the clinical setting, some absorption and some penetration
exposure and manifest as a range of responses from minor of x-ray photons through the anatomic area of interest are nec-
damage that is reversible to malignant response and per- essary for image production. But keep in mind that absorption
equates to patient dose and it is the radiographer’s responsibil-
manent damage. Finally, because the human body is about
ity to maintain a balance of absorption and penetration so that
80% water, irradiation of water (interactions between x-ray
the risk of exposure outweighs the biologic harm to the tissues
photons and water molecules) can create harmful free and so that the resulting image benefits the patient.
radicals that then indirectly damage molecules and cells.

SUMMARY
• Classical interactions are scattering events in which the image as fog and add to patient and occupational radia-
atom involved is not ionized. They do not significantly tion dose.
affect the radiographic image but contribute slightly to • Photoelectric events result in the total absorption of the
patient dose. incident photon. For this to occur, the incident photon
• Compton interactions are scattering events in which the energy must be equal to or greater than the orbital shell
atom is ionized and a characteristic cascade may result. binding energy.
The incident photon is deflected in a new direction, be- • Photoelectric events result in ionization of the atom, a char-
coming a scatter photon, and this photon and the ejected acteristic cascade producing secondary photons, and an
Compton electron both have sufficient energy to undergo ejected photoelectron capable of many more interactions.
many other interactions. • Photoelectric probability depends on the energy of the
• Compton interactions are one of the most prevalent inter- incident photon and the atomic number of the tissue
actions and may contribute negatively to the radiographic being irradiated.
Continued
80 SECTION I  Principles of Radiation Physics

S U M M A R Y — cont’d
• Pair production involves very high–energy photon inter- image production. But keep in mind that absorption
actions with the nucleus of the tissue atom producing a equates to patient dose and a balance of absorption and
positron and an electron. This event occurs outside of the penetration must be kept so that the benefit of exposure
energy range of diagnostic radiography. outweighs the biologic harm to the tissues.
• Photodisintegration is a very high–energy photon interac- • X-ray photons interact at an atomic level (classical, Comp-
tion with the nucleus of a tissue atom, resulting in the ton, photoelectric, pair production, and photodisintegra-
nucleus emitting a nuclear particle to regain stability. tion), but the damage they may cause is manifest at the
• Differential absorption is the difference between x-ray macro level through changes or damage sustained by the
photons that are absorbed photoelectrically and those that macromolecules. This may occur directly when x-ray pho-
penetrate the body. tons interact with atoms composing the macromolecule or
• Some absorption and some transmission of x-ray photons indirectly through irradiation of water that creates harmful
through the anatomic area of interest are necessary for free radicals that then damage macromolecular structures.

CRITICAL THINKING QUESTIONS

1. How would a radiographer use his/her knowledge of x-ray radiation for medical imaging and a committee member
interactions with human tissue to describe how an image wants to know what happens inside the body when it
is formed to a patient? is exposed to x-rays. Use material from this chapter
2. Imagine you are testifying before Congress on the need to formulate a response that a layperson would under-
for regulation of professionals who dispense ionizing stand.

REVIEW QUESTIONS
1. Which of the following is a major source of occupational 6. Which of the following events will not occur in the diag-
exposure? nostic range of x-ray energies?
a. photodisintegration a. classical
b. pair production b. Compton
c. photoelectric interactions c. photoelectric
d. Compton interactions d. photodisintegration
2. Which interaction, within the diagnostic range, does not 7. Positive contrast media is administered to increase what
involve the removal of an orbital electron? type of interactions?
a. pair production a. photoelectric
b. photoelectric effect b. pair production
c. Compton effect c. classical
d. classical scattering d. Compton
3. Which interaction requires 1.02 MeV of energy? 8. Which of the following contributes most to image fog?
a. pair production a. classical
b. photodisintegration b. photoelectric
c. Compton effect c. pair production
d. photoelectric effect d. Compton
4. A photon of 10 MeV colliding with a nucleus will likely 9. Which interaction in the diagnostic range involves the
result in what type of total absorption of the incident photon?
interaction? a. pair production
a. photoelectric b. photodisintegration
b. photodisintegration c. Compton effect
c. Thompson d. photoelectric effect
d. Compton 10. When the kV selected is equal to or slightly greater than
5. Which technique will produce the greatest number of the inner-shell binding energy of a target tissue atom,
photodisintegration events which interaction predominates?
in an average abdomen? a. photoelectric
a. 120 kV and 5 mAs b. Thompson
b. 108 kV and 10 mAs c. pair production
c. 98 kV and 20 mAs d. photodisintegration
d. none of the above
 SECTION II
Image Production
and Evaluation

81
 8
Image Production

OUTLINE
Introduction Image Receptors
Differential Absorption Digital Image Receptors
Beam Attenuation Film-Screen Image Receptors
Absorption Dynamic Imaging: Fluoroscopy
Scattering Summary
Transmission
Factors Affecting Beam Attenuation

OBJECTIVES
• Describe the process of radiographic image formation. • State the effect of scatter radiation on the radiographic
• Explain the process of beam attenuation. image.
• Identify the factors that affect beam attenuation. • Explain the process of creating the various shades of gray
• Describe the x-ray interactions termed photoelectric effect in the image.
and Compton effect. • Differentiate among digital and film-screen imaging.
• Define the term ionization. • Define fluoroscopy and describe the process of image
• State the composition of exit radiation. intensification.

KEY TERMS
absorption fluoroscopy output phosphor
attenuation flux gain photocathode
brightness gain fog photoelectric effect
coherent scattering image intensification photoelectron
Compton effect image receptor remnant radiation
Compton electron input phosphor scattering
conversion factor ionization secondary electron
differential absorption latent image tissue density
electrostatic focusing lenses manifest image transmission
exit radiation minification gain

INTRODUCTION DIFFERENTIAL ABSORPTION

To produce a radiographic image, x-ray photons must pass The process of image formation is a result of differential
through tissue and interact with an image receptor (a device absorption of the x-ray beam as it interacts with the ana-
that receives the radiation leaving the patient) such as a digi- tomic tissue.
tal imaging system. Both the quantity and quality of the pri-
mary x-ray beam affect its interaction within the various tis- MAKE THE PHYSICS CONNECTION
sues that make up the anatomic part. In addition, the Chapter 7
composition of the anatomic tissues affects the x-ray beam
interaction. The absorption characteristics of the anatomic Differential absorption is the difference between the x-ray
part are determined by its composition, such as thickness, photons that are absorbed photoelectrically and those that
penetrate the body.
atomic number, and tissue density (compactness of the cel-
lular structures). Finally, the radiation that exits the patient is
composed of varying energies and interacts with the image The term differential is used because varying anatomic
receptor to form the latent or invisible image. parts do not absorb the primary beam to the same degree.
82
 CHAPTER 8  Image Production 83

Primary x-ray photon (eject) an inner-shell electron. The ejected electron, called a
photoelectron, quickly loses energy by interacting with
nearby tissues.
The ability to remove (eject) electrons, known as ioniza-
tion, is one of the characteristics of x-rays. In the diagnostic
X-ray photons that range, this x-ray interaction with matter is known as the
are absorbed by
the part
photoelectric effect.

X-ray photons that MAKE THE PHYSICS CONNECTION

become scatter
radiation Chapter 7
Photoelectric interactions occur throughout the diagnostic
range (i.e., 20 kVp to 120 kVp) and involve inner-shell orbital
electrons of tissue atoms. For photoelectric events to occur,
the incident x-ray photon energy must be equal to or greater
Image receptor than the orbital shell binding energy. In these events the inci-
dent x-ray photon interacts with the inner-shell electron of a
X-ray photons that penetrate tissue atom and removes it from orbit. In the process the
the part to help form the image incident x-ray photon expends all of its energy and is totally
FIG 8-1  Differential Absorption. As the primary beam inter- absorbed.
acts with the anatomic part, x-ray photons are transmitted, ab-
sorbed, and scattered based on the tissue’s composition. Dif-
ferential absorption of the primary x-ray beam creates an image With the photoelectric effect, the ionized atom has a va-
that structurally represents the anatomic area of interest. cancy, or electron hole, in its inner shell. An electron from an
outer-shell drops down to fill the vacancy. Because of the dif-
ference in binding energies between the two electron shells, a
Anatomic parts composed of bone absorb more x-ray secondary x-ray photon is emitted (Figure 8-2). This second-
photons than parts filled with air. Differential absorption of ary x-ray photon typically has very low energy and is there-
the primary x-ray beam creates an image that structurally fore unlikely to exit the patient.
represents the anatomic area of interest (Figure 8-1).

CRITICAL CONCEPT
CRITICAL CONCEPT X-ray Photon Absorption
Differential Absorption and Image Formation During attenuation of the x-ray beam, the photoelectric effect
A radiographic image is created by passing an x-ray beam is responsible for total absorption of the incoming x-ray
through the patient and interacting with an image receptor, photon.
such as a digital imaging system. The variations in absorption
and transmission of the exiting x-ray beam structurally repre-
sent the anatomic area of interest. The probability of total photon absorption during the
photoelectric effect depends on the energy of the incoming
x-ray photon and the atomic number of the anatomic tissue.
The energy of the incoming x-ray photon must be at least
BEAM ATTENUATION equal to the binding energy of the inner-shell electron. After
As the primary x-ray beam passes through anatomic tissue, it absorption of some of the x-ray photons, the overall energy
loses some of its energy. Fewer x-ray photons remain in the or quantity of the primary beam decreases as it passes
beam after it interacts with anatomic tissue. This reduction in through the anatomic part.
the energy or number of photons in the primary x-ray beam
is known as attenuation. Beam attenuation occurs as a result Scattering
of the photon interactions with the atomic structures that Some incoming photons are not absorbed but instead lose
compose the tissues. Two distinct processes occur during energy during interactions with the atoms composing the
beam attenuation in the diagnostic range: absorption and tissue. This process is called scattering. It results from the
scattering. diagnostic x-ray interaction with matter known as the Comp-
ton effect. The loss of some energy of the incoming photon
Absorption occurs when it ejects an outer-shell electron from a tissue
As the energy of the primary x-ray beam is deposited within atom. The ejected electron is called a Compton electron
the atoms composing the tissue, some x-ray photons are or secondary electron. The remaining lower-energy x-ray
completely absorbed. Complete absorption of the incoming photon changes direction and may leave the anatomic part to
x-ray photon occurs when it has enough energy to remove interact with the image receptor (Figure 8-3).
84 SECTION II  Image Production and Evaluation

Photoelectric effect
1
Incident photon interacts
with an inner orbital, K or
L, electron, giving all of
its energy to the electron,
ejecting it from orbit. The 1
photon is “absorbed.”

2
The ejected electron (photo-
electron) imparts the atom with
energy equal to the excess of
the electron's binding energy.

2
3
There is a vacancy in the
inner orbital shell, K or L,
which must be filled. One of
the electrons from the outer
orbital shell, usually the next
orbit out, drops to the void. 3

4
As the electron drops to the
void, it may shed its excess
energy as a secondary
photon.
4

FIG 8-2  Photoelectric Effect. The photoelectric effect is responsible for total absorption of the
incoming x-ray photon.

while the percentage of Compton interactions is likely to in-

CRITICAL CONCEPT
crease. Box 8-1 compares photoelectric and Compton inter-
X-ray Beam Scattering actions. Scattered and secondary radiations provide no useful
During attenuation of the x-ray beam, the incoming x-ray pho- information and must be controlled during radiographic
ton may lose energy and change direction as a result of the imaging.
Compton effect.
MAKE THE PHYSICS CONNECTION
Compton interactions can occur within all diagnostic x-ray Chapter 7
energies and are, therefore, an important interaction in radiog- The problem with Compton scatter interacting with the im-
raphy. The probability of a Compton interaction occurring age receptor is that it is not following its original path through
depends on the energy of the incoming photon. It does not the body and strikes the image receptor in the wrong area. In
depend on the atomic number of the anatomic tissue. For ex- so doing, it contributes no useful information to the image
ample, a Compton interaction is just as likely to occur in soft and results only in image fog. Because most scattered pho-
tissue as in tissue composed of bone. However, if the tissue has tons are still directed toward the image receptor and result in
image fog, it is desirable to minimize Compton scattering as
more complex atoms, there are more opportunities for interac-
much as possible.
tion. With higher atomic number particles, such as bone, if the
energy of the incoming photon is appropriate (high enough),
more scatter will occur; otherwise, more absorption will take Coherent scattering is an interaction that occurs with
place. For Compton interactions to occur, the energy of the low-energy x-rays, typically below the diagnostic range.
photon is more important, whereas the atomic number of the The incoming photon interacts with the atom, causing it
tissue is just the opportunity for x-ray interactions. to become excited. The x-ray does not lose energy but
At higher kilovoltages within the diagnostic range, the changes direction. Coherent scattering could occur within
percentage of photoelectric interactions generally decreases the diagnostic range of x-rays and may interact with the
 CHAPTER 8  Image Production 85

Compton effect
1
Photon interacts with an outer
orbital electron, imparting 2
some of its energy to the
electron, ejecting it from orbit.

The ejected electron (Compton 1

electron) leaves the atom with
an energy equal to the excess
imparted by the photon.

The photon continues on an

altered path, scattered, with
less energy (longer wavelength) 3
than before the collision.

FIG 8-3  Compton Effect. During the Compton effect, the incoming x-ray photon loses energy
and changes its direction.

BOX 8-1  Comparing Photoelectric image receptor, but it is not considered an important inter-
and Compton Effects action in radiography.
If a scattered photon strikes the image receptor, it does not
Photoelectric Effect Compton Effect contribute any useful information about the anatomic area
Incoming photon has suffi- Incoming photon loses en- of interest. If scattered photons are absorbed within the ana-
cient energy to eject an ergy when it ejects an tomic tissue, they contribute to the radiation exposure to the
inner-shell electron and be outer-shell electron and patient. In addition, if the scattered photon leaves the patient
completely absorbed. changes direction.
and does not strike the image receptor, it could contribute to
An electron from an outer- The scattered photon may
the radiation exposure of anyone near the patient.
shell fills the electron hole be absorbed within the
or vacancy. patient tissues, leave the
A secondary photon is cre- anatomic part, interact
Transmission
ated because of the differ- with the image receptor, If the incoming x-ray photon passes through the anatomic
ence in the electrons’ or expose anyone near the part without any interaction with the atomic structures, it
binding energies. patient. is called transmission (Figure 8-4). The combination of
The probability of this effect Scattered photons that strike
depends on the energy of the image receptor pro-
the incoming x-ray photon vide no useful information.
and the composition of The probability of this effect
the anatomic tissue. depends on the energy of
Fewer photon interactions incoming x-ray photon but
occur at higher kVp set- not the composition of the
tings, but of those interac- anatomic tissue.
tions, a smaller percent- Fewer photon interactions
age are photoelectric occur at higher kVp set-
interactions. tings, but of those interac-
tions, a greater percent-
age are Compton
interactions.
kVp, Kilovoltage peak.
Transmitted
photon

FIG 8-4  X-ray Transmission. Transmission occurs when the

incoming x-ray photon passes through the anatomic part with-
out any interaction.
86 SECTION II  Image Production and Evaluation

absorption and transmission of the x-ray beam provides an 100 x-rays incident
image that structurally represents the anatomic part. Because
scatter radiation is also a process that occurs during interac- Number of x-rays
at beginning of
tion of the x-ray beam and anatomic part, the quality of the each centimeter
image created is compromised if the scattered photon strikes of tissue interval
the image receptor.
100
The preceding discussion focused on photon interac-
tions that occur in radiography when using x-ray energies 50
within the moderate or diagnostic range. Higher-energy 5 cm of
tissue 25
x-rays, beyond the diagnostic range, result in other inter-
actions, pair production and photodisintegration. X-ray
interactions beyond the diagnostic range are important in
radiation therapy. FIG 8-6  Tissue Beam Attenuation. X-rays are attenuated
exponentially and generally reduced by approximately 50%
Factors Affecting Beam Attenuation for each 4-5 cm of tissue thickness.
The amount of x-ray beam attenuation is affected by the
thickness of the anatomic part, its tissue atomic number and
tissue density, and the energy of the x-ray beam.

Tissue Thickness.  For a given anatomic tissue, increasing

its thickness increases beam attenuation by either absorption
(see Figure 8-5, A, B) or scattering. X-rays are attenuated ex-
ponentially and generally reduced by approximately 50% for
each 4 to 5 cm of tissue thickness (Figure 8-6). The thicker
the anatomic part, the more x-rays are needed to produce a
radiographic image. The thinner the anatomic part, the fewer
x-rays are needed to produce a radiographic image.

Type of Tissue.  Tissue composed of a higher atomic num-

ber such as bone attenuates the x-ray beam more than tis-
sue composed of a lower atomic number such as fat. The BONE FAT AIR
higher atomic number indicates there are more atomic
particles for interaction with the x-ray photons. X-ray
absorption is more likely to occur in tissues composed of a FIG 8-7  Type of Tissue and X-ray Absorption. Bone
higher atomic number when compared with tissues com- absorbs more radiation than fat and air. Air transmits more
posed of a lower atomic number (Figure 8-7). Tissues that radiation than fat and bone.

X-ray photons that are

absorbed by the part

Transmitted Transmitted
photon photon

A B
FIG 8-5  Tissue Thickness and X-ray Absorption. A, thinner patient transmits more radiation
when compared to a thicker patient. B, thicker patient absorbs more radiation than a thinner patient.
 CHAPTER 8  Image Production 87

absorb more x-rays demonstrate increased brightness in a TABLE 8-1  Factors Affecting Attenuation
digital image. Tissues that transmit more x-rays (absorb
fewer x-rays) demonstrate decreased brightness in the Beam
Factor Attenuation Absorption Transmission
digital image.
Tissue Thickness
Tissue Density.  Matter per unit volume—or the compact- Increasing h h g
thickness
ness of the atomic particles composing the anatomic part—
Decreasing g g h
also affects the amount of beam attenuation. For example, thickness
muscle and fat tissue are similar in composition; however,
their atomic particles differ in compactness and therefore Tissue Atomic Number
tissue density varies. Muscle tissue has atomic particles that Increasing atomic h h g
are more dense or compact and therefore attenuate the x-ray number
beam more than fat cells. Bone is composed of tissue with Decreasing g g h
a higher atomic number, and the atomic particles are more atomic number
compacted or dense. Anatomic tissues are typically ranked
Tissue Density
based on their attenuation properties. Four substances ac- Increasing tissue h h g
count for most of the beam attenuation in the human body: density
bone, muscle, fat, and air. Bone attenuates the x-ray beam Decreasing g g h
more than muscle, muscle attenuates the x-ray beam more tissue density
than fat, and fat attenuates the x-ray beam more than the
air. The atomic number of the anatomic part and its tissue X-ray Beam Quality
density affect x-ray beam attenuation. Increasing beam g g h
quality
Decreasing beam h h g
X-ray Beam Quality.  The quality of the x-ray beam or its
quality
penetrating ability affects its interaction with anatomic tis-
sue. Higher-penetrating x-rays (shorter wavelength with
higher frequency) are more likely to be transmitted through
anatomic tissue without interacting with the tissues’ atomic
structures. Lower-penetrating x-rays (longer wavelength with CRITICAL CONCEPT
lower frequency) are more likely to interact with the atomic
Factors Affecting Beam Attenuation
structures and be absorbed. The kilovoltage selected during
x-ray production determines the energy or penetrability of Increasing tissue thickness, atomic number, and tissue den-
the x-ray photon and this affects its attenuation in anatomic sity increases x-ray beam attenuation because more x-rays
tissue (Figure 8-8). Beam attenuation is decreased with a are absorbed by the tissue. Increasing the quality of the x-ray
beam decreases beam attenuation because the higher-
higher-energy x-ray beam and increased with a lower-energy
energy x-rays penetrate the tissue.
x-ray beam (Table 8-1).

Low-energy High-energy
(kVp) beam (kVp) beam

Most x-ray photons are Photons have more energy

absorbed. Few emerge to to penetrate the part.
strike the image receptor.
FIG 8-8  X-ray Beam Quality. The energy of the x-ray beam affect its interaction within the ana-
tomic tissues. Lower kVp results in more absorption in the tissue. Higher kVp results in more
transmission through the tissue.
88 SECTION II  Image Production and Evaluation

Imaging Effect.  When the attenuated x-ray beam leaves the

patient, the remaining x-ray beam, referred to as exit radia-
tion or remnant radiation, is composed of both transmitted
and scattered radiation (Figure 8-9). The varying amounts of Increased
brightness
transmitted and absorbed radiation (differential absorption)
create an image that structurally represents the anatomic area Shades of
gray
of interest. Scatter exit radiation (Compton interactions) that
reaches the image receptor does not provide any diagnostic
information about the anatomic area. Scatter radiation cre-
ates unwanted exposure on the image called fog. Methods
used to decrease the amount of scatter radiation reaching the
image receptor are discussed in later chapters.
The areas within the anatomic tissue that absorb incom-
ing x-ray photons (photoelectric effect) create the white or
clear areas (increased brightness) on the displayed image.
The incoming x-ray photons that are transmitted create the Decreased
black areas (decreased brightness) on the displayed image. brightness
Anatomic tissues that vary in absorption and transmission FIG 8-10  Radiographic Image. Anatomic tissues vary in
create a range of dark and light areas (shades of gray) (Figure their absorption and transmission of x-ray photons to create
8-10). The various shades of gray or brightness recorded in the range of brightness or gray levels that structurally repre-
the radiographic image make anatomic tissue visible. Skeletal sents the anatomic area of interest. Increased brightness
represents absorbed radiation, whereas decreased bright-
bones are differentiated from the air-filled lungs because of
ness represents transmitted radiation. (From Fauber TL: Ra-
their differences in absorption and transmission. diographic imaging and exposure, ed 3, St Louis, 2009,
Mosby.)
CRITICAL CONCEPT
Image Brightness
The range of brightness levels visible after image processing
IMAGE RECEPTORS
is a result of the variation in x-ray absorption and transmission Less than 5% of the primary x-ray beam interacting with the
as the x-ray beam passes through anatomic tissues. In addi- anatomic part actually reaches the image receptor, and an
tion, the radiographer can manipulate the quality of the even lower percentage is used to create the radiographic
primary x-ray beam to affect its attenuation and modify the
image. The exit or remnant radiation leaving the patient in-
visibility of anatomic structures.
teracts with an image receptor to create the latent (invisible)
image. This latent image is not visible until processed to
Image characteristics and exposure techniques are dis- produce the manifest (visible) image.
cussed in more detail in later chapters. Two types of image receptors are used in radiography:
digital and film-screen. A more detailed discussion of each
type of image receptor can be found in Chapter 12.

Digital Image Receptors

Primary radiation Digital imaging can be accomplished by using a specialized
image receptor that acquires the latent image, from which the
computer processes the visible image for display on a monitor.
There are several types of digital image receptors used in diag-
nostic imaging. Unlike film-screen imaging in which the film
is the medium to acquire, process, and display the image,
digital imaging includes three separate stages. The digital im-
Scattered age receptor acquires the latent image, the computer processes
radiation Scattered the image, and the monitor displays the visible image. Regard-
radiation
less of the type of digital-imaging receptor, the radiographic
image is composed of digital data and can then be altered in a
variety of ways.
Transmitted
radiation Image receptor Film-screen Image Receptors
FIG 8-9  Exit Radiation. When the attenuated x-ray beam Although film-screen imaging is nearly obsolete, familiarity
leaves the patient, the remnant x-ray beam is composed of with film-screen imaging is still necessary. Film-screen imag-
both transmitted and scattered radiation. ing uses a cassette, or light-tight container, for the radiographic
 CHAPTER 8  Image Production 89

film, which is placed between two intensifying screens within

the cassette. The exit radiation interacts with the intensifying
screens and is converted to visible light. The intensifying
TV monitor
screens serve to intensify the action of the x-rays, thereby re-
ducing radiation exposure to the patient. Because x-rays have
more energy than visible light, fewer x-rays can be used to im-
age the area of interest when using intensifying screens. The
visible light energies emitted from the intensifying screens are
proportional in quantity or intensity to the radiation exiting
the patient. The film records the latent image based on the pat-
tern of remnant x-rays and the light produced by the intensify- TV camera
ing screens. The absorption of visible light by the film’s emul-
Spot film Cine
sion initiates a conversion process that is continued by chemical camera camera
processing to create a permanent visible image. The composi-
tion and type of film and intensifying screens, in addition to
the quality of film processing, have an important role in radio- Light photons
graphic imaging. Output phosphor
Anode

CRITICAL CONCEPT
Electrostatic
Differential Absorption and Image Receptor lenses
Image
The process of differential absorption for image formation intensifier
remains the same regardless of the type of image receptor. Electrons
The varying x-ray intensities exit the anatomic area of interest
to form the latent image. Photocathode
Input phosphor
X-rays
Both digital and film-screen radiography create a static
image of the anatomic area of interest. Dynamic imaging, or
fluoroscopy, provides imaging of the movement of internal
structures.

Dynamic Imaging: Fluoroscopy

Fluoroscopy (Figure 8-11) differs from static imaging by its X-rays
use of a continuous beam of x-rays to create images of moving
internal structures that can be viewed on a display monitor. Under table
x-ray tube
Internal structures, such as the vascular or gastrointestinal
FIG 8-11  Fluoroscopy. Fluoroscopic system used for dy-
systems, can be visualized in their normal state of motion with namic imaging of internal structures.
the aid of special liquid or gas substances (contrast media)
that are either injected or instilled. Although there are newer
digital technologies available for fluoroscopy, the basics of
image-intensified fluoroscopy are still important and need to Output phosphor
be understood. During image-intensified fluoroscopy, the Anode
internal structures can best be visualized when the images are
Focal point
brighter. Creating a brighter image is accomplished with
image intensification.

Image Intensification.  Image intensification (Figure Glass envelope

Electrostatic
lenses
8-12) is the process in which the exit radiation from the
anatomic area of interest interacts with a light-emitting
material (input phosphor) for conversion to visible light.
The light intensities (energies) are equal to the intensities
of the exit radiation and are converted to electrons by a Electrons
photocathode (photoemission). The electrons are focused Photocathode
by electrostatic focusing lenses and accelerated toward an Input phosphor
anode to strike the output phosphor and create a brighter FIG 8-12  Image Intensification. Major components of an
image. image intensifier.
90 SECTION II  Image Production and Evaluation

CRITICAL CONCEPT The image light intensities from the output phosphor are
converted to an electronic video signal and sent to a display
Fluoroscopy
monitor for viewing. Additional filming devices such as spot
Dynamic imaging of internal anatomic structures can be visu- film or cine (movie film) can be attached to the fluoroscopic
alized with the use of an image intensifier. The exit radiation system to create permanent radiographic images of specific
is absorbed by the input phosphor, converted to electrons, areas of interest. Additionally, the electronic video signal cre-
sent to the output phosphor, released as visible light, and ated from the output phosphor light intensities during
then converted to an electronic video signal for transmission
image-intensified fluoroscopy can be converted to digital
to the display monitor.
data and displayed on a high-resolution display monitor.
Once the fluoroscopic image is digitized, a computer can
manipulate the image in a variety of ways. Fluoroscopy will
Brightness Gain.  A brighter image is a result of the high- be discussed in detail in Chapter 14. Whether the radio-
energy electrons striking a small output phosphor. Accelerat- graphic image is displayed on a computer monitor or on film,
ing the electrons increases the light intensities at the output the process of differential absorption for image formation
phosphor (flux gain). The reduction in size of the output remains the same. The varying x-ray intensities exiting the
phosphor image as compared with the input phosphor image anatomic area of interest form the image.
also increases the light intensities (minification gain). Bright- Several important steps in creating a radiographic image
ness gain is the product of both flux gain and minification have been discussed in this and the previous chapters. Fur-
gain and results in a brighter image on the output phosphor. ther discussion of radiographic image characteristics, expo-
Although the term brightness gain continues to be used, it is sure technique selection, image receptors, control of scatter
now common practice to express this increase in brightness radiation, and problem solving are included in subsequent
with the term conversion factor. Conversion factor is an ex- chapters.
pression of the luminance at the output phosphor divided by
the input exposure rate. CRITICAL CONCEPT
Image Formation
CRITICAL CONCEPT The process of differential absorption for image formation
remains the same regardless of the type of imaging system.
Brightness Gain
The varying x-ray intensities exiting the anatomic area of in-
A brighter image is created on the output phosphor when the terest form the radiographic image. The radiographic image
accelerated electrons strike a smaller output phosphor. can be viewed on a computer display monitor or film.

SUMMARY
• A radiographic image is a result of the differential absorp- • A radiographic image is composed of varying brightness
tion of the primary x-rays that interact with the varying levels that structurally represent the anatomic area of
tissue composition of the anatomic area of interest. interest.
• Beam attenuation occurs when the primary x-ray beam • Digital and film-screen image receptors receive the exit
loses energy as it interacts with anatomic tissues. radiation from the area of interest to record the latent
• Beam attenuation is affected by tissue thickness, atomic image.
number, tissue density, and x-ray beam quality. • Digital imaging includes three separate stages to acquire,
• X-rays have the ability to eject electrons (ionization) from process, and display the image, whereas film is the me-
atoms within anatomic tissue. dium for all three stages. Fluoroscopy allows imaging of
• Three primary processes occur during x-ray interaction with the movement of internal structures for viewing on a dis-
anatomic tissues: absorption, transmission, and scattering. play monitor.
• Total absorption of the incoming x-ray photon is a result • Image intensification creates a brighter image for viewing
of the photoelectric effect. by the combination of flux gain and minification gain.
• Scattering of the incoming x-ray photon is a result of the • The process of differential absorption remains the same
Compton effect. for image formation regardless of the type of image recep-
• Scatter radiation reaching the image receptor provides no tor: digital, film-screen, or fluoroscopy.
useful information and creates unwanted exposure or fog
on the radiograph.
 CHAPTER 8  Image Production 91

CRITICAL THINKING QUESTIONS

1. During beam attenuation, what occurs at the molecular 3. How does the response of film-screen, digital, and fluoro-
level of anatomic tissues to affect the radiation exiting the scopic image receptors differ with respect to radiation in-
patient? tensity exiting the patient?
2. Why is scatter radiation detrimental to the radiographic
image, patient, and personnel in the vicinity?

REVIEW QUESTIONS
1. Which of the following describes the process of radio- 6. What type of imaging system uses an emulsion to absorb
graphic image formation? the radiant energy?
a. beam attenuation a. film
b. differential absorption b. image intensification
c. dynamic imaging c. digital
d. ionization d. fluoroscopy
2. X-rays have the ability to eject electrons from atoms. This 7. Which component of the image intensifier converts the
is known as: light intensities into electrons?
a. beam attenuation. a. electrostatic focusing lenses
b. differential absorption. b. output phosphor
c. dynamic imaging. c. input phosphor
d. ionization. d. photocathode
3. The x-ray interaction with anatomic tissue that is respon- 8. The purpose of image intensification during fluoroscopy
sible for scattering is: is to:
a. ionization. a. decrease motion during dynamic imaging.
b. photoelectric. b. increase the brightness of the fluoroscopic image.
c. Compton. c. increase the size of the fluoroscopic image.
d. absorption. d. decrease the size of the fluoroscopic image.
4. Which of the following will increase beam attenuation? 9. Which component of an image intensifier converts the
a. higher kilovoltage electrons to light intensities?
b. decreasing tissue density a. electrostatic focusing lenses.
c. thicker anatomic part b. output phosphor.
d. lower atomic number c. input phosphor.
5. Factors that decrease x-ray absorption include: d. photocathode.
a. increased tissue density. 10. The process of differential absorption to form a radio-
b. decreased x-ray beam quality. graphic image is the same for digital and film-screen
c. decreased tissue thickness. image receptors.
d. increased atomic number. a. True
b. False
 9
Image Quality and Characteristics

OUTLINE
Introduction Contrast
Image Quality Spatial Resolution
Brightness or Density Image Noise
Contrast Film-Screen Characteristics
Spatial Resolution or Recorded Detail Density
Distortion Radiographic Contrast
Scatter Sensitometry
Quantum Noise Recorded Detail
Image Artifacts Summary
Digital Image Characteristics
Brightness

OBJECTIVES
• Describe the necessary components of radiographic im- • Compare the dynamic range between film-screen and
age quality. digital imaging.
• Differentiate between the visibility and sharpness factors • Discuss bit depth and its effect on digital image quality.
of a radiograph. • Compare the digital image characteristics brightness,
• Explain the importance of brightness or density to image contrast, and resolution to film-screen image quality.
quality. • Explain how adjusting the window level and window
• Explain the importance of radiographic contrast to width affects digital image quality.
image quality. • Differentiate between high- and low-contrast radio-
• Differentiate between tissues that have high and low graphic images.
subject contrast. • Describe sensitometry and explain the construction of
• Explain the importance of spatial resolution or recorded sensitometric curves.
detail to image quality. • Differentiate among the film characteristics of speed,
• Differentiate between size and shape distortion. contrast, and latitude.
• Recognize the effect of quantum noise and scatter on • Compare the characteristics of different sensitometric
digital image quality. curves.
• Discuss the effects of image artifacts on radiographic • State the relationship between film-screen image receptor
quality. speed and recorded detail.
• Explain the digital image characteristics, matrix and pixels.

KEY TERMS
artifact distortion intensity of radiation exposure
average gradient dynamic range log relative exposure
base plus fog (B 1 F) elongation long-scale contrast
bit depth exposure indicator low contrast
brightness exposure intensity magnification
contrast resolution exposure latitude matrix
Dmax film contrast optical density
Dmin foreshortening penetrometer
densitometer grayscale pixel density
density high contrast pixel pitch
diagnostic densities image receptor contrast pixels

92
 CHAPTER 9  Image Quality and Characteristics 93

K E Y T E R M S — cont’d
quantum noise sensitometry speed point
radiographic contrast sharpness factors step-wedge densities
radiographic density short-scale contrast straight-line region
recorded detail shoulder region subject contrast
resolution size distortion toe region
scale of contrast slope visibility factors
sensitometer spatial resolution window level
sensitometric curve speed window width
sensitometric strip speed exposure point

overall quality of the radiographic image (Figure 9-1). Visi-

INTRODUCTION bility of the recorded detail refers to the brightness or den-
A quality radiographic image accurately represents the ana- sity and contrast of the image. The accuracy of the structural
tomic area of interest, and information is well visualized for lines (sharpness) is achieved by maximizing the amount of
diagnosis. It is important to identify the characteristics of a spatial resolution or recorded detail and minimizing the
quality radiographic image before comprehending all the fac- amount of distortion. Visibility of the anatomic tissues is
tors that affect its quality. achieved by the proper balance of image brightness or den-
As stated in Chapter 8, radiographic images can be acquired sity and contrast.
from two different types of image receptors: digital and film-
screen. The process of creating the latent image by differential Brightness or Density
absorption is the same for both digital and film image recep- How the radiograph is displayed determines whether to
tors, but the acquisition, processing, and display vary greatly. evaluate the image in terms of brightness or density. Digital
images are typically displayed on a computer monitor,
whereas film-screen images are displayed on film. Digital im-
MAKE THE PHYSICS CONNECTION
ages can also be printed on specialized film. Brightness and
Chapter 7 density refer to the same image quality attribute but are de-
Transmission refers to those x-ray photons that pass through the fined differently. Brightness is the amount of luminance
body and reach the image receptor. It is desirable for some of (light emission) of a display monitor. Density is the amount
the x-ray photons to pass through the anatomic area of interest of overall blackness on the processed image. An area of in-
or no image would result. X-ray photons reaching the image re- creased brightness viewed on a computer monitor shows
ceptor create the dark shades of the image. Absorption refers decreased density on a film image. An area of decreased
to those photons that are attenuated by the body and do not brightness visualized on a computer monitor has increased
reach the image receptor. Absorption has the opposite effect on density on a film image.
the image as transmission. Recall that these photons are ab-
A radiograph must have sufficient brightness or density to
sorbed photoelectrically and do not reach the image receptor.
make visible the anatomic structures of interest (Figure 9-2).
This lack of exposure to the image receptor results in the lighter
shades of the image. It is also desirable to have some absorp-
A radiograph that is too light has too much brightness or
tion; otherwise, the image would be uniformly dark. insufficient density to allow visualization of the structures of
the anatomic part (Figure 9-3). Conversely, a radiograph that
is too dark has insufficient brightness or excessive density,
This chapter will focus on the characteristics of a quality im- and the anatomic part cannot be well visualized (Figure 9-4).
age displayed on a computer monitor and film. We will first de-
scribe the visibility and sharpness factors that comprise a
quality radiographic image for both digital and film-screen im- Radiographic Quality
aging. Following the discussion on image quality, digital and
film-screen imaging will be discussed separately to distinguish Visibility Sharpness
their unique characteristics. Information about the construction
of image receptors and how the image is acquired, processed,
and displayed is discussed in detail in subsequent chapters.

Brightness Contrast Spatial Distortion

IMAGE QUALITY A B Resolution
The visibility of the anatomic structures and the accuracy of FIG 9-1  ​Radiographic Quality. Factors affecting radiographic
their structural lines recorded (sharpness) determine the image quality. A, Visibility factors. B, Sharpness factors.
94 SECTION II  Image Production and Evaluation

FIG 9-2  ​Optimal Density. Radiograph with optimal density. FIG 9-4  ​Excessive Density. Radiograph with excessive den-
(From Mosby’s instructional radiographic series: radiographic sity.  (From Fauber TL: Radiographic imaging and exposure,
imaging, St Louis, 1998, Mosby.) ed 3, St Louis, 2009, Mosby.)

radiation reaching the image receptor. However, the quantity

of radiation reaching the image receptor has less of an effect
on the brightness of a digital image because of computer
processing. The quantity of radiation reaching a film-screen
image receptor has a direct effect on the amount of density
produced in a film image. In order to evaluate other attri-
butes of radiographic quality, such as contrast and sharpness,
the image must have sufficient brightness or density to visu-
alize the anatomic area of interest.

Contrast
In addition to sufficient brightness or density, the radiograph
must exhibit differences in the brightness levels or densities
(contrast) in order to differentiate among the anatomic tis-
sues. The range of brightness levels is a result of the tissues’
differential attentuation of the x-ray photons. An image that
has sufficient brightness or density but no differences appears
as a homogeneous object (Figure 9-5). This appearance indi-
cates that the absorption characteristics of the object are equal.
When the absorption characteristics of an object differ, the im-
age has varying levels of brightness or densities (Figure 9-6).
FIG 9-3  ​Insufficient Density. Radiograph with insufficient
The anatomic tissues are easily differentiated because of these
density.  (From Mosby’s instructional radiographic series:
radiographic imaging, St Louis, 1998, Mosby.) differences in brightness or density (i.e., contrast). Tissues
that attenuate the x-ray beam equally are more difficult to
visualize because the brightness or densities are too similar to
The radiographer must evaluate the overall brightness or differentiate. To differentiate among the anatomic tissues,
density on the image to determine whether it is sufficient to there must be density differences. Density differences refer to
visualize the anatomic area of interest. He or she then decides an image’s radiographic contrast. Radiographic contrast af-
whether the radiograph is diagnostic or unacceptable. fects the visibility of the structural lines that make up the
The primary factor that affects the amount of brightness recorded image. Density differences are a result of the tissues’
or density produced in an image is the amount or quantity of differential absorption of the x-ray photons.
 CHAPTER 9  Image Quality and Characteristics 95

number contribute to subject contrast. For example, the chest

is composed of tissues that vary greatly in x-ray lucency, such
as the air-filled lungs, the heart, and the bony thorax. This
anatomic region creates high subject contrast because the tis-
sues attenuate the x-ray beam very differently compared with
the abdomen for the same beam quality (Figures 9-7 and
9-8). When the thorax is imaged, great differences in bright-
ness levels or densities are recorded for the varying tissues.
The abdomen is composed of tissues that attenuate the x-ray
beam similarly and is considered to be a region of low subject

FIG 9-5  ​Homogeneous. Radiograph of a homogeneous ob-

ject having no differences in density. (From Fauber TL: Radio-
graphic imaging and exposure, ed 3, St Louis, 2009, Mosby.)

BONE FAT AIR

Higher contrast
FIG 9-7  ​High Subject Contrast. Higher contrast resulting
from great differences in radiation absorption for tissues that
have greater variation in composition.

FIG 9-6  ​Differential Absorption. Object with different ab-

sorption characteristics produces an image with varying den-
sities. (From Fauber TL: Radiographic imaging and exposure,
ed 3, St Louis, 2009, Mosby.)

Radiographic contrast is the combined result of multiple

factors associated with the anatomic structure, quality of the
radiation, capabilities of the image receptor, and, in digital
imaging, computer processing and display. Subject contrast FIG 9-8  ​High Subject Contrast. The chest is an area of high
refers to the absorption characteristics of the anatomic tissue subject contrast because there is great variation in tissue
radiographed and the quality of the x-ray beam. Differences composition.  (From Fauber TL: Radiographic imaging and
in tissue thickness, tissue density, and effective atomic exposure, ed 3, St Louis, 2009, Mosby.)
96 SECTION II  Image Production and Evaluation

contrast. The brightness or densities representing the organs MAKE THE PHYSICS CONNECTION
in the abdomen are more similar (Figures 9-9 and 9-10).
Chapter 7
Therefore, it is difficult to distinguish the stomach from the
kidneys. Differential absorption is the difference between the x-ray
As discussed previously, the quality of the x-ray beam also photons that are absorbed photoelectrically and those that
affects its attenuation in tissues, which alters subject con- penetrate the body. It is called differential because different
trast. Increasing the penetrating power of the x-ray beam body structures absorb x-ray photons to different extents.
decreases attenuation, reduces absorption, and increases Anatomic structures such as bone are denser and absorb
more x-ray photons than structures filled with air, such as the
x-ray transmission—resulting in fewer differences in bright-
lungs.
ness and density recorded in the radiographic image.

Brightness or density is easily measurable; however, con-

trast is a more complex attribute. Evaluating radiographic
quality in terms of contrast is more subjective (it is affected
by individual preferences). The level of radiographic contrast
desired in an image is determined by the composition of the
anatomic tissue to be radiographed and the amount of infor-
mation needed to visualize the tissue for an accurate diagno-
sis. For example, the level of contrast desired in a chest radio-
graph is different from the level of contrast required in a
radiograph of an extremity.

Spatial Resolution or Recorded Detail

MUSCLE WATER FAT The quality of a radiographic image depends on both the vis-
ibility and the accuracy of the anatomic structural lines re-
corded (sharpness). Adequate visualization of the anatomic
Lower contrast area of interest (brightness/density and contrast) is just one
FIG 9-9  ​Low Subject Contrast. Lower contrast resulting component of image quality. To produce a quality radio-
from fewer differences in radiation absorption for tissues that graph, the anatomic details must be recorded accurately and
are more similarly composed. with the greatest amount of sharpness. Spatial resolution
and recorded detail are terms used to evaluate accuracy of the
anatomic structural lines recorded. Spatial resolution refers
to the smallest object that can be detected in an image and is
the term typically used in digital imaging. Recorded detail
refers to the distinctness or sharpness of the structural lines
that make up the recorded image and is the term used in film-
screen imaging.
Resolution is the ability of the imaging system to resolve
or distinguish between two adjacent structures. Resolution
can be expressed as line pairs per millimeter (Lp/mm). A
resolution test pattern is a device used to record and measure
line pairs (Figure 9-11). The greater the number of line pairs
per millimeter resolved, the greater the resolution.
In the space of 1 mm, the number of line pairs resolved deter-
mines the amount of sharpness. Each line pair is made up of a
line and a space. If 5 Lp/mm were resolved, each line or space
measures 0.1 mm and a line pair measures 0.2 mm (Figure 9-12).
An imaging system that can resolve a greater number of line pairs
within 1 mm (e.g., 8 to 10 Lp/mm) is said to have improved
sharpness. An imaging system that can resolve fewer line pairs
within 1 mm (e.g. 2-3 Lp/mm) is said to have decreased sharp-
ness. The ability to discern small changes in spatial resolution
FIG 9-10  ​Low Subject Contrast. The abdomen is an area of when viewing radiographic images depends on the viewer’s vi-
low subject contrast because it is made up of similar tissue sual acuity and distance from the image.
types. (From Fauber TL: Radiographic imaging and exposure, The ability of a radiographic image to demonstrate sharp
ed 3, St Louis, 2009, Mosby.) lines determines the quality of the spatial resolution or
 CHAPTER 9  Image Quality and Characteristics 97

density varies significantly from the background. If unsharp-

ness is increased, the visibility of small anatomic detail is
compromised. An increase in the amount of unsharpness
recorded on the image decreases the contrast of small ana-
tomic structures, reducing the overall visibility of the struc-
tural lines. The spreading of the structural lines with in-
creased unsharpness decreases the differences in brightness
or density between the structural lines of the area of interest
and the background. As a result, the difference in brightness
or density between the area of interest and the background
becomes less (low contrast), and the visibility of the ana-
tomic structure is reduced (Figure 9-13).
A radiographic image cannot be an exact reconstruction
of the anatomic structure. Some information is always lost
during the process of image formation. In addition, factors
such as patient motion increase the amount of unsharpness
recorded in the image (Figure 9-14). It is the radiographer’s
responsibility to minimize the amount of information lost by
manipulating the factors that affect the sharpness of the re-
corded image. Diagnostic quality is achieved by maximizing
the amount of spatial resolution or recorded detail and
minimizing the amount of image distortion.

Distortion
Distortion results from the radiographic misrepresentation
of either the size (magnification) or the shape of the ana-
tomic part. When the image is distorted, spatial resolution or
FIG 9-11  ​Resolution Test Pattern. A resolution test pattern recorded detail is also reduced.
measures and records line pairs per millimeter.  (Courtesy
Fluke Biomedical.) Size Distortion (Magnification). ​The term size distortion
(or magnification) refers to an increase in the image size of
an object compared with its true, or actual, size. Radio-
recorded detail. The imaging process makes it impossible to graphic images of objects are always magnified in terms of
produce a radiographic image without some degree of un- the true object size. The source-to-image receptor distance
sharpness. A radiographic image that has a greater amount of (SID) and object-to-image receptor distance (OID) play an
spatial resolution or recorded detail minimizes the amount of important role in minimizing the amount of size distortion
unsharpness of the anatomic structural lines. of the radiographic image.
Sharpness of recorded detail and visibility of recorded Because radiographers produce radiographs of three-
detail have typically been discussed as two separate qualities dimensional objects, some size distortion always occurs as a
of the radiographic image. Generally, this separation remains result of OID. The parts of the object that are farther away
true except when imaging small anatomic structures. A small from the image receptor are represented radiographically
anatomic structure is best visualized when its brightness or with more size distortion than parts of the object that are

Line pair (Lp) = 0.2 mm Line = 0.1 mm

Air space Lead strip

Space = 0.1 mm
FIG 9-12  ​Line Pairs per Millimeter. Five line pairs in the space of 1 millimeter (5 Lp/mm). A line
pair includes a line and a space. If 5 Lp/mm are visualized, a line pair measures 0.2 mm, and each
line measures 0.1 mm.
98 SECTION II  Image Production and Evaluation

Relative Shape Distortion. ​In addition to size distortion, objects that

Object point Unsharpness Image contrast are being imaged can be misrepresented radiographically by
distortion of their shape. Shape distortion can appear in two
different ways radiographically: elongation or foreshorten-
ing. Elongation refers to images of objects that appear longer
100% than the true objects. Foreshortening refers to images that
appear shorter than the true objects. Examples of elongation
and foreshortening can be seen in Figure 9-15.
Shape distortion can occur from inaccurate central ray
50%
(CR) alignment of the tube, the part being radiographed, or
the image receptor. Any misalignment of the CR among these
three factors—tube, part, or image receptor—alters the shape
of the part recorded in the image.
20%
Sometimes shape distortion is used to advantage in par-
ticular projections or positions. For example, CR angulation
is sometimes required to elongate a part so that a particular
anatomic structure can be visualized better. Also, rotating the
FIG 9-13  ​Unsharpness and image contrast. Increasing the part (and therefore creating shape distortion) is sometimes
amount of unsharpness decreased the brightness or density required to eliminate superimposition of objects that nor-
difference (contrast) between the area of interest and its sur- mally obstruct visualization of the area of interest. In general,
rounding background. (Modified from Sprawls: Physical prin-
shape distortion is not a necessary or desirable characteristic
ciples of medical imaging online, ed 2, http://www.sprawls.
rg/ppmi2/)
of radiographs.
The factors that determine the amount of image distor-
tion are equally important for digital and film-screen imag-
ing. Both SID and OID determine the amount of magnifica-
tion of the anatomic structures on the image. In addition,
improper alignment of the CR, anatomic part, image recep-
tor, or a combination of these components distorts the shape
of the image, whether obtained with a digital or film-screen
image receptor. The factors that affect size and shape distor-
tion are discussed in more detail in Chapter 10.

FIG 9-14  ​Image showing motion unsharpness. (From

Fauber TL: Radiographic imaging and exposure, ed 3,
St Louis, 2009, Mosby.)

closer to the image receptor. Even if the object is in close

contact with the image receptor, some part of the object is
farther away from the image receptor than other parts. SID
also influences the total amount of magnification on the A B C
image. As SID increases, size distortion (magnification) FIG 9-15  ​Shape Distortion. A, No distortion. B, Fore­
decreases; as SID decreases, size distortion (magnification) shortened. C, Elongated. (From Mosby’s instructional radio-
increases. graphic series: radiographic imaging, St Louis, 1998, Mosby.)
 CHAPTER 9  Image Quality and Characteristics 99

MAKE THE PHYSICS CONNECTION

Scatter
Chapter 7
Scatter radiation, as described previously, can add unwanted
exposure to the radiographic image as a result of Compton Compton scattering is one of the most prevalent interactions
interactions. Unwanted exposure or fog on the image does not between x-ray photons and the human body in general diag-
provide information about the anatomic area of interest. Scat- nostic imaging and is responsible for most of the scatter that
ter degrades or decreases the visibility of the anatomic struc- fogs the image. The probability of Compton scattering does
not depend on the atomic number of atoms involved. Comp-
tures. The scatter or unwanted exposure recorded on the image
ton scattering may occur in both soft tissue and bone. The
has the effect of decreasing the contrast by masking the desired
probability of Compton scattering is related to the energy of
brightness or densities on the image and changing the degree the photon. As x-ray photon energy increases, the probability
of differences (Figure 9-16). of that photon penetrating a given tissue without interaction
Fog produced as a result of scatter reaching the image re- increases. However, with this increase in photon energy, the
ceptor can be visualized on both a digital and a film image. likelihood of Compton interactions relative to photoelectric
Even though the computer can change the contrast or gray interactions also increases.
levels displayed in the digital image, scatter radiation reaching

the image receptor does not provide any information about

the area of interest. Because digital image receptors can detect
low levels of radiation intensity, they are more sensitive to
scatter radiation than film.

CRITICAL CONCEPT
Scatter and Digital Image Receptors
Because digital image receptors can detect low levels of ra-
diation intensity, they are more sensitive to scatter radiation
than film-screen image receptors. Digital image receptors
can detect the low-level scatter radiation and create fog on
the digital image.

There are multiple factors that affect the amount of scatter

reaching the image receptor. These factors along with con-
trolling scatter are discussed more thoroughly in Chapter 11,
“Scatter Control.”
A
Quantum Noise
Image noise contributes no useful diagnostic information
and serves only to detract from the quality of the image.
Quantum noise, a concern in digital and film-screen imag-
ing, is photon-dependent. Quantum noise is visible as
brightness or density fluctuations on the image Figure 9-17.
Quantum mottle is the term typically used when referring to
noise on a film image. The fewer the photons reaching the
image receptor to form the image, the greater the quantum
noise visible on the digital image. It is important to mini-
mize the amount of quantum noise or mottle on a radio-
graphic image.

Image Artifacts
An artifact is any unwanted image on a radiograph. Arti-
facts are detrimental to radiographs because they can make
visibility of anatomy, a pathologic condition, or patient
identification information difficult or impossible. They de-
B crease the overall quality of the radiographic image. Various
FIG 9-16  ​Scatter. Scatter degrades or decreases the visibility methods are used to classify artifacts. Generally, artifacts
of the anatomic structures. A, Image created with less scat- can be classified as plus-density and minus-density. Plus-
ter compared with image B, created with increased scatter. density artifacts are greater in density than the area of the
100 SECTION II  Image Production and Evaluation

A B
FIG 9-17  ​Quantum Noise. A, Image created using an appropriate x-ray exposure technique.
B, Image shows increased quantum noise as a result of insufficient x-ray exposure to the image
receptor. (From Fauber TL: Radiographic imaging and exposure, ed 3, St Louis, 2009, Mosby.)

image immediately surrounding them. Minus-density arti-

facts are of less density than the area of the image immedi-
ately surrounding them.
Errors such as double exposing an image receptor or the
improper use of equipment can result in image artifacts and
must be avoided. Foreign bodies are a classification of arti-
facts imaged within the patient’s body. Variation in exposure
techniques may be necessary when imaging for a suspected
foreign body.
Although the causes of some artifacts are the same regard-
less of the type of imaging system, others are specific to digi-
tal or film imaging. Artifacts from patient clothing and items
imaged that are not a part of the area of interest are the same
for both digital and film systems. The radiographer must be
diligent in removing clothing or items that could obstruct
visibility of the anatomic area of interest (Figure 9-18). Scat-
ter radiation or fog and image noise have also been classified
as radiographic artifacts because they add unwanted infor-
mation on the image.
Digital image artifacts can be a result of errors during ex-
traction of the latent image from the image receptor, inade-
quate CR imaging plate erasure, or performance of the elec-
tronic detectors. Artifacts specific to film-screen imaging are
typically a result of film storage, handling, and chemical pro-
cessing. Common types and sources of image artifacts are FIG 9-18  ​Image artifact. (From Fauber TL: Radiographic
discussed in Chapter 12, “Image Receptors.” imaging and exposure, ed 3, St Louis, 2009, Mosby.)
 CHAPTER 9  Image Quality and Characteristics 101

1 Pixel
DIGITAL IMAGE CHARACTERISTICS
Digital imaging possesses a number of unique qualities that
distinguish it from film-screen imaging. Digital image recep-
tors can respond to a wide range of x-ray exposures (wide
dynamic range). The dynamic range of an imaging system
refers to the range of exposure intensities an image receptor
can accurately detect. Anatomic areas of widely different at-
tenuation such as soft tissues and bony structures can be
more easily visualized due to the wider dynamic range in
digital imaging. In addition, due to computer processing,
moderately underexposed or overexposed images may still be
of acceptable diagnostic quality.

CRITICAL CONCEPT
Dynamic Range
The range of exposure intensities an image receptor can ac-
curately detect determines its dynamic range. Digital image
receptors have a wide dynamic range and can accurately
detect very low exposure intensities and very high exposure Matrix
intensities.
FIG 9-19  ​Image Matrix. Location of the pixel within the
image matrix corresponds to an area within the patient or
volume of tissue. Note: Pixel size is not to scale and used for
Digital images are composed of numerical data that can be
illustration only.  (From Fauber TL: Radiographic imaging and
easily manipulated by a computer. When displayed on a com- exposure, ed 3, St Louis, 2009, Mosby.)
puter monitor, this allows tremendous flexibility in terms of
altering in real time the brightness and contrast of a digital
image. The practical advantage of such capability is that, re-
gardless of the original exposure parameters (within reason), the amount of precision in digitizing the analog signal and
any anatomic structure can be independently and optimally thus controls the exact pixel brightness (gray level) that can
visualized. Computers can also perform various postprocess- be specified. Bit depth is determined by the analog-to-digital
ing image manipulations to further improve visibility of the converter, which is an integral component of every digital
anatomic region. imaging system. A larger bit depth allows a greater number of
A digital image is recorded as a matrix, or combination of shades of gray to be displayed on a computer monitor. For
rows and columns (array), of small, usually square, “picture example, a 12-bit depth can display 4096 shades of gray,
elements” called pixels. Each pixel is recorded as a single nu- whereas a 14- and 16-bit depth can display 16,384 and 65,536
merical value, which is represented as a single brightness level shades of gray, respectively. A system that can display a
on a display monitor. The location of the pixel within the greater number of shades of gray has better contrast resolu-
image matrix corresponds to an area within the patient or tion (Box 9-2).
volume of tissue (Figure 9-19). Visibility and accuracy of the anatomic structural lines
For a given anatomic area, or field of view, a matrix size of recorded are equally important in digital imaging. However,
1024 3 1024 has 1,048,576 individual pixels, whereas a ma- the intensity of exposure reaching the image receptor does
trix size of 2048 3 2048 has 4,194,304 pixels. Digital image not control the amount of brightness produced on the digital
quality is improved with a larger matrix size that includes a image. Digital image characteristics include brightness, con-
greater number of smaller pixels (Figure 9-20 and Box 9-1). trast, spatial resolution, and noise (Figure 9-22).
Although image quality is improved for a larger matrix size
and smaller pixels, it is important to understand that com- Brightness
puter processing time, network transmission time, and digital In digital imaging, the level of brightness displayed on the
storage space increase as the matrix size increases. computer monitor is also important to visualizing anatomic
The numerical value assigned to each pixel is determined detail. Because the image is composed of numerical data, the
by the relative attenuation of x-rays passing through the cor- brightness level displayed on the computer monitor can be
responding volume of tissue. Pixels representing highly at- easily altered to visualize the range of anatomic structures
tenuating tissues, such as bone, are usually assigned a low recorded.
value for higher brightness (lower density) than pixels repre- The x-ray beam that exits the patient contains a wide range
senting tissues of low x-ray attenuation (Figure 9-21). Each of x-ray intensities (often varying by more than 1000-fold). To
pixel also has a bit depth, or number of bits, that determines adequately capture these intensity extremes, a receptor with a
102 SECTION II  Image Production and Evaluation

A B

C D
FIG 9-20  ​Matrix Size. For a given field of view, the larger the matrix size, the greater the number
of smaller individual pixels. Increasing the number of smaller pixels will improve the quality of
the image. A, Matrix size is 64 3 64. B, Matrix size is 215 3 215. C, Matrix size is 1024 3 1024.
D, Matrix size is 2048 3 2048.  (From Fauber TL: Radiographic imaging and exposure, ed 3,
St Louis, 2009, Mosby.)

BOX 9-1  Digital Imaging Terminology level of brightness yet also have been over- or under-exposed.
As a result, the radiographer may be unaware of the exposure
Matrix: Image displayed as a combination of rows and col- error. An important feature of digital imaging systems is the
umns (array); for a given field of view (FOV), a larger matrix
exposure indicator. The exposure indicator provides a nu-
size improves digital spatial resolution.
meric value indicating the level of radiation exposure to the
Pixel: Smallest component of the matrix; a greater number
of smaller pixels improves digital spatial resolution.
digital image receptor. Currently, exposure indicators are not
Pixel Bit Depth: The number of bits that determines the standardized among various types of digital imaging equip-
amount of precision in digitizing the analog signal and there- ment in use today; however, the industry is working toward
fore the number of shades of gray that can be displayed in standardization of the exposure indicator. See Table 9-1 for a
the image. list of CR vendor-specific exposure indicators. The radiogra-
pher should evaluate the exposure indicator value along with
the quality of the digital image before determining whether a
wide dynamic range is required. Because digital imaging pro- repeat image is warranted.
vides a wider dynamic range than film-screen imaging and the A wide dynamic range is only useful, however, if the dis-
computer can adjust for exposure errors, a greater margin of played image brightness can be optimized for human percep-
error exists for exposure techniques to yield acceptable image tion. This adjustment is accomplished using the windowing
densities. function. The window level (or center) sets the midpoint of
Because digital image processing can compensate for ex- the range of densities visible in the image. Changing the win-
posure errors, the digital image may display the appropriate dow level on the display monitor allows the image brightness
 CHAPTER 9  Image Quality and Characteristics 103

Pixel

Decreased
brightness

Pixel

Increased
brightness

FIG 9-21  ​Pixel Value. Each pixel value represents a volume of tissue imaged. (From Fauber TL:
Radiographic imaging and exposure, ed 3, St Louis, 2009, Mosby.)

BOX 9-2  Binary Digits

Computers operate and communicate through the binary
number system, which uses combinations of zeros and ones
to process and store information. A digital transistor can be
operated in two states, either off (0) or on (1). Each 0 and 1
is called a bit and refers to the computer’s basic unit of infor-
mation. When eight bits are combined they form a byte, and
two bytes form a word.
Binary digits are used to display the brightness level
(shades of gray) of the digital image. The greater the number
of bits, the greater the number of shades of gray and the
quality of the image is improved.

to be increased or decreased throughout the entire range of

densities. When the range of densities displayed is less than
the maximum, the processed image presents only a small FIG 9-22  ​Digital Image Quality. Visibility and accuracy of
the anatomic structural lines recorded are equally important
sample of the total information contained within the com-
in digital imaging. Digital image characteristics include bright-
puter (Figure 9-23).
ness, contrast, spatial resolution, and noise.
Assume that pixel values from 0 to 2048 are used to repre-
sent the full range of digital image densities or brightness
levels. A high pixel value could represent a volume of tissue a low pixel value, one would decrease the window level to
that attenuated fewer x-ray photons and is displayed as a de- decrease the brightness on the display monitor.
creased brightness level or increased density. Therefore, a low
pixel value represents a volume of tissue that attenuates more CRITICAL CONCEPT
x-ray photons and is displayed as increased brightness or Window Level and Image Brightness
decreased density.
Moving the window level up to a high pixel value increases A direct relationship exists between window level and image
visibility of the darker anatomic regions (e.g., lung fields), by brightness on the display monitor. Increasing the window
level increases the image brightness; decreasing the window
increasing overall brightness on the display monitor. Con-
level decreases the image brightness.
versely, to better visualize an anatomic region represented by
104 SECTION II  Image Production and Evaluation

Subject density Image brightness the range of densities visible varies the image contrast. When
the entire range of densities is displayed (wide window
Air Black
width), the image has lower contrast, or more shades of gray;
when a smaller range of densities is displayed (narrow win-
dow width), the image has higher contrast, or fewer shades of
gray (Figure 9-24).
Fat
The center or midpoint of the window level and the width
Water of the window determine the brightness and contrast of the
Muscle displayed image (Figure 9-25). Figure 9-26 demonstrates how
the image is altered when the window level is changed for a
given window width.
It is also important to display digital images on a monitor
Bone White
with high luminance to optimally visualize the wide range of
gray levels contained within the image.
FIG 9-23  ​Window Level. Changing the window level in-
creases or decreases the image brightness throughout the
range of densities recorded in the image.
Subject density Image brightness
Air Black

Contrast
In digital imaging, the number of different shades of gray
that can be stored and displayed by a computer system is Fat
termed grayscale. Contrast resolution is another term associ- Water
ated with digital imaging and is used to describe the ability of Muscle
the imaging system to distinguish between small objects that
attenuate the x-ray beam similarly. An important distinguish-
ing characteristic of a digital image is its improved contrast
resolution when compared with a film-screen image. The Bone White
contrast resolution of the imaging system determines the
level of visibility of small objects having similar densities FIG 9-24  ​Window Width. Changing the window width in-
or shades of gray. As mentioned previously, the depth of creases or decreases the range of densities visible. A narrow
the pixel is determined by the bit depth or number of bits window width decreases the range of densities and increases
(e.g., 10, 12, or 14), which affects the number of shades of contrast. Wider window width increases the range of densi-
ties and reduces contrast.
gray available for image display. Increasing the number of
shades of gray increases the contrast resolution within the
image. An image with increased contrast resolution increases
the visibility of recorded detail and the ability to distinguish Digital image windowing
among small anatomic areas of interest. 2048
All pixels dark (black)
No contrast
CRITICAL CONCEPT
Pixel Bit Depth and Contrast Resolution
The greater the pixel bit depth (e.g., 14-bit) the greater the
Image
number of shades of gray available for image display. Increas- 1024 Center Width
contrast
ing the number of shades of gray available to display on a
digital image improves its contrast resolution.

Once the digital image is processed, radiographic contrast All pixels bright (white)
can be adjusted to vary visualization of the area of interest. No contrast
This is necessary because the contrast resolution of the 0
human eye is limited. The window width is a control that Image (pixel values)
adjusts the radiographic contrast. Because the digital image FIG 9-25  ​Windowing. The level or center of window and the
can display grayscale densities ranging from black to white, window width changes the visual display of the digital image.
the display monitor can vary the range or number of densi- (From Sprawls: Physical principles of medical imaging online,
ties visible on the image to show all of the anatomy. Adjusting ed 2, http://www.sprawls.org/ppmi2/)
 CHAPTER 9  Image Quality and Characteristics 105

Effect of window selection on contrast

CRITICAL CONCEPT
2048 High window Pixel Density and Pitch and Spatial Resolution
Increasing the pixel density and decreasing the pixel pitch
increases spatial resolution. Decreasing pixel density and in-
creasing pixel pitch decreases spatial resolution.
Low window

1024
Good contrast in Different types of digital image receptors use varying
higher range of methods of transforming the continuous exit radiation in-
pixel values
tensities into the array of discrete pixels for image display.
Some digital image receptors use a sampling technique,
whereas others have fixed detector elements that are used to
Good contrast in 0 capture the exit radiation intensities. Regardless of the type
lower range of used, a major determinant of spatial resolution of digital
pixel values
images is the pixel size and its spacing.
FIG 9-26  ​Window Selection. Changing the window level for The device used for digital image display also affects the
a chest x-ray varies the visibility of the anatomic detail or
ability to view anatomic details. High-resolution monitors
contrast for both low- and high-density areas. (From Sprawls:
Physical principles of medical imaging online, ed 2, http://
are required to maximize the amount of spatial resolution
www.sprawls.org/ppmi2/) viewed in the digital image.

Image Noise
As mentioned previously, the digital computer system can
CRITICAL CONCEPT adjust for low or high x-ray exposures during image acquisi-
Window Width and Radiographic Contrast tion. When the x-ray exposure to the image receptor is too
low (decreased number of photons), computer processing
A narrow (decreased) window width increases radiographic
alters the appearance of the digital image to make the bright-
contrast, whereas a wider (increased) window width de-
creases radiographic contrast. ness acceptable but the image displays increased quantum
noise (Figure 9-28). Certain postprocessing options may
render quantum noise more noticeable or less so.

Spatial Resolution
A digital image is composed of discrete information in the CRITICAL CONCEPT
form of pixels that display various shades of gray. The size of
the pixel is measured in microns (100 microns 5 0.1 mm). As Number of Photons and Quantum Noise
mentioned previously, the greater the number of pixels in a Decreasing the number of photons reaching the image re-
matrix image, the smaller their size. An image consisting of a ceptor increases the amount of quantum noise within the
greater number of pixels per unit area or pixel density pro- digital image; increasing the number of photons reaching the
vides improved spatial resolution. In addition to its size, the image receptor decreases the amount of quantum noise
pixel spacing or distance measured from the center of a pixel within the digital image.
to an adjacent pixel determines the pixel pitch (Figure 9-27).

Pixel size The exposure technique should be selected based on the

requirements for the type of radiographic procedure per-
formed. The quality of the digital image depends on many
of the same factors as film-screen radiography. However, a
factor that differentiates digital from film-screen imaging is
the ability of the computer to adjust the brightness of the
image following exposure technique errors. It should be
noted that, although the computer can adjust for both low-
and high-exposure technique errors, the radiographer is still
responsible for selecting exposure techniques that produce
acceptable image quality while simultaneously maintaining
Pixel pitch patient exposure as low as reasonably achievable (ALARA).
FIG 9-27  ​Pixel Pitch. The pixel spacing or distance mea- In particular, exposures that are too low adversely affect the
sured from the center of a pixel to an adjacent pixel (pixel quantum noise of the image even though the computer can
pitch) affects the spatial resolution of the digital image. adjust the brightness. Exposures that are too high result in
106 SECTION II  Image Production and Evaluation

B
FIG 9-28  ​Quantum Noise. A, Image created using an appropriate x-ray exposure technique.
B, Image demonstrates increased quantum noise as a result of insufficient x-ray exposure to the
image receptor. (From Fauber TL: Radiographic imaging and exposure, ed 3, St Louis, 2009, Mosby.)

excessive radiation exposure to the patient. It is recom- FILM-SCREEN CHARACTERISTICS

mended that radiographers continue to select exposure tech- Film-screen imaging has a number of limitations that were
niques that produce diagnostic-quality radiographic images, overcome with digital imaging. One major deficiency is the
regardless of whether the imaging system is film-screen or limited dynamic range of film-screen. This limitation renders
digital. a film-screen radiograph very sensitive to under- or overex-
posure, which may necessitate image retakes. A limited dy-
namic range also restricts visibility of structures that differ
CRITICAL CONCEPT greatly in x-ray attenuation. An example is the difficulty of
optimally visualizing both soft tissue and bony structures
Exposure Technique Selection and Digital
within a given film image.
Imaging
Unlike digital imaging, the intensity of exposure reaching
Optimal exposure techniques should be selected regardless the film-screen image receptor has a direct effect on the
of whether digital or film-screen image receptors are used. amount of density produced in the processed image. Film-
Although digital processing can create an acceptable image screen image characteristics include density, contrast, and
following an exposure error, poor image quality or increased
recorded detail. Distortion, discussed previously, is the same
radiation exposure to the patient may result.
for digital and film-screen imaging.
 CHAPTER 9  Image Quality and Characteristics 107

CRITICAL CONCEPT
Dynamic Range
The range of exposure intensities an image receptor can ac-
curately detect determines its dynamic range. Film-screen
image receptors have a narrow dynamic range when com-
pared with digital image receptors.

Density
Radiographic film that has been exposed to radiant energy
and chemically processed is composed of minute deposits of
black metallic silver visualized as density. The varying densi-
ties on the processed film represent the attenuation proper-
ties of the anatomic part imaged. Radiographic density is the FIG 9-29  ​Densitometer. A densitometer is used to measure
amount of overall blackness produced on the processed optical densities.
image. If a radiograph is deemed unacceptable, the radiogra-
pher must determine what factors contributed to the density original incident light to be transmitted has a transmittance
error. Knowledge about the factors that affect the density on of 1/10 or 0.1. The inverse of transmittance is therefore 10,
a radiographic image is critical to developing effective prob- and the logarithm of 10 (the optical density) is 1. Similarly,
lem-solving skills. The factors that affect the density of the an area that allows only 1% of the original incident light
image are discussed in Chapter 10, “Radiographic Exposure through has an optical density of 2.
Technique.”
MATH APPLICATION
Optical Density. ​Density on the printed radiographic image
can be quantified and is therefore an objective measure that Optical Density Formula
can be used for comparison. A densitometer is a device used
I0
to numerically determine the amount of blackness on the Optical density 5 log10
radiograph (i.e., it measures radiographic density). It
This device is constructed to emit a constant intensity
of light (incident) onto an area of the image and then in which Io represents the amount of original light incident on
the film and It represents the amount of transmitted light.
measure the amount of light transmitted through the area
(Figure 9-29). The densitometer determines the amount
of light transmitted and calculates a measurement known
as optical density (OD). Optical density is a numeric cal- CRITICAL CONCEPT
culation that compares the intensity of light transmitted Light Transmittance and Optical Density
through an area on the film (It) with the amount of light
As the percentage of light transmitted decreases, the optical
originally striking (incident) the area (Io). The ratio of density increases; as the percentage of light transmitted
these intensities is called transmittance. The Math Appli- increases, the optical density decreases.
cation below shows the mathematical formula used to
calculate percent transmittance. Because the range of ra-
diographic densities is large, the calculation of radio- Notice the relationship between light transmittance and
graphic densities is compressed into a logarithmic scale optical density (see Table 9-1). When 100% of the light is
(see Table 9-1) for easier management. transmitted, the optical density equals 0. When 50% of the
light is transmitted, the optical density is equal to 0.3, and
MATH APPLICATION when 25% of the light is transmitted, the optical density
equals 0.6. When a logarithmic scale base 10 is used, every
Light Transmittance Formula 0.3 change in optical density corresponds to a change in
the percentage of light transmitted by a factor of 2 (log10
It
100 of 2 5 0.3).
I0
Diagnostic Range. ​Optical densities can range from 0 to
in which It represents the amount of light transmitted and Io
represents the amount of original light incident on the film.
4 OD. However, the diagnostic range of optical densities for
general radiography usually falls between 0.5 and 2 OD. This
desired range of optical densities is found between the ex-
As shown in Math Application 9-2, optical density is de- treme low and high densities produced on the radiograph.
fined as the logarithm (Log10) of the inverse of transmittance. The radiation exposure to the film-screen image receptor
For example, an area of the image that allows 10% of the primarily determines the amount of optical density created
108 SECTION II  Image Production and Evaluation

TABLE 9-1  Percentage of Light

Transmittance and Calculated Optical
Radiographic Contrast
Densities Radiographic film images are typically described by their
scale of contrast or the range of densities visible. A radio-
Percentage of Fraction of
graph with few densities but great differences among them is
Light Transmitted Light Transmit- Optical
said to have high contrast. This is also described as short-
(It/Io 3 100) ted (It/Io) Density (log Io/It)
scale contrast (Figure 9-30). A radiograph with a large num-
100 1 0 ber of densities but little differences among them is said to
50 1
⁄2 0.3 have low contrast. This is also described as long-scale con-
32 8
⁄25 0.5
trast (Figure 9-31).
25 1
⁄4 0.6
12.5 1
⁄8 0.9
The inherent response of the film (receptor contrast) also
10 1
⁄10 1 affects radiographic contrast. Film can be manufactured to
5 1
⁄20 1.3 display different levels of contrast, such as medium or high.
3.2 4
⁄125 1.5 In addition, the quality of chemical processing affects the
2.5 1
⁄40 1.6 contrast displayed on the radiograph.
1.25 1
⁄80 1.9 Radiographic contrast can be best evaluated when the ra-
1 1
⁄100 2 diographic density is adequate to visualize the density differ-
0.5 1
⁄200 2.3 ences. When density is either too light or too dark, radio-
0.32 2
⁄625 2.5 graphic contrast cannot be adequately visualized. When
0.125 1
⁄800 2.9 radiographic density is unacceptable, radiographic contrast is
0.1 1
⁄1000 3
decreased.
0.05 1
⁄2000 3.3
0.032 1
⁄3125 3.5
It is important to have a basic understanding of how
0.01 1
⁄10,000 4 radiographic film responds to radiation exposure and
creates the optical densities visible after processing. This

CRITICAL CONCEPT
Optical Density and Light Transmittance
For every 0.3 change in optical density, the percentage of
light transmitted has changed by a factor of 2. A 0.3 increase
in optical density results from a decrease in the percentage
of light transmitted by half, whereas a 0.3 decrease in optical
density results from an increase in the percentage of light
transmitted by a factor of 2.

on the film after processing. The intensity of radiation expo-

sure, or exposure intensity, is a measurement of the amount
and energy of the x-rays reaching an area of the film. When
all other factors remain the same, increasing the exposure
intensity increases the optical density.

CRITICAL CONCEPT
Exposure Intensity and Optical Density
Increasing the exposure intensity to the film-screen image
receptor increases the optical density, whereas decreasing
the exposure intensity to the film-screen image receptor de-
creases the optical density.

In film-screen imaging the optical densities created on the

processed radiograph cannot be altered. As a result, choosing
the proper exposure intensity to create an appropriate range of
optical densities (or diagnostic densities) during film-screen FIG 9-30  ​High-contrast (short-scale) image showing
imaging is critical to producing a good-quality radiographic fewer gray tones and greater differences between indi-
image. Diagnostic densities must be present in a radiographic vidual densities. (From Fauber TL: Radiographic imaging and
image to visualize the anatomic area of interest. exposure, ed 3, St Louis, 2009, Mosby.)
 CHAPTER 9  Image Quality and Characteristics 109

Sensitometric Equipment. ​Several pieces of equipment are

needed to evaluate the relationship between the intensity of
radiation exposure and the density produced after process-
ing. The radiographic film should be exposed to a range of
radiation intensities to evaluate its response to low, middle,
and high exposures. This can be accomplished easily by using
a radiographic x-ray unit and passing the radiation through
an object that varies in thickness. The resultant effect is an
image of varying uniform densities that correspond to a spe-
cific intensity of radiation exposure.
Penetrometer. ​A penetrometer is a device constructed of
uniform absorbers of increasing thicknesses, such as alumi-
num or tissue-equivalent plastic (Figure 9-32). When radio-
graphed, the penetrometer produces a series of uniform
densities that resemble a step wedge (Figure 9-33). When
step-wedge densities are produced with a penetrometer and
a radiographic x-ray unit, the variability of the output of the
equipment could affect the range of densities produced.

FIG 9-31  ​Low-contrast (long-scale) image showing many

FIG 9-32  ​Penetrometer. When radiographed, a penetrome-
gray tones and little difference between individual densi-
ter produces an image showing a series of uniform densities.
ties. (From Fauber TL: Radiographic imaging and exposure,
(From Fauber TL: Radiographic imaging and exposure, ed 3,
ed 3, St Louis, 2009, Mosby.)
St Louis, 2009, Mosby.)

relationship demonstrates how inherent differences in the

manufacturing of the film affect the visibility characteristics
of the radiograph.

Sensitometry
In radiography, sensitometry is the study of the relation-
ship between the intensity of radiation exposure to the film
and the amount of blackness produced after processing
(density).
Sensitometry provides a method of evaluating the charac-
teristics of film and film-screen combinations used in radio­
graphy. Radiographic film and intensifying screen manufac-
turers are capable of designing film and screens to respond
differently to a given intensity of radiation exposure. For equal
radiation exposures, film designed for radiography of the
chest responds differently than extremity film. The radiogra-
pher should understand how the film-screen system used
responds to a given intensity of exposure.
Sensitometry is also a method of evaluating the perfor-
mance of automatic film processors. Because automatic film FIG 9-33  ​Step-Wedge Densities. Radiograph of a penetrom-
processors affect a radiograph’s density and contrast, the eter showing step-wedge of densities.  (From Fauber TL:
variability of their performance can be monitored by sensito- Radiographic imaging and exposure, ed 3, St Louis, 2009,
metric methods, as explained in Chapter 12. Mosby.)
110 SECTION II  Image Production and Evaluation

Vertical Shoulder
axis (y)

Straight-line

Optical density
region

FIG 9-34  ​Sensitometer. A sensitometer is designed to pro-

duce consistent step-wedge densities.
Toe

Radiation exposure Horizontal

Sensitometer. ​A device known as a sensitometer is de- axis (x)
signed to produce consistent step-wedge densities by elimi- FIG 9-35  ​Sensitometric Curve. Plotting optical densities
nating the variability of the x-ray unit (Figure 9-34). It uses a corresponding to the change in intensity of exposure results
controlled light source to expose an optical step-wedge tem- in a curve characteristic of the type of film.
plate. The step-wedge template transmits light in varying in-
tensities to expose the radiographic film. After the film has density occurs. Similarly, along the x-axis, for every 0.3 change
been processed, a density step-wedge image, or sensitometric in log relative exposure, the intensity of radiation exposure
strip, is produced. Penetrometers and sensitometers are changes by a factor of 2 (Figure 9-36). When Figure 9-36 is
available in 11-, 15-, or 21-step densities. used as an example, the relative mAs value is 32 for the log
As discussed earlier, a densitometer is the device that mea- exposure of 1.5, and the relative mAs value is 64 for the log
sures the densities processed on the film. When the optical exposure of 1.8. This relationship can be demonstrated
density measurements from a sensitometric strip are graphed
on semilogarithmic paper, the result is a curve characteristic
of the radiographic film type. Box 9-3 lists other terms used
for the sensitometric curve.
This sensitometric curve visually demonstrates the rela- .01 4
tionship between the intensity of radiation exposure (x-axis)
and the resultant optical densities (y-axis) (Figure 9-35). The .1 3
% Transmission

Optical density

position of the curve on the x-axis and its shape can vary
greatly and depend on the type of radiographic film used. 1 2
The range of optical densities, represented by the y-axis, as
discussed previously, represents the amount of light that is
10 1
transmitted through an area on the film.

Log Relative Exposure. ​When sensitometric methods are 100 0

used to evaluate the characteristics of radiographic film, it is

more useful to measure the intensity of radiation exposure in 0 10 100 1000
Exposure (mR)
increments of a constant factor, such as doubling or halving.
As discussed previously, for every doubling or halving change 0.3 0.9 1.5 2.1 2.7 3.3
Log relative exposure
in the percentage of light transmitted, a 0.3 change in optical
2 8 32 128 512 2048
Relative mAs

BOX 9-3  Other Terms for Sensitometric FIG 9-36  ​Log Relative Exposure. A sensitometric curve is
Curve created by plotting the optical density values obtained from
the range of exposures that are used to create the step-
Characteristic curve
wedge densities. The log relative exposure value represent-
D log E curve
ing the change in exposure by a factor of 2 is a more useful
H & D curve
value than the milliroentgen exposure (mR) or relative
Hurter & Driffield curve
milliamperage/second (mAs).
 CHAPTER 9  Image Quality and Characteristics 111

throughout the log relative exposure scale on the sensitomet- Shoulder Region. ​There is a point on the sensitometric
ric curve. Two exposures, one double the other, will always be curve where changes in exposure intensity no longer affect
separated by 0.3 on the logarithmic exposure scale. the optical density. In this shoulder region, the point on the
curve where maximum density has been produced is known
as Dmax. Once the maximum density achievable within the
CRITICAL CONCEPT film has been reached (Dmax), continued increases in expo-
Log Relative Exposure sure intensity begin to reverse the amount of optical density.
This process is called solarization, and it is the process used
A 0.3 change in log relative exposure represents a change in
in the design of duplicating film.
intensity of radiation exposure by a factor of 2. An increase of
0.3 log relative exposure results in a doubling of the amount
of radiation exposure, whereas a decrease in 0.3 log relative Film Characteristics. ​Comparing sensitometric curves on
exposure results in halving the amount of radiation exposure. these regions provides information about three important
characteristics of the radiographic film. Each film character-
istic plays an important role in radiographic imaging.
Regions. ​A sensitometric curve demonstrates three distinct Speed. ​An important characteristic of radiographic film is its
regions (Figure 9-37). When the characteristics of different sensitivity to radiation exposure, which is referred to as its speed.
types of radiographic film are evaluated, differences are dem- The speed of a film indicates the amount of optical density pro-
onstrated within any of these regions. duced for a given amount of radiation exposure. It is a character-
Toe Region. ​The toe region of the sensitometric curve istic of the film’s sensitivity to the intensity of radiation exposure.
represents the area of low density. Because most radiographic
film has a tint added to its base and processing adds a slight
amount of fog, the lowest amount of optical density is usually CRITICAL CONCEPT
between 0.1 and 0.2 OD. This minimum amount of density Film Speed and Optical Density
on the radiographic film is termed the base plus fog (B 1 F).
For a given exposure intensity, as the speed of a film in-
The point on the sensitometric curve where the minimum
creases, the optical density produced also increases; as the
amount of radiation exposure produced a minimum amount
speed of a film decreases, the optical density decreases.
of optical density is known as Dmin. Generally, the Dmin is
equal to B 1 F even though they represent two different mea-
surements. Changes in exposure intensity in this region have Speed Point. ​The speed of radiographic film typically is
little effect on the optical density. determined by locating the point on a sensitometric curve
Straight-Line Region. ​At some point along the x-axis, that corresponds to the optical density of 1 plus B 1 F. This
changes in exposure begin to have a much greater effect on point is called the speed point (Figure 9-38). This optical
the optical density. This straight-line region is where the density point is used because it is within the straight-line
diagnostic or most useful range of densities is produced. portion of the sensitometric curve. The speed point serves as
a standard method of indicating film speed.
Speed Exposure Point. ​When comparing film types, the
radiographer must determine what log exposure produced
Shoulder the speed point. This can be determined by drawing a line
Vertical
axis (y)
Dmax
Optical Density

Straight-line
region
Speed
point
1.18
Toe
Dmin

Log relative exposure

Base plus Horizontal
fog axis (x)

FIG 9-37  ​Sensitometric Curve. The sensitometric curve FIG 9-38  ​Speed Point. The sensitometric curve speed point
demonstrates three distinct regions: toe, straight-line, and indicates the intensity of exposure needed to produce a den-
shoulder. sity of 1 plus base plus fog.
112 SECTION II  Image Production and Evaluation

speed film is positioned to the left (closer to the y-axis) of

slower-speed film.
Contrast. ​Radiographic contrast is a result of both the
subject contrast and the film contrast (or image receptor
contrast). Film contrast is controlled by the design and
Speed manufacturing of the film components and the effect of pro-
point cessing. The ability of a radiographic film to provide a level
Density

1.18
of contrast can be evaluated by the steepness, or slope, of the
sensitometric curve. The slope of this line mathematically
indicates the ratio of the change in y (optical density) for a
unit change in x (log relative exposure).
Speed
exposure
point
MATH APPLICATION
Log relative exposure
Determining the Slope of a Line
FIG 9-39  ​Speed Exposure Point. The speed exposure point
indicates the intensity of exposure needed to produce a den- Y(rise) Y2 Y1
sity of 1 plus base plus fog (speed point). Slope  ,
X (run) X 2  X 1

The slope of a line mathematically indicates its tilt or slant.

from the sensitometric curve speed point to the area on the Comparisons of the slope (mathematical calculation) can be
x-axis (log exposure) that produced the optical density at made among different lines. For radiography, the higher the
1 plus B 1 F (Figure 9-39). This important point, called the number the steeper the slope, and the lower the number the
speed exposure point, indicates the intensity of exposure lesser the slope.
needed to produce a density of 1 plus B 1 F (speed point). A
film that has a speed exposure point of 0.9 is faster than a film Visually comparing the steepness (slope) of the straight-
having a speed exposure point of 1.2. line region of the curve provides a method of evaluating the
level of contrast produced by a film (Figure 9-41). Radio-
CRITICAL CONCEPT graphic film capable of producing higher contrast has a more
Film Speed and Speed Exposure Point vertical straight-line region (steeper slope).
The lower the speed exposure point, the faster the film speed;
the higher the speed exposure point, the slower the film speed.
CRITICAL CONCEPT
Slope and Film Contrast
Figure 9-40 presents two sensitometric curves and their
respective speed points and speed exposure points. A faster- The steeper the slope of the straight-line region (more verti-
cal), the higher the film contrast; the lesser the slope (less
vertical), the lower the film contrast.

Film A
3
Film B
Density

2
Speed
point

1 Slope Slope
Speed
exposure
point
0.3 0.6 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3.0
Log relative exposure

FIG 9-40  ​Film Speed. Obtaining the same speed point re-
quires that Film A have a 1.5 log of exposure and Film B have FIG 9-41  ​Slope. The slope of the straight-line region deter-
a 2 log of exposure. Faster-speed films are located to the left mines the inherent film contrast. Steeper slopes indicate
of slower-speed films. higher contrast.
 CHAPTER 9  Image Quality and Characteristics 113

CRITICAL CONCEPT
Average Gradient and Film Contrast
3.0
The greater the average gradient, the higher the film con-
trast; the lower the average gradient, the lower the film
contrast.
2.0
Density

Area to calculate Exposure Latitude.  Exposure latitude refers to the range

1.0 average gradient of exposures that produce optical densities within the straight-
line region of the sensitometric curve (Figure 9-43). Radio-
0.5
graphic films that are capable of responding to a wide range
0.25
of exposures to produce optical densities within the straight-
line region are considered wide-latitude film. When compar-
Log relative exposure
ing a film with narrow latitude to one with wide latitude, it is
FIG 9-42  ​Average Gradient. A film’s average gradient is apparent that a film with narrow latitude is a higher-contrast
calculated between a low density (0.25 plus base plus fog) film and a film with wide latitude is a lower-contrast film
and a high density (2 plus base plus fog). (Figure 9-44). A steep slope has a small range of exposures
available to produce densities within the straight-line region,
whereas a less steep slope has a greater range of exposures
General-purpose radiographic film is categorized as either available to produce densities within the straight-line region.
high contrast or medium contrast.
Average Gradient. ​When comparing film, the radiogra-
pher typically determines contrast by calculating the sensito- CRITICAL CONCEPT
metric curve’s average gradient of the slope of the straight- Exposure Latitude and Film Contrast
line region (Figure 9-42). A standard used in sensitometry is
Exposure latitude and film contrast have an inverse relation-
to determine the film contrast between the optical densities
ship. High-contrast radiographic film has narrow latitude, and
of 0.25 and 2 plus B 1 F. Finding the difference between these low-contrast film has wide latitude.
two points and dividing by the difference between their re-
spective log exposures provides a numerical calculation for
film contrast. Most radiographic film has an average gradient When selecting a type of radiographic film, the radiogra-
between 2.5 and 3.5. pher should evaluate its characteristics in terms of speed,
Film contrast is higher for a film with an average gradient
of 3.0 than it is for a film having an average gradient of 2.7.
4.0

MATH APPLICATION
3.0
Calculating Average Gradient
Given the log RE1 that corresponds to D1 and the log RE2 that
Optimal Density

D2
corresponds to D2, calculate the average gradient to deter-
2.0
mine its slope.
D2  D1
Average gradient 
log RE2  log RE1 1.0

where
D1
D1  OD 0.25  0.17 (B  F)
0.3 0.6 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3.0
D2  OD 2.0  0.17 (B F
F)
Base plus E1 E2
log RE1  Exposure that produces D1 fog (0.18)
Log relative exposure
log RE2  Exposure that produces D2
FIG 9-43  ​Exposure Latitude. A film’s exposure latitude can
Example: be determined by finding the range of exposures that pro-
duce densities within the straight-line region of the curve.
2.17  0.42 1.75 Using a low and high density similar to those used to calcu-
  2.65 Average gradient
1.46  0.8 0.66 late average gradient provides optical densities within the
straight-line region of the sensitometric curve.
114 SECTION II  Image Production and Evaluation

Recorded Detail
3.5 Film A In film-screen imaging, sharpness of the recorded detail de-
pends primarily on the construction of the film in combination
with the intensifying screen. The speed of the film-screen image
Film B
receptor affects its sensitivity to the radiation and therefore its
speed and resulting density. The factors that affect the speed of
2.5 the film-screen image receptors also affect the recorded detail or
sharpness of the anatomic tissues recorded. Factors that in-
crease the speed will also decrease the recorded detail. The
Optimal Density

thickness of the intensifying screen’s phosphor layer, size of the

Diagnostic crystals used in the phosphor, type of phosphor material, and
1.5 range presence of additional layers (such as a reflective or absorbing
layer) will all impact how sensitive the image receptor is to the
radiation exposure. However, factors that increase the speed
will result in more unsharpness recorded in the image. Film-
0.25 screen image receptors can vary greatly in terms of their speed
and therefore the amount of unsharpness recorded in the im-
0.3 0.6 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3.0 age. The speed and recorded detail required in a radiographic
procedures are important factors to consider. Reducing patient
Film A exposure when using a higher-speed film-screen image receptor
increases unsharpness in the recorded image. The construction
Film B of film-screen image receptors is discussed more thoroughly in
Chapter 12, “Image Receptors.”
Diagnostic range of exposures
An important difference between film-screen and digital
imaging is that digital images don’t have the same visual cues
FIG 9-44  ​Contrast and Exposure Latitude. A higher-con- as film images have regarding exposure to the image receptor.
trast film, Film A, has a narrower range of exposures available Excessive or insufficient exposure to the film-screen image
to produce optical densities within the straight-line region receptor will present a film image with excessive or insuffi-
compared with a lower-contrast film, Film B. cient density, respectively. However, digital images can be
displayed with appropriate brightness for excessive or insuf-
ficient exposure, within reason.
Regardless of the receptor type, the radiographer must
contrast, and latitude. Radiographic film used in chest radi- select the required exposure factors of milliamperage/second
ography typically requires lower contrast and wide expo- (mAs), and kilovoltage peak (kVp). In addition, accurate
sure latitude, whereas film designed for use with skeletal positioning of the patient for a variety of projections remains
radiography requires higher contrast, resulting in narrow a critical part of the imaging process. Various accessory de-
exposure latitude. In film-screen receptors, the film alone vices such as grids and collimators are still used for digital
determines contrast (hence latitude). Speed, however, is in- imaging. Regardless of the type, the image receptor receives
fluenced by both the film and the screen choice. The speed the varying radiation intensities exiting the anatomic part.
of radiographic film is considered in combination with the Although the design of the image receptor may differ greatly,
intensifying screen speed to provide a film-screen system a latent image is still produced (at least momentarily) and is
speed. processed to form a manifest image.

SUMMARY
• A good-quality radiographic image accurately represents • Differences in tissue thickness, tissue density, and effective
the anatomic area of interest and its information is well atomic number contribute to subject contrast.
visualized for diagnosis. • Resolution is an expression of the imaging system’s ability
• Visibility factors refer to the visibility of the anatomic to distinguish between two adjacent structures and can be
structures, and sharpness factors refer to the accuracy of measured in line pairs per millimeter.
their structural lines recorded in the radiographic image. • Distortion results from the misrepresentation of either the
• A radiograph must have sufficient brightness or density to size (magnification) or shape of the anatomic part and
permit visualization of the anatomic structures of interest. should be minimized to improve radiographic quality.
• Radiographic contrast is a result of tissue differential at- • Reducing image unsharpness is achieved by maximizing
tenuation of the x-ray beam and makes anatomic detail the amount of recorded detail and minimizing the amount
visible. of distortion of the image.
 CHAPTER 9  Image Quality and Characteristics 115

S U M M A R Y — cont’d
• Shape distortion can appear radiographically as elonga- • Digital imaging systems can adjust for exposure technique
tion or foreshortening. errors, but poor image quality or increased patient expo-
• Scatter radiation provides unwanted exposure or fog on sure may result.
the image and does not provide information about the • Film-screen image receptors have a narrow dynamic range
anatomic area of interest. when compared with digital image receptors.
• Quantum noise is visible as brightness or density fluctua- • Optical density is a measurement of the amount of light
tions on the image and contributes no useful information. transmitted through an area on the radiograph.
• Image artifacts are detrimental to radiographs and should • Radiographic images are typically described by their scale
be avoided. of contrast, or the range of densities visible.
• Digital image receptors have a wide dynamic range and • A radiograph with few densities but great differences
can accurately detect very low exposure intensities and among them is said to have high contrast or short-scale
very high exposure intensities. contrast.
• The exposure indicator provides a numeric value indicat- • A radiograph with a large number of densities but few dif-
ing the level of radiation exposure to the digital image ferences among them is said to have low contrast or long-
receptor. scale contrast.
• A digital image is displayed as a matrix having columns • A sensitometric curve is characteristic of film and can dif-
and rows composed of pixels. fer in speed, contrast, and latitude.
• A digital image consisting of a greater number of smaller • Speed is the sensitivity of film to radiation and has a direct
pixels will improve spatial resolution. relationship with optical density.
• The pixel bit depth determines the number of shades of • The slope of the straight-line portion of a sensitometric
gray the digital image can display. The larger the bit depth, curve (average gradient) indicates the film’s level of con-
the greater the number of shades of gray displayed to trast; the steeper the slope, the higher the contrast.
improve image quality. • Latitude refers to the range of exposures that produce
• Contrast resolution determines the level of visibility of optical densities in the straight-line portion of the sensito-
small objects having similar shades of gray. A digital image metric curve and is inversely related to contrast. Higher-
has improved contrast resolution when compared with a contrast films have narrow exposure latitude.
film-screen image. • The speed of the film-screen image receptor is inversely
• The window level controls image brightness by manipu- related to the recorded anatomic detail. Increasing the
lating the midpoint of the range of densities visible in the speed of the film-screen image receptor results in de-
image. creased recorded detail.
• The window width adjusts the grayscale to display the • Film-screen images provide visual cues for overexposure
level of contrast. Increasing the (wider) window width will and underexposure, whereas digital images can display
decrease the contrast displayed in the digital image. De- adequate brightness for exposure errors.
creasing the (narrow) window width will increase the
contrast displayed in the digital image.

CRITICAL THINKING QUESTIONS

1. Why does the visibility of anatomic tissue depend on the 3. Why does a good-quality radiographic image also depend
radiograph’s optical density/brightness and contrast? on its recorded detail/spatial resolution and distortion?
2. How does anatomic tissue composition affect beam at- 4. How do the effects of quantum noise and scatter differ
tenuation and subsequently the radiographic contrast between digital and film screen imaging?
produced after processing?

REVIEW QUESTIONS
1 . A quality radiograph must include: 2 . Visibility factors of a quality radiograph include:
a. accuracy of structural lines recorded. a. brightness/density.
b. minimal unsharpness. b. spatial resolution/recorded detail.
c. visibility of anatomic structures. c. contrast.
d. all of the above. d. a and c.
Continued
116 SECTION II  Image Production and Evaluation

R E V I E W Q U E S T I O N S — cont’d
3. A digital image with _____________ brightness will have 10. In digital imaging, which of the following determines the
_____________ density on film. range of grayscale available for display?
a. increased, increased a. pixel density
b. increased, decreased b. matrix size
c. decreased, decreased c. pixel bit depth
d. None of the above d. exposure indicator
4. Increasing the quantity of radiation will 11. During digital image display, the contrast can be lowered
______________________ film density? (decreased) by increasing _____________.
a. increase a. pixel density.
b. decrease b. grayscale.
c. maintain c. window level.
d. have no effect on d. window width.
5. Anatomic tissues that attenuate the x-ray beam equally are 12. A digital image receptor exposed to excessive radiation
said to have: would result in:
a. high density. a. excessive brightness.
b. high contrast. b. higher contrast.
c. low subject contrast. c. insufficient brightness.
d. less unsharpness. d. increased patient exposure.
6. An imaging system that is capable of resolving 10 Lp/mm 13. A calculation of the amount of light transmitted through
instead of 6 Lp/mm is said to have: film is known as:
a. less distortion. a. contrast resolution.
b. more unsharpness. b. grayscale.
c. more distortion. c. optical density.
d. improved sharpness. d. dynamic range.
7. Unwanted exposure to the image receptor will likely 14. In film imaging, diagnostic densities should fall within
increase: which region of the sensitometric curve?
a. unsharpness. a. shoulder
b. noise. b. straight-line
c. fog. c. base plus fog
d. none of the above. d. toe
8. What is defined as “The range of exposure intensities an 15. A film manufactured to display high contrast would
image receptor can accurately detect”? have_________ slope and _________ latitude.
a. resolution a. narrow, narrow
b. sharpness b. steep, narrow
c. speed exposure point c. steep, wide
d. dynamic range d. none of the above
9. For a given field of view (FOV), a _________ matrix size
will result in _________pixels.
a. large, fewer
b. large, more
c. small, more
d. none of the above
 10
Radiographic Exposure Technique

OUTLINE
Introduction Film-Screen Relative Speed
Primary Factors Compensating Filters
Milliamperage and Exposure Time Patient Factors
Kilovoltage Body Habitus
Secondary Factors Part Thickness
Focal Spot Size Pediatric Patients
Source-to-Image Receptor Distance Radiation Protection Review
Object-to-Image Receptor Distance kVp and mAs
Calculating Magnification Beam Restriction
Central Ray Alignment Grid Selection
Grids Film-Screen Speed
Beam Restriction Excessive Radiation Exposure and Digital Imaging
Generator Output Summary
Tube Filtration

OBJECTIVES
• Explain the relationship between milliamperage and ex- • Calculate the magnification factor and object percent
posure time with radiation production and image recep- magnification and determine image and object size.
tor exposure. • Describe the use of grids and beam restriction and their
• Calculate changes in milliamperage and exposure time to effect on image receptor exposure and image quality.
change or maintain exposure to the image receptor. • Calculate changes in mAs when adding or removing
• Compare the effect of changes in milliamperage and a grid.
exposure time on film-screen and digital images. • Calculate the change in mAs when changing the film-
• Recognize how to correct exposure factors for a density screen relative speed.
error. • Recognize patient factors that may affect image receptor
• Explain how kVp affects radiation production and image exposure.
receptor exposure. • Identify the exposure factors that can affect patient radia-
• Calculate changes in kVp to change or maintain exposure tion exposure.
to the image receptor. • State exposure technique modifications for patient fac-
• Recognize the factors that affect recorded detail and tors such as body habitus, part thickness, and pediatric
distortion. patients.
• Calculate changes in mAs for changes in source-to-image
receptor distance.

KEY TERMS
15% rule mAs/distance compensation formula source-to-image receptor distance
body habitus object-to-image receptor distance (SID)
inverse square law (OID) Source-to-object distance (SOD)
magnification factor (MF)

117
118 SECTION II  Image Production and Evaluation

INTRODUCTION Milliamperage and Exposure Time

In Chapter 6 variables that affect both the quantity and qual- The quantity of radiation reaching the patient affects the
ity of the x-ray beam were presented. Milliamperage and time amount of remnant radiation reaching the IR. The product
affect the quantity of radiation produced and kilovoltage of milliamperage and exposure time has a direct proportional
affects both the quantity and quality. Chapter 9 emphasized relationship with the quantity of x-rays produced.
that a good-quality radiographic image accurately represents
the anatomic area of interest. The characteristics evaluated
for image quality are brightness/density, contrast, spatial MAKE THE PHYSICS CONNECTION
resolution/recorded detail, distortion, and quantum noise. Chapter 6
This chapter focuses on radiographic exposure techniques
Because the milliamperage/second (mAs) controls the num-
and the use of accessory devices and their effect on the radia-
ber of electrons boiled off of the filament and available to
tion reaching the image receptor (IR) and the image pro-
produce x-rays, it is considered the primary factor controlling
duced. Radiographers have the responsibility of selecting the quantity. All other factors remaining constant, an increase in
combination of exposure factors to produce a quality image. milliamperage increases the amplitude of both the continu-
Knowledge of how these factors affect the image individually ous and discrete portions of the spectrum.
and in combination helps radiographers produce a radio-
graphic image with the amount of information desired for
diagnostic interpretation. Once the anatomic part is adequately penetrated, as the
Because various types of IRs respond differently to the quantity of x-rays is increased, the exposure to the IR propor-
radiation exiting the patient (remnant), these differences are tionally increases (Figure 10-1). Conversely, when the quan-
noted throughout this chapter. However, regardless of the tity of x-rays is decreased, the exposure to the IR decreases.
type of IR, the patient should be exposed to the least amount Therefore, exposure to the IR can be increased or decreased
of radiation necessary to produce a diagnostic-quality radio- by adjusting the amount of radiation (mAs).
graph. This chapter discusses all of the primary and second-
ary factors and their effects on the radiation reaching the IR.
CRITICAL CONCEPT
PRIMARY FACTORS mAs and Quantity of Radiation
As the mAs is increased, the quantity of radiation reaching
The primary exposure technique factors the radiographer
the IR is increased proportionally. As the mAs is decreased,
selects on the control panel are milliamperage, time of expo-
the amount of radiation reaching the IR is decreased propor-
sure, and kilovoltage peak (kVp). Depending on the type of tionally.
control panel, milliamperage and exposure time may be se-
lected separately or combined as one factor, milliamperage/
second (mAs). Regardless, it is important to understand how Because the mAs is the product of milliamperage and ex-
changing each separately or in combination affects the radia- posure time, increasing milliamperage or time has the same
tion reaching the IR and the radiographic image. effect on the radiation exposure.

Less More
mAs mAs

Less exit radiation More exit radiation

reaching image receptor reaching image receptor
FIG 10-1  ​mAs and Radiation Exposure. As the quantity of x-rays is increased (mAs), the expo-
sure to the image receptor proportionally increases.
 CHAPTER 10  Radiographic Exposure Technique 119

MATH APPLICATION can detect a wider range of radiation intensities (wider dy-
namic range) exiting the patient and therefore are not as
Adjusting Milliamperage or Exposure Time
dependent on the mAs as film-screen IRs. However, expo-
100 mA  0.1 s  10 mAs sure errors can adversely affect the quality of the digital im-
age. If the mAs is too low (low exposure to the digital IR),
To increase the mAs to 20, you could use: image brightness is adjusted during computer processing
100 mA  0.2 s  20 mAs to achieve the desired level. Although the level of brightness
has been adjusted, there may be increased quantum noise
200 mA  0.1 s  20 mAs visible within the image. If the mAs selected is too high (high
exposure to the digital IR), the brightness can also be ad-
justed, but the patient has received more radiation than
As demonstrated in the Math Application, mAs can be necessary. The radiographer should be diligent in monitor-
doubled by doubling the milliamperage or doubling the ex- ing exposure indicator values to ensure that quality images
posure time. A change in either milliamperage or exposure are obtained with the lowest possible radiation dose to the
time proportionally changes the mAs. To maintain the same patient (Box 10-1).
mAs, the radiographer must increase the milliamperage and
proportionally decrease the exposure time.
CRITICAL CONCEPT
mAs and Digital Image Brightness
CRITICAL CONCEPT
The mAs does not have a direct effect on image brightness
Milliamperage and Exposure Time when using digital IRs. During computer processing, image
Milliamperage and exposure time have an inverse propor- brightness is maintained when the mAs is too low or too
tional relationship when maintaining the same mAs. high. A lower-than-required mAs produces an image with in-
creased quantum noise and a higher-than-needed mAs ex-
poses the patient to unnecessary radiation.

MATH APPLICATION
Adjusting Milliamperage and Exposure Time For film-screen IRs, the mAs controls the density pro-
to Maintain mAs duced in the image. There is a direct relationship between the
amount of mAs and the amount of density produced when
100 mA  100 ms (0.1 s)  10 mAs using film-screen IRs. For example, when the mAs is in-
creased, density is increased; when the mAs is decreased,
To maintain the mAs, use:
density is decreased (Figure 10-2).
50 mA  200 ms (0.2 s)  10 mAs When a film image is too light (insufficient density), a
greater increase in mAs may be needed to correct the density,
200 mA  50 ms (0.05 s)  10 mAs or the mAs may need to be decreased to correct a film image
that has excessive density. This relationship between radia-
tion exposure intensity and density is discussed in more de-
It is important for the radiographer to determine the tail in Chapter 9. In addition, the film characteristic, speed,
amount of mAs needed to produce a diagnostic image. This and chemical processing determine the amount of optical
is not an easy task because there are so many variables that density produced on the image for a given mAs.
can affect the amount of mAs required. For example, single- When using a film-screen IR, radiographers need to assess
phase generators produce less radiation for the same mAs the level of density produced on the processed image and
than do high-frequency generators. determine whether the density is sufficient to visualize the
anatomic area of interest. When the radiograph is deemed
MAKE THE PHYSICS CONNECTION
Chapter 6
BOX 10-1  Radiation Protection:
High-frequency units produce x-rays much more efficiently
than single-phase units. A high-frequency unit produces
Excessive Radiation Exposure and Digital
more x-rays using the same amount of electricity. Imaging
Although the computer can adjust image brightness for tech-
A patient’s age, condition, and the presence of a patho- nique exposure errors, routinely using more radiation than
logic condition also affect the amount of mAs required for required for the procedure in digital radiography unnecessar-
the procedure. Additionally, for a given mAs, IRs respond ily increases patient exposure. Even though the digital sys-
tem can adjust for overexposures, it is an unethical practice
differently. For example, mAs does not control the amount
to knowingly overexpose a patient.
of brightness displayed within a digital image. Digital IRs
120 SECTION II  Image Production and Evaluation

A B C
FIG 10-2  ​mAs and Radiographic Density. Changes in mAs have a direct effect on density. A,
Original image. B, Decreased in density when the mAs is decreased by half. C, Increase in den-
sity when the mAs is doubled.  (From Fauber TL: Radiographic imaging and exposure, ed 3,
St Louis, 2009, Mosby.)

unacceptable, this means the optical densities lie outside the (depending on equipment, this may vary between 25% and
film’s sensitometric curve’s straight-line portion, and the 35%). Radiographic images generally are not repeated to
radiograph may need to be repeated. The radiographer must make only a slight visible change. A radiographic image re-
decide how much of a change in mAs is needed to correct for peated because of insufficient or excessive density requires a
the density error. change in mAs by a factor of at least 2.
In general, for repeat radiographs necessitated by density
errors, the mAs is adjusted by a factor of 2; therefore, a mini-
mum change involves doubling or halving the mAs. This CRITICAL CONCEPT
typically brings the optical densities back within the straight-
mAs and Film-Screen Density
line portion of the film’s sensitometric curve to best visualize
the anatomic area of interest. As mentioned previously, it The mAs has a direct effect on the amount of radiographic
may take more than doubling the mAs to correct for a density density produced when using a film-screen IR. The minimum
error. If the radiograph necessitates an adjustment greater change needed to correct for a density error is determined by
than a factor of 2, the radiographer should multiply or divide multiplying or dividing the mAs by 2. When a greater change
in mAs is needed, the radiographer should multiply or divide
the mAs by 4 (Figure 10-3).
by 4, 8, and so on.
Radiographs that have sufficient but not optimal density
usually are not repeated. If a radiograph must be repeated
because of another error, such as positioning, the radiogra- To best visualize the anatomic area of interest, the mAs
pher may also use the opportunity to make an adjustment in selected must produce a sufficient amount of radiation reach-
density to produce a radiograph of optimal quality. Making ing the IR, regardless of type. Excessive or insufficient mAs
a visible change in radiographic density requires that the adversely affects image quality and affects patient radiation
minimum amount of change in mAs be approximately 30% exposure.

A B
FIG 10-3  ​Adjusting mAs for Density Errors. A, A greater increase in mAs, four times the
original mAs, is needed. B, A greater decrease in mAs, one-fourth the original mAs, is needed.
(From Fauber TL: Radiographic imaging and exposure, ed 3, St Louis, 2009, Mosby.)
 CHAPTER 10  Radiographic Exposure Technique 121

Kilovoltage adjusted, but quantum noise may be visible. Additionally,

The kVp affects the exposure to the IR because it alters the when a kVp that is too high is selected, the image brightness
amount and penetrating ability of the x-ray beam. and contrast are adjusted, but patient exposure may be in-
creased. Although image contrast can be adjusted when using
a kVp that is too high, increased scatter radiation reaches the
MAKE THE PHYSICS CONNECTION IR and may adversely affect image quality.
Chapter 6
When the kVp is increased at the control panel, a larger po- CRITICAL CONCEPT
tential difference occurs in the x-ray tube, giving more elec- Kilovoltage and Digital Image Quality
trons the kinetic energy to produce x-rays and increasing the
kinetic energy overall. The result is more photons (quantity) Assuming that the anatomic part is adequately penetrated,
and higher-energy photons (quality). changing the kVp does not affect the digital image the same
as a film-screen image. Image brightness and contrast are
primarily controlled during computer processing.
The area of interest must be adequately penetrated before
the mAs can be adjusted to produce a diagnostic-quality ra- The kVp has a greater effect on the image when using
diographic image. When adequate penetration is achieved, film-screen IRs. Increasing the kVp increases IR exposure and
further increasing the kVp results in more radiation reaching the density produced on a film image, and decreasing the kVp
the IR. Unlike mAs, the kVp affects the amount of radiation decreases IR exposure and the density produced on a film
exposure to the IR and radiographic contrast. image (Figure 10-4).
For film-screen IRs, kVp has a direct relationship with
density; however, the effect of the kVp on density is not equal
CRITICAL CONCEPT throughout the range of kVp (low, middle, and high). A
kVp and the Radiographic Image greater change in the kVp is needed when operating at a high
kVp (greater than 90) compared with operating at a low kVp
Increasing or decreasing the kVp changes the amount of ra- (less than 70) (Figure 10-5).
diation exposure to the IR and the contrast produced within
Because kVp affects the amount of radiation reaching the
the image.
IR, its effect on the digital image is similar to the effect of
mAs. Too much radiation reaching the IR (within reason)
Adequate penetration of the anatomic area of interest is produces a digital image with the appropriate level of bright-
equally important when using digital IRs, and therefore kVp ness as a result of computer adjustment during image pro-
selection is important in producing a quality image. Assum- cessing; however, the patient has been overexposed. Similarly,
ing that the anatomic part is adequately penetrated, changing too little radiation reaching the IR (within reason) produces
the kVp does not affect the digital image in the same way as a digital image with the appropriate level of brightness, but
it does a film-screen image. The kVp affects the contrast in a the increased noise decreases image quality.
digital image; however, image brightness and contrast are Kilovoltage is not a factor typically manipulated to vary
primarily controlled during computer processing. When a the amount of IR exposure in film-screen imaging because
kVp that is too low is selected, the brightness and contrast are the kVp also affects contrast. However, it is sometimes

Low-energy High-energy
(kVp) beam (kVp) beam

Most x-ray photons are Photons have more energy

absorbed. Few emerge to to penetrate the part.
strike the image receptor.
FIG 10-4  ​kVp and Radiation Exposure. Increasing the kVp increases the penetrating power of
the radiation and increases the exposure to the image receptor.
122 SECTION II  Image Production and Evaluation

A B

C D
FIG 10-5  ​kVp Range and Radiographic Density. Produced at 50 kVp (A) and produced at
90 kVp with the mAs adjusted to maintain radiographic density (C). A 10-kVp increase at 50 kVp
(B) produces a greater change in density than a 10-kVp increase at 90 kVp (D). (From Fauber TL:
Radiographic imaging and exposure, ed 3, St Louis, 2009, Mosby.)

necessary to manipulate the kVp to maintain the required low or high kVps are used, the amount of change in the kVp
exposure to the IR. For example, using portable or mobile required to maintain the exposure to the IR may be greater
x-ray equipment may limit choices of mAs settings, and or less than 15%.
therefore the radiographer must adjust the kVp to maintain
sufficient exposure to the IR.
Maintaining or adjusting exposure to the IR can be ac- MATH APPLICATION
complished with kVp by using the 15% rule. The 15% rule Using the 15% Rule
states that changing the kVp by 15% has the same effect as
doubling the mAs or reducing the mAs by 50%; for example, To increase exposure to the IR, multiply the kVp by 1.15
increasing the kVp from 82 to 94 (15%) produces the same (original kVp 1 15%).
exposure to the IR as increasing the mAs from 10 to 20. 80 kVp  1.15  92 kVp

CRITICAL CONCEPT To decrease exposure to the IR, multiply the kVp by 0.85
(original kVp 2 15%).
kVp and the 15% Rule
A 15% increase in kVp has the same effect as doubling the 80 kVp  0.85  68 kVp
mAs. A 15% decrease in kVp has the same effect as decreas- To maintain exposure to the IR, when increasing the kVp by
ing the mAs by half. 15% (kVp 3 1.15), divide the original mAs by 2.

80 kVp  1.15  92 kVp and mAs/2

Increasing the kVp by 15% increases the exposure to the
IR, unless the mAs is decreased. Also, decreasing the kVp by When decreasing the kVp by 15% (kVp 3 0.85), multiply the
15% decreases the exposure to the IR, unless the mAs is mAs by 2.
increased. As mentioned earlier, the effects of changes in the 80 kVp  0.85 and mAs  2
kVp are not uniform throughout the range of kVp. When
 CHAPTER 10  Radiographic Exposure Technique 123

Altering the penetrating power of the x-ray beam affects MAKE THE PHYSICS CONNECTION
its absorption and transmission through the anatomic tissue
Chapter 7
being radiographed. Higher kVp increases the penetrating
power of the x-ray beam and results in less absorption and The probability of Compton scattering is related to the energy
more transmission in the anatomic tissues, which results in of the photon. As x-ray photon energy increases, the probabil-
less variation in the x-ray intensities exiting the patient (rem- ity of that photon penetrating a given tissue without interac-
nant). As a result, images with lower contrast are produced tion increases. However, with this increase in photon energy,
the likelihood of Compton interactions relative to photoelec-
(Figure 10-6). When a low kVp is used, the x-ray beam pen-
tric interactions also increases. Scatter radiation remains a
etration is decreased, resulting in more absorption and less
concern at higher kVp and provides no useful information and
transmission, which results in greater variation in the x-ray always decreases the radiographic contrast.
intensities exiting the patient (remnant). This produces a
high-contrast radiographic image (Figure 10-7).
CRITICAL CONCEPT
CRITICAL CONCEPT Kilovoltage, Scatter Radiation,
kVp and Radiographic Contrast and Radiographic Contrast
A high kVp results in less absorption and more transmission At higher kVp, a greater proportion of Compton scattering
in the anatomic tissues, which results in less variation in the occurs compared with x-ray absorption (photoelectric effect),
x-ray intensities exiting the patient (remnant), producing a which decreases radiographic contrast. Decreasing the kVp
low-contrast (long-scale) image. A low kVp results in more decreases the proportion of Compton scattering and
absorption and less transmission in the anatomic tissues, but increases radiographic contrast.
with more variation in the x-ray intensities exiting the patient,
resulting in a high-contrast (short-scale) image.

The level of radiographic contrast desired, and therefore

Changing the kVp affects its absorption and transmission the kVp selected, depends on the type and composition of the
as it interacts with anatomic tissue; however, using a higher anatomic tissue, the structures that must be visualized, and to
kVp reduces the total number of interactions and increases some extent the diagnostician’s preference. These factors
the amount of x-rays transmitted. In these interactions, more make achieving a desired level of radiographic contrast more
Compton scattering than x-ray absorption occurs (photo- complex than achieving a desired level of radiographic den-
electric effect) and more scatter exits the patient. sity, especially for film-screen imaging.

BONE FAT AIR

FIG 10-6  ​kVp and Exit-Beam Intensities. Higher kVp increases the penetrating power of the
x-ray beam and results in less absorption and more transmission in the anatomic tissues, which
results in less variation in the x-ray intensities exiting the patient. As a result, images with lower
contrast are produced.  (From Fauber TL: Radiographic imaging and exposure, ed 3, St Louis,
2009, Mosby.)
124 SECTION II  Image Production and Evaluation

BONE FAT AIR

FIG 10-7  ​kVp and Exit-Beam Intensities. Lower kVp decreases the x-ray beam penetration,
resulting in more absorption and less transmission, which results in greater variation in the x-ray
intensities exiting the patient. As a result, images with higher contrast are produced.  (From
Fauber TL: Radiographic imaging and exposure, ed 3, St Louis, 2009, Mosby.)

For most anatomic regions, an accepted range of kVp BOX 10-2  Radiation Protection:
provides an appropriate level of radiographic contrast. As kVp and mAs
long as the kVp selected is sufficient to penetrate the ana-
Whenever possible, a higher kVp and lower mAs should be
tomic part, the kVp can be further manipulated to alter the
used to reduce patient exposure. Increasing kVp requires less
radiographic contrast.
mAs to maintain the correct exposure to the IR and decreases
Radiographs generally are not repeated because of con- the radiation dose to the patient. For example, changing from
trast errors. More often, the radiographer evaluates the level 70 to 81 when radiographing a pelvis is a 15% increase in kVp
of contrast achieved to improve the contrast for additional and requires half the mAs needed at 70 kVp. Higher kVp in-
radiographs or similar circumstances that arise with a differ- creases the beam penetration and therefore less quantity of
ent patient. If a repeat radiograph is necessary and kVp is to radiation is needed to achieve the required amount of radia-
be adjusted to either increase or decrease the level of contrast, tion reaching the IR and produce a diagnostic-quality image.
the 15% rule provides an acceptable method of adjustment.
In addition, whenever a 15% change is made in the kVp to
maintain the exposure to the IR, the radiographer must
adjust the mAs by a factor of 2. Remember that a 15% change
SECONDARY FACTORS
in kVp does not produce the same effect across the entire Many secondary factors affect the radiation reaching the IR
range of kVp used in radiography. A greater increase is and image quality. It is important for the radiographer to
needed for high kVp (90 and above) than for low kVp understand their effects individually and in combination.
(below 70).
The selection of kVp alters its absorption and transmis- Focal Spot Size
sion through the anatomic part regardless of the type of On the control panel the radiographer can select whether to
IR used and therefore must be selected wisely. Exposure use a small or large focal spot size. The physical dimensions
techniques using higher kVp with lower mAs exposure of the focal spot on the anode target in x-ray tubes used
techniques are recommended in digital imaging because in standard radiographic applications usually range from
contrast is primarily controlled during computer process- 0.5 to 1.2 mm. Small focal spot sizes are usually 0.5 or
ing. Higher kVp and lower mAs values are not recom- 0.6 mm, and large focal spot sizes are usually 1 or 1.2 mm.
mended as a general rule during film-screen imaging Focal spot size is determined by the filament size. When the
because of the contrast required to best visualize the ana- radiographer selects a particular focal spot size, he or she
tomic structures (Box 10-2). is actually selecting a filament size that is energized during
 CHAPTER 10  Radiographic Exposure Technique 125

x-ray production. Focal spot size is an important consider- a particular examination or anatomic part against the amount
ation for the radiographer because the focal spot size affects of radiation exposure used. Modern radiographic x-ray gen-
sharpness. erators are equipped with safety circuits that prevent an expo-
sure from being made if that exposure exceeds the tube load-
MAKE THE PHYSICS CONNECTION ing capacity for the focal spot size selected. Repeated exposures
Chapter 5 made just under the limit over a long period can still jeopar-
dize the life of the x-ray tube.
The actual focal spot is the area being bombarded by the fila-
ment electrons. The size of the electron stream depends on Source-to-Image Receptor Distance
the size of the filament. The smaller this stream, the greater
the heat generated in a small area; therefore, it is desirable The distance between the source of the radiation and the IR,
to have a larger actual focal spot area. The effective focal spot source-to-image receptor distance (SID), affects the amount
is the origin of the x-ray beam and is the area as seen from of radiation reaching the patient. Because of the divergence
the patient’s perspective. The smaller this area of origin, the of the x-ray beam, the intensity of the radiation varies at dif-
sharper the image. It is desirable to keep this as small as ferent distances.
practical to improve image quality (Figure 10-8).
MAKE THE PHYSICS CONNECTION
Chapter 6
CRITICAL CONCEPT
X-ray photons diverge as they travel away from the source. If
Focal Spot Size and Spatial Resolution the distance is shorter, they do not have the opportunity to
As focal spot size increases, unsharpness increases and spa- diverge as much and are then concentrated on a smaller area.
tial resolution decreases; as focal spot size decreases, un-
sharpness decreases and spatial resolution increases.
This relationship between distance and x-ray beam inten-
sity is best described by the inverse square law. The inverse
In general, the smallest focal spot size available should be square law states that the intensity of the x-ray beam is in-
used for every exposure. Unfortunately, exposure is limited versely proportional to the square of the distance from the
with a small focal spot size. When a small focal spot is used, source. Because beam intensity varies as a function of the
the heat created during the x-ray exposure is concentrated in square of the distance, SID affects the quantity of radiation
a smaller area and could cause tube damage. The radiographer reaching the IR. As SID is increased, the x-ray intensity is
must weigh the importance of improved spatial resolution for spread over a larger area. This decreases the overall intensity
of the x-ray beam reaching the IR (Figure 10-9).
F F

CRITICAL CONCEPT
SID and X-ray Beam Intensity
As SID increases, the x-ray beam intensity is spread over a
larger area. This decreases the overall intensity of the x-ray
beam reaching the IR.

Object Object MATH APPLICATION

Inverse Square Law Formula

I1 (D2 )2

I2 (D1)2
The intensity of radiation at an SID of 40 inches (100 cm) is
equal to 500 mR. What is the intensity of radiation when the
distance is increased to 56 inches (140 cm)?
Image Image
500 mR (56)2
Area of Area of 
A unsharpness B unsharpness
X (40)2
500 mR  1600  3136X;
FIG 10-8  ​Focal Spot Size and Spatial Resolution. Focal
spot size influences the amount of unsharpness recorded in 800,000
 X; 255.1 mR  X
the image. As focal spot size changes, so does the amount of 3136
unsharpness. A, Larger focal spot. B, Smaller focal spot.
126 SECTION II  Image Production and Evaluation

1m
20
inches

40
inches 2m

A B
FIG 10-9  ​SID and Radiation Intensity. Beam intensity varies as a function of the square of the
distance. A, This decreases the overall intensity of the x-ray beam reaching the image receptor
and B, as SID is increased, the x-ray intensity is spread over a larger area.

Because increasing the SID decreases x-ray beam intensity, MATH APPLICATION
the mAs must be increased accordingly to maintain the
mAs/Distance Compensation Formula
proper exposure to the IR. When the SID is decreased, the
beam intensity increases; therefore the mAs must be de-
mAs1 (SID1)2
creased accordingly to maintain proper exposure to the IR. 
mAs2 (SID2 )2
CRITICAL CONCEPT Proper exposure to the IR is achieved at an SID of 40 inches
SID and mAs using 25 mAs. The SID must be increased to 56 inches. What
adjustment in mAs is needed to maintain exposure to the IR?
Increasing the SID requires that the mAs be increased to
maintain exposure to the IR, and decreasing the SID requires 25 (40)2
a decrease in the mAs to maintain exposure to the IR.  ;
mAs2 (56)2
78,400
1600X  78,400 ;
Maintaining consistent radiation exposure to the IR when 1600
the SID is altered requires that the mAs be adjusted to com- mAs2  49
pensate. The mAs/distance compensation formula provides
a mathematical calculation for adjusting the mAs when
changing the SID.
between the source and IR increases, the diverging x-rays
Standard distances are used in radiography to provide become more perpendicular to the object radiographed and
more consistency in radiographic quality. Most diagnostic influence the amount of size distortion produced on a radio-
radiography is performed at an SID of 40, 48, or 72 inches. graph (Figure 10-10).
Certain circumstances, such as trauma or mobile radiogra-
phy, do not allow for standard distances to be used. In these
circumstances the radiographer must determine the change CRITICAL CONCEPT
needed in the mAs to obtain a diagnostic-quality radiograph. SID, Size Distortion, and Spatial Resolution
When a 72-inch (180 cm) SID cannot be used, adjusting the
As SID increases, size distortion (magnification) decreases
SID to 56 inches (140 cm) requires half the mAs. When a
and spatial resolution increases; as SID decreases, size
40-inch (100 cm) SID cannot be used, adjusting the SID to distortion (magnification) increases and spatial resolution
56 inches (140 cm) requires twice the mAs. This quick decreases.
method of calculating mAs changes should produce suffi-
cient exposure to the IR.
In addition to altering the intensity of radiation, SID also Standard distances for SID are used in radiography to
affects image distortion and spatial resolution. As the distance accommodate equipment limitations. Except for chest and
 CHAPTER 10  Radiographic Exposure Technique 127

Source

Source

A B

Air gap

FIG 10-11  ​OID and Air Gap. Distance created between the
Large Small
size size
object and the image receptor reduces the amount of scatter
radiation reaching the image receptor.
FIG 10-10  ​SID and Size Distortion. A long SID creates less
magnification than a short SID. The image in A is larger than
that in B because the object is closer to the source.
the anatomic part with increased size distortion or magnifi-
cation (Figure 10-12).
cervical spine radiography, a 40-inch (100-cm) or 48-inch
(122-cm) SID is standard. A greater 72-inch (180-cm) SID, CRITICAL CONCEPT
such as used for chest imaging, decreases the magnification of OID, Size Distortion, and Spatial Resolution
the heart and records its size more accurately.
Increasing the OID increases magnification and decreases
Object-to-Image Receptor Distance spatial resolution, whereas decreasing the amount of OID
decreases magnification and increases spatial resolution.
When distance is created between the object radiographed
and the IR, known as object-to-image receptor distance
(OID), decreased beam intensity may result. As the exit ra- OID is the factor that affects the intensity of radiation
diation continues to diverge, less overall intensity of the x-ray reaching the IR, image contrast, magnification, and spatial
beam reaches the IR. resolution. The distance between the area of interest and the
When sufficient distance between the object and IR exists, IR has the greatest effect on the amount of size distortion. The
an air gap is created, preventing the scatter radiation from radiographer must position the area of interest as close to
striking the IR (Figure 10-11). Whenever the amount of the IR as possible to minimize the amount of distortion.
scatter radiation reaching the IR is reduced, the radiographic Although the amount of OID necessary to adversely affect
contrast is increased. The amount of OID required to in- image quality has not been standardized, the radiographer
crease contrast depends in part on the percentage of scatter should minimize the amount of OID whenever possible. In
radiation exiting the patient. For anatomic areas that pro- some situations it is difficult to minimize OID because of fac-
duce a high percentage of scatter radiation, less OID is tors or conditions beyond the radiographer’s control. In these
needed to increase contrast than for anatomic areas that instances size distortion can still be reduced by increasing SID.
produce less scatter.
In addition to affecting the intensity of radiation reach- Calculating Magnification
ing the IR, the OID also affects the amount of image distor- To observe the effect of distance (SID and OID) on size
tion and spatial resolution. Optimal spatial resolution is distortion, it is necessary to consider the magnification
achieved when the OID is zero. Unfortunately, this cannot factor. The magnification factor (MF) indicates how
realistically be achieved in radiographic imaging because much size distortion or magnification is demonstrated on a
there is always some distance created between the area of radiograph. The MF can be expressed mathematically by
interest and the IR. As the exit beam leaves the patient, it the following formula:
continues to diverge. When distance is created between the
MF  SID  SOD
area of interest and the IR, the diverging exit beam records
128 SECTION II  Image Production and Evaluation

Source of radiation Source of radiation

Object

Object

Image Image

A B
FIG 10-12  ​OID and Size Distortion. A long OID creates more magnification than a short OID.
The image in A is larger than that in B because the object is farther from the image receptor.

Source-to-object distance (SOD) refers to the distance In the case of the Math Application for MF, an MF of
from the x-ray source (focal spot) to the object being 1.044 means that the image is 4.4% larger than the true object
radiographed. SOD can be expressed mathematically as size. It should be noted that the MF computed here is a
follows: minimum. A 3-inch OID implies that the anterior surface of
the patient’s chest was 3 inches away from the IR for a PA
SOD  SID  OID
projection. Anatomy that is posterior to the anterior chest
SOD is demonstrated in Figure 10-13. wall is farther away from the IR and is magnified even more.
An MF of 1 indicates no magnification, which means that It may be helpful to know the measurement of the true object
the size of the radiographic image matches the true object size in comparison with its size on a radiographic image.
size. True object size on a radiograph is impossible to achieve Once the MF is known, the object size can then be deter-
because some magnification exists on every radiograph. An mined. This requires the use of another formula:
MF greater than 1 can be expressed as a percentage of magni-
Image size
fication. For example, an MF of 1.2 indicates the image size is Object size 
20% larger than the object size. MF

MATH APPLICATION
Determining Object Size
MATH APPLICATION
On a PA chest film taken with an SID of 72 inches and an OID
The Magnification Factor
of 3 inches (SOD is equal to 69 inches), the size of a round
A posteroanterior (PA) projection of the chest is produced lesion in the right lung measures 1.5 inches in diameter on
with an SID of 72 inches and an OID of 3 inches (SOD is the radiograph. The MF has been determined to be 1.044.
equal to 69 inches). What is the MF? What is the object size of this lesion?

72 inches 1.5 inches

SOD  SID  OID MF  Object size 
69 inches 1.044
69  72  3 MF  1.044 The object size is 1.44 inches.
 CHAPTER 10  Radiographic Exposure Technique 129

Source-to-object
distance (SOD)

Object
Source-to-image
receptor distance
(SID)

Image

MF = SID
SOD
FIG 10-13  ​Source-to-Object Distance (SOD). The SOD is the distance between the source of
the x-ray and the object radiographed.

If both the object size and image size are known, then the that any time magnification is increased, spatial resolution
percentage of magnification of the object can be calculated decreases.
with the formula:
Central Ray Alignment
object % of Magnification Shape distortion of the anatomic area of interest can occur
Image size  Object size from inaccurate central ray (CR) alignment of the tube, the
  100
Object size part being radiographed, or the IR. Any misalignment of the
CR among these three factors alters the shape of the part
recorded on the image.
MATH APPLICATION For example, Figure 10-14 demonstrates shape distor-
tion when the anatomic part and IR are misaligned. In
Determining Object % of Magnification
addition, shape distortion can occur if the CR of the pri-
A lesion on the radiographic image measures 1.68 cm, and mary beam is not directed to enter or exit the anatomy
the lesion’s (object) true size measures 1.56 cm. What is the as required for the particular projection or position (off
object % of magnification? centering). This happens because the path of individual
Object % of magnification photons in the primary beam becomes more divergent as
1.68  1.56 the distance increases from the CR. The radiographer must
  100 properly control alignment of the tube, part, and IR, and
1.56 cm
he or she must properly direct the CR to minimize shape
0.12/1.56  100  0.0769  100 distortion. In addition to creating shape distortion, CR
 7.69% object magnification angulation and misalignment of the tube, part, and IR
could affect the exposure to the IR. For example, when the
CR is angled, the distance between the source of the radia-
Perhaps the most practical use of these formulas is to tion and the IR is increased. As a general rule, when the
observe how changing the SID and OID affects the image CR is angled, the SID is decreased accordingly to maintain
size. Size distortion or magnification can be increased by exposure to the IR. If misalignment occurs among the tube,
decreasing the SID or by increasing the OID. This increase part, or IR, the distance between the source of radiation
in magnification can be demonstrated mathematically by and the IR or the part and the IR could be increased or
using the MF, then calculating the change in the size of the decreased. This could affect the amount of exposure to the
object on the radiographic image. It is important to note IR and therefore the mAs may need adjustment.
130 SECTION II  Image Production and Evaluation

FIG 10-14  ​Misalignment and Shape Distortion. A, Proper alignment among the x-ray tube,
part, and image receptor. Image A is a quality image with minimal distortion. Note the proper
alignment of the radial head with capitulum in the image. B, Improper alignment among the x-ray
tube, part, and image receptor. The illustration on the left shows the image receptor misaligned
to the part and the one on the right shows the part not parallel to image receptor. Image B has
shape distortion due to misalignment of the part and image receptor. Note the improper align-
ment of the radial head with capitulum in the image. C, Improper alignment among the x-ray tube,
part, and image receptor. Image C has shape distortion due to the central ray not perpendicular
to the part. Note the elongation of the olecranon process.

Grids not reach the IR when absorbed by a grid (Figure 10-15).

A radiographic grid is a device that is placed between the The effect of less scatter, or unwanted exposure, on the im-
anatomic area of interest and the IR to absorb scatter radia- age is to increase the radiographic contrast. Grids are typi-
tion exiting the patient. Limiting the amount of scatter cally used only when the anatomic part is 10 cm (4 inches)
radiation that reaches the IR improves the quality of the or greater in thickness, and more than 60 kVp is needed for
image. Much of the scatter radiation exiting the patient will the exam.
 CHAPTER 10  Radiographic Exposure Technique 131

Primary
x-ray beam

Scatter radiation
hits the lead strip
and is absorbed Grid

Image receptor

FIG 10-15  ​Grids and Scatter Absorption. Much of the scatter radiation toward the image receptor
is absorbed when a grid is used.

CRITICAL CONCEPT When a grid is added, the radiographer must use the cor-
Grids, Scatter, and Contrast rect grid conversion factor to multiply by the mAs to com-
pensate for the decrease in exposure. When a grid is removed,
Placing a grid between the anatomic area of interest and the
the correct conversion grid factor must be divided into the
IR absorbs scatter radiation exiting the patient and increases
radiographic contrast.
mAs to compensate for the increase in exposure (Box 10-3).
When the grid ratio is changed, the following formula should
be used to adjust the exposure:
The more efficient a grid is in absorbing scatter, the
greater its effect on radiographic contrast. Grids also absorb mAs1 Grid conversion factor1

some of the transmitted radiation exiting the patient and mAs2 Grid conv ersion factor2
therefore reduce the amount of radiation reaching the IR.

MATH APPLICATION
CRITICAL CONCEPT Adjusting mAs for Changes in Grid
Grids and Image Receptor Exposure
A quality radiograph is obtained using 2 mAs at 70 kVp with-
Adding, removing, or changing a grid requires an adjustment out using a grid. What new mAs is needed when adding a
in mAs to maintain radiation exposure to the IR. 12:1 grid to maintain the same exposure to the IR?

2 mAs 1
When grids are used, the mAs must be adjusted to main- 
X 5
tain exposure to the IR. In addition, the more efficient a grid
2 mAs  5  1 X; 10 mAs  X
is in absorbing scatter, the greater the increase in mAs. The
grid conversion formula is a mathematical formula for ad- The new mAs produces an exposure comparable to the IR.
justing the mAs for changes in the type of grid (Table 10-1).

Grid construction and efficiency are discussed in greater

TABLE 10-1  Grid Conversion Chart detail in Chapter 11.

Grid Conversion Factor

Grid Ratios (GCF) BOX 10-3  Radiation Protection:
No grid 1 Grid Selection
5:1 2 Decisions regarding the use of a grid and grid ratio should be
6:1 3 made by balancing image quality and patient protection. To
8:1 4 keep patient exposure as low as possible, grids should be
12:1 5 used only when appropriate, and the grid ratio should be the
16:1 6 lowest that will provide sufficient contrast improvement.
132 SECTION II  Image Production and Evaluation

MAKE THE PHYSICS CONNECTION

Beam Restriction
Chapter 6
Any change in the size of the x-ray field alters the amount of
tissue irradiated (Box 10-4). A larger field size (decreasing The use of filtration decreases x-ray quantity to the extent
collimation) increases the amount of tissue irradiated, caus- that it depends on the thickness and type of filtration mate-
ing more scatter radiation to be produced, and increases the rial. Filtration absorbs low-energy photons that do not contrib-
amount of radiation reaching the IR. The increased amount ute to the image. Added filtration placed at the collimator
serves to reduce patient dose by removing such photons.
of scatter reaching the IR results in less radiographic contrast.
Conversely, a smaller field size (increasing collimation) re-
duces the amount of tissue irradiated, reduces the amount of
scatter radiation produced, and the amount of radiation Variability of the x-ray tube filtration should be checked as
reaching the IR. The decreased amount of scatter radiation a part of routine quality control checks on the radiographic
reaching the IR results in higher radiographic contrast but equipment. X-ray tubes that have excessive or insufficient
requires an increase in the mAs. The effect of collimation is filtration may begin to affect image quality. Increasing the
greater when imaging large anatomic areas, performing amount of tube filtration increases the percentage of higher-
examinations without a grid, and using a high kVp. penetrating x-rays to lower-penetrating x-rays. As a result,
the x-ray beam has increased energy and can increase the
amount of scatter radiation reaching the IR. The increased
CRITICAL CONCEPT x-ray energy (kVp) and scatter production decrease radio-
Beam Restriction and Image Receptor Exposure graphic contrast. The amount of tube filtration should not
vary greatly and therefore small changes do not have a visible
Changes in beam restriction alter the amount of tissue irradi-
effect on radiographic contrast.
ated and therefore affect the amount of exposure to the IR.
The effect of collimation is greater when imaging large ana-
tomic areas, performing examinations without a grid, and
Film-Screen Relative Speed (RS)
using a high kVp. Because the film-screen system speed affects radiographic
density, the mAs should be adjusted if the film-screen speed
is changed. Increasing the film-screen system speed requires
Generator Output a decrease in the mAs to maintain exposure to the IR. A de-
Exposure techniques and the amount of radiation output crease in the film-screen system speed requires an increase in
depend on the type of generator used. Generators with more the mAs to maintain exposure to the IR.
efficient output, such as three-phase or high-frequency units,
require lower exposure technique settings to produce an im-
age comparable to those of single-phase units. The radiogra- CRITICAL CONCEPT
pher must be aware of the generator output when using dif- Film-screen Relative Speed and Exposure
ferent types of equipment, especially when performing to the Image Receptor
examinations in different departments. For example, imaging
As the relative speed of the film-screen IR is increased, the
a knee using a single-phase generator requires more mAs
amount of mAs needs to decrease to maintain the exposure
than imaging a knee using a three-phase generator. In addi-
to the IR. As the relative speed of the film-screen IR is de-
tion, x-ray generators must be calibrated periodically to creased, the amount of mAs needs to increase to maintain
ensure that they are producing consistent radiation output. the exposure to the IR.
The RS classification for film-screen systems provides a
Tube Filtration method whereby exposure techniques can be adjusted for
According to the National Council on Radiation Protection changes in film-screen speed. The relative film-screen speed
and Measurement (NCRP), x-ray tubes operated above conversion formula is a mathematical formula for adjusting
70 kVp are required to have a minimum of 2.5 mm of alumi- the mAs for changes in the film-screen system speed:
num filtration. Small variations in the amount of tube filtra- The correct relative film-screen speed factors must be
tion should not have any effect on radiographic quality. used to calculate the new mAs required to compensate
for the change in density. The new mAs then produces
an exposure comparable to that of the original exposure
technique.
BOX 10-4  Radiation Protection:
Beam Restriction
In performing a radiographic examination, the radiographer The availability of IRs with different relative speeds is de-
should be aware of the anatomic area of interest and limit the termined by the range of procedures and protocols for each
x-ray field size to just beyond this area. Collimating to the ap- radiology department. The radiographer should select the
propriate field size is a basic method for protecting the
appropriate film-screen IR for the type of imaging procedure
patient from unnecessary exposure.
(Box 10-5).
 CHAPTER 10  Radiographic Exposure Technique 133

BOX 10-5  Radiation Protection: two types of body habitus combined account for approxi-
Film-Screen Relative Speed mately 85% of adults.
Hypersthenic and asthenic body habitus types are more
In film-screen radiography, the speed of the IR selected for
extreme and are more rare. The hypersthenic body habitus—
an examination has a significant effect on the amount of ex-
a large, stocky build—accounts for only 5% of adults. These
posure the patient receives. The radiographer is responsible
for selecting the film-screen IR that balances patient expo-
individuals have thicker part sizes compared with sthenic or
sure and the level of recorded detail necessary for the ex- hyposthenic individuals, so exposure factors for their radio-
amination. Film-screen IRs will be discussed in more detail in graphic examinations are higher.
Chapter 12. Asthenic refers to a very slender body habitus and accounts
for only 10% of adults. Exposure factors for asthenic indi-
viduals are at the low end of technique charts because their
respective part sizes are thinner than those of sthenic and
MATH APPLICATION hyposthenic individuals.
Adjusting mAs for changes in Film-Screen
Relative Speed (RS) Part Thickness
The thickness of the anatomic part being imaged affects the
mAs1 RS2 amount of x-ray beam attenuation that occurs. A thick part

mAs2 RS1 absorbs more radiation, whereas a thin part transmits more
radiation.
A quality radiograph is obtained using 5 mAs at 70 kVp and
Maintaining the exposure to the IR when imaging a
400 speed film-screen system. What new mAs is used to
thicker part requires the mAs to be increased accordingly. In
maintain exposure to the IR when changing to a 100 speed
film-screen system?
addition, when a thinner anatomic part is being radio-
graphed, the mAs must be decreased accordingly.
5 mAs 100 RS Because x-rays are attenuated exponentially, a general

X 400 RS guideline is that for every change in part thickness of 4 to
2000 5 cm, the radiographer should adjust the mAs by a factor of
5 mAs  400; 2000  100X; 2 (Figure 10-17). For example, an optimal radiograph was
100
obtained using 40 mAs on an anatomic part that measured
 20 mAs  X
18 cm. The same anatomic part is radiographed in another
patient, and it measures 22 cm. What new mAs is needed to
expose the IR? Because the part thickness was increased by
Compensating Filters 4 cm, the original mAs is multiplied by 2, yielding 80 mAs.
When imaging an anatomic area that varies greatly in tissue If another patient for the same part measures 26 cm, what
thickness, a compensating filter can be placed in the primary new mAs is needed? Because the part thickness increased by
beam to produce a more uniform exposure to the IR. The use another 4 cm, the mAs is multiplied by 2, yielding 160 mAs.
of compensating filters requires an increase in the mAs to This mAs is four times greater than for the original patient
maintain the overall exposure to the IR. The amount of in- who measured 8 cm less.
crease in the mAs depends on the thickness and type of com- The amount of radiographic contrast achieved is also
pensating filter. Additionally, the use of a compensating filter influenced by the anatomic part to be radiographed. As
increases the exposure to the patient. mentioned in Chapter 9, subject contrast is one of the cat-
egories of radiographic contrast. The atomic number and
PATIENT FACTORS thickness of the tissue and cell compactness affect its ab-
sorption characteristics. The absorption characteristics of
Body Habitus the anatomic tissue create the range of densities and bright-
Body habitus refers to the general form or build of the body, ness produced on a radiograph. Tissues that have a higher
including size. It is important for the radiographer to con- atomic number absorb more radiation than those with a
sider body habitus when establishing exposure techniques. lower atomic number.
There are four types of body habitus: sthenic, hyposthenic, Anatomic structures that have a wide range of tissue com-
hypersthenic, and asthenic (Figure 10-16). position demonstrate high subject contrast (Figure 10-18).
The sthenic body habitus accounts for approximately 50% Alternately, anatomic structures that consist of similar type
of the adult population and is commonly called a normal or tissue demonstrate low subject contrast (Figure 10-19). The
average build. Hyposthenic accounts for approximately 35% radiographer cannot control the composition of the anatomic
of adults and refers to a similar type of body habitus as part to be radiographed. Changing the kVp alters its absorp-
sthenic, but with a tendency toward a more slender and taller tion and transmission within anatomic tissues. Knowledge
build. Together the sthenic and hyposthenic types of body about the absorption characteristics of anatomic tissues and
habitus are, in terms of establishing radiographic techniques, the effect of kVp helps the radiographer produce a desired
classified as normal or average of the adult population. These level of radiographic contrast.
134 SECTION II  Image Production and Evaluation

Hyposthenic

Hypersthenic

Sthenic
FIG 10-16  ​Body Habitus. Four types of body habitus.  (From Long BW, Rollins JH, Smith BJ:
Merrill’s Atlas of Radiographic Positioning and Procedures, vol 1, ed 13, St Louis, 2016, Mosby.)
(Continued on next page)
 CHAPTER 10  Radiographic Exposure Technique 135

Asthenic
FIG 10-16,­  cont’d

100 x-rays incident

Number of x-rays at
beginning of each centimeter
of tissue interval

100

50
5 cm
of tissue 25

FIG 10-17  ​Tissue Beam Attenuation. X-rays are attenuated exponentially and generally reduced
by approximately 50% for each4-5 cm of tissue thickness.

BONE FAT AIR

MUSCLE WATER FAT

Higher contrast
FIG 10-18  ​High Subject Contrast Tissues. Higher con- Lower contrast
trast resulting from great differences in the radiation FIG 10-19  ​Low Subject Contrast Tissues. Lower contrast
absorption for tissues that have greater variation in resulting from fewer differences in the radiation absorption
composition. for tissues that are more similarly composed.
136 SECTION II  Image Production and Evaluation

As the thickness of a given type of anatomic tissue in- TABLE 10-2  Exposure Factors and Their
creases, the amount of scatter radiation also increases and Effect on the Primary and Exit X-ray Beam
radiographic contrast decreases. Using a higher kVp for a
thicker part only adds to the increase in scatter radiation. Primary Beam Exit Beam
Reaching the Reaching the
Increased scatter radiation will continue to degrade the qual-
Patient Image Receptor
ity of the image because it creates fog, which decreases the
mAs
contrast.
Increasing mAs h Quantity h Quantity
Decreasing mAs g Quantity g Quantity
Pediatric Patients
Pediatric patients are a technical challenge for radiographers kVp
for a number of reasons. Because they are smaller, they Increasing kVp h Quantity and h Quantity and
quality quality
require lower kVp and mAs values than do adults.
Decreasing kVp g Quantity and g Quantity and
Pediatric chest radiography requires the technologist to
quality quality
choose fast exposure times to stop diaphragm motion in pa-
tients who cannot or will not voluntarily suspend their Focal Spot Size
Smaller focal spot No effect No effect
breathing. A fast exposure time may eliminate the possibility
size
of using automatic exposure control (AEC) systems for pedi-
Larger focal spot No effect No effect
atric chest radiography. size
Exposure factors used for the adult skull can be used for
pediatric patients 6 years of age and older because the bone SID
Increasing SID g Quantity g Quantity
density of these children has developed to an adult level.
Decreasing SID h Quantity h Quantity
However, exposure factors must be modified for patients
younger than 6 years of age. It is recommended that the ra- OID
diographer decrease the kVp by at least 15% to compensate Increasing OID No effect g Quantity and
scatter
for this lack of bone density.
Decreasing OID No effect h Quantity and
Radiographic examination of all other parts of pediatric
scatter
patients’ anatomy will require an adjustment in exposure
techniques. Grid
The quality of the radiographic image depends on a mul- Increasing grid No effect g Quantity and
ratio scatter
titude of variables. Knowledge of these variables and their
Decreasing grid No effect h Quantity and
radiographic effect assists the radiographer in producing
ratio scatter
quality radiographs. Table 10-2 provides a chart demon-
strating how the variables discussed in this chapter affect IR Beam Restriction
Increasing g Quantity g Quantity and
exposure.
collimation scatter
Because differing types of IRs may respond differently to
Decreasing h Quantity h Quantity and
radiation exposure, it is critical for the radiographer to be collimation scatter
knowledgeable about the characteristics of the IR in use. Ra-
diographic film acquires the latent image and then needs to Generator Output
Single-phase g Quantity and g Quantity and
be chemically processed before the image can be displayed.
generator quality quality
Therefore changes in the quantity and quality of radiation High frequency h Quantity and h Quantity and
exposure to a film-screen IR affect the amount of density and generator quality quality
contrast visible on the processed radiograph. Because digital
Compensating Filter
IRs separate acquisition from processing and image display,
Adding a compen- g Quantity g Quantity
their response to changes in radiation exposure do not affect
sating filter
the amount of brightness displayed on the image. However,
the amount of exposure to the digital IR needs to be carefully
selected, as with film-screen IRs, to produce a quality image
with the least amount of exposure to the patient. Film-screen 70 to 81 when radiographing a pelvis is a 15% increase in kVp
and digital IRs are discussed in more detail in Chapter 12. peak and requires half the mAs needed at 70 kVp. Higher
kVp increases the beam penetration, and therefore less quan-
RADIATION PROTECTION REVIEW tity of radiation is needed to achieve the required amount of
radiation reaching the IR and produce a quality image.
kVp and mAs
Whenever possible, a higher kVp and lower mAs should be Beam Restriction
used to reduce patient exposure. Increasing kVp requires less In performing a radiographic examination, the radiographer
mAs to maintain the correct exposure to the IR and decreases should be aware of the anatomic area of interest and limit
the radiation dose to the patient. For example, changing from the x-ray field size to just beyond this area. Collimating to the
 CHAPTER 10  Radiographic Exposure Technique 137

appropriate field size is a basic method for protecting the exposure the patient receives. The radiographer is respon-
patient from unnecessary exposure. sible for selecting the film-screen IR that balances patient
exposure and the level of recorded detail necessary for the
Grid Selection examination.
Decisions regarding the use of a grid and grid ratio should be
made by balancing image quality and patient protection. To Excessive Radiation Exposure and Digital
keep patient exposure as low as possible, grids should be used Imaging
only when appropriate, and the grid ratio should be the low- Although the computer can adjust image brightness for tech-
est that will provide sufficient contrast improvement. nique exposure errors, routinely using more radiation than
required for the procedure in digital radiography unnecessar-
Film-Screen Speed ily increases patient exposure. Even though the digital system
In film-screen radiography, the speed of the IR selected for can adjust for overexposures, it is an unethical practice to
an examination has a significant effect on the amount of knowingly overexpose a patient.

SUMMARY
• The product of milliamperage and exposure time (mAs) • Increasing OID decreases exposure to the IR.
has a direct proportional relationship with the quantity of • Decreasing SID and increasing OID increases size distor-
x-rays produced and exposure to the IR. tion (magnification) and decreases recorded detail.
• Milliamperage and exposure time have an inverse rela- • Grids absorb scatter exiting the patient and increase ra-
tionship to maintain exposure to the IR. diographic contrast.
• The kVp changes the penetrating power of the x-ray beam • Beam restriction affects the amount of tissue irradiated,
and has a direct effect on exposure to the IR. scatter produced, and the exposure to the IR.
• Changing the kVp by 15% has the same effect on the x-ray • Changes in SID, grids, film-screen relative speed, and pa-
beam as changing the mAs by a factor of 2. tient thickness require a change in mAs to maintain the
• kVp has an inverse relationship with radiographic con- exposure to the IR.
trast: A high kVp creates an image with low contrast, and • Generators with more efficient output, such as three-
a low kVp creates an image with high contrast. phase or high frequency, require lower exposure tech-
• Focal spot size affects only spatial resolution. A smaller niques to produce the same exposure to the IR as a single-
focal spot size increases spatial resolution. phase generator.
• SID has an inverse squared relationship with the intensity • Exposure factors may need to be modified for body habi-
of radiation reaching the patient and the IR. tus, part thickness and pediatric patients.

CRITICAL THINKING QUESTIONS

1. Given a diagnostic radiograph, describe how the exposure 2. Given patient and exposure factor variability, how do ra-
technique would be adjusted for individual changes in diographers select exposure techniques to produce diag-
mAs or exposure time, kVp, grid ratio, beam collimation, nostic-quality radiographic images?
SID, film-screen RS, and patient thickness. 3. What considerations can be made when selecting expo-
sure techniques to minimize patient exposure?

REVIEW QUESTIONS
1. What type of relationship does mAs have with the expo- 3. Increasing the mAs has __________ effect on brightness
sure reaching the image receptor? displayed in digital imaging.
a. Direct a. direct
b. Inverse b. indirect
c. Direct proportional c. inverse
d. Inverse proportional d. no
2. Which of the following describes the relationship between 4. Given the anatomic part is adequately penetrated in film-
mA and time to maintain exposure to the image receptor? screen imaging, changing the kVp will affect:
a. Direct a. density.
b. Inverse b. Compton scattering.
c. Direct proportional c. contrast.
d. Inverse proportional d. all of the above.
Continued
138 SECTION II  Image Production and Evaluation

R E V I E W Q U E S T I O N S — cont’d
5. Which of the following will produce the same effect as 9. What factor affects the amount of radiation intensity and
doubling the mAs? scatter reaching the image receptor, magnification, and
a. Increase grid ratio from 5:1 to 8:1 spatial resolution?
b. Increase kVp 15% a. OID
c. Decrease the SID by ½ b. SID
d. Decreasing the film-screen RS from 400 to 200 c. Grid ratio
6. Which of the following factor does not affect spatial reso- d. Beam restriction
lution? 10. A diagnostic image is created using 80 kVp, 10 mAs, and
a. Focal spot size a grid ratio of 12:1. Which of the following exposure
b. SID techniques would maintain exposure to the image recep-
c. OID tor when the grid is removed?
d. Grid a. 68 kVp at 10 mAs
7. The amount of remnant radiation will decrease when b. 80 kVp at 2 mAs
increasing: c. 92 kVp at 5 mAs
a. focal spot size. d. 80 kVp at 50 mAs
b. tissue thickness. 11. What is the magnification factor when using a 72-inch
c. mAs. SID and 1.5-inch OID?
d. kVp. a. 0.979
8. A diagnostic image was produced using 70 kVp, 15 mAs at b. 1.021
40 inch SID. Which of the following exposure techniques c. 1.5
would maintain the exposure to the image receptor when d. 2.0
decreasing the SID to 30 inches? 12. How is the primary beam affected when increasing the
a. 80 kVp at 15 mAs tube filtration?
b. 70 kVp at 8.4 mAs a. Increase in the number of x-ray photons
c. 70 KVp at 11.3 mAs b. Increase in the proportion of lower-energy x-rays
d. 60 kVp at 27 mAs c. Increase in the proportion of higher-energy x-rays
d. Increase in the speed of the x-ray photons
 11
Scatter Control

OUTLINE
Introduction Grid Performance
Beam Restriction Grid Cutoff
Beam Restriction and Scatter Radiation Moiré Effect
Collimation and Contrast Grid Usage
Compensating for Collimation Radiation Protection
Types of Beam-Restricting Devices The Air Gap Technique
Radiographic Grids Shielding Accessories
Grid Construction Summary
Types of Grids

OBJECTIVES
• State the purpose of beam-restricting devices. • Demonstrate use of the grid conversion formula.
• Describe each of the types of beam-restricting devices. • Describe different types of grid cutoff that can occur and
• State the purpose of automatic collimators or positive their radiographic appearance.
beam-limiting devices. • Identify the factors to be considered in using a grid.
• Describe the purpose of a radiographic grid. • Recognize how beam restriction and use of grids affect
• Describe the construction of grids, including the differ- patient radiation exposure.
ent types of grid pattern and grid focus. • Explain the air gap technique and describe its use.
• Calculate grid ratio. • Describe the use of shielding accessories to absorb scatter
• List the various types of stationary grids and describe the radiation.
function and purpose of a moving grid.

KEY TERMS
air gap technique cross-hatched grid grid frequency
aperture diaphragm crossed grid grid pattern
automatic collimator cylinder grid ratio
beam-restricting device focal distance interspace material
beam restriction focal range lead mask
Bucky focused grid linear grid
Bucky factor grid Moiré effect
collimation grid cap nonfocused grid
collimator grid cassette parallel grid
cone grid conversion factor (GCF) positive beam-limiting (PBL) device
convergent line grid cutoff wafer grid
convergent point grid focus

Two major factors affect the amount of scatter radiation

INTRODUCTION produced and exiting the patient: the volume of tissue irradi-
Chapters 7 and 8 discuss the interactions of x-rays with mat- ated and the kilovoltage peak (kVp). The volume of tissue
ter. Scatter radiation is primarily the result of the Compton depends on the thickness of the part as well as the x-ray beam
interaction, in which the incoming x-ray photon loses energy field size. Increasing the volume of tissue irradiated results in
and changes direction. increased scatter production. In addition, using a higher kVp
139
140 SECTION II  Image Production and Evaluation

increases x-ray transmission and reduces its overall absorp- noted that grids do nothing to prevent scatter production; they
tion (photoelectric interactions); however, a higher kVp in- merely reduce the amount of scatter reaching the IR.
creases the energy of scatter radiation exiting the patient.
BEAM RESTRICTION
MAKE THE PHYSICS CONNECTION
It is up to each radiographer to limit the x-ray beam field size
Chapter 7 to the anatomic area of interest. Beam restriction serves two
Compton scattering is one of the most prevalent interactions purposes: limiting patient exposure and reducing the amount
between x-ray photons and the human body in general diag- of scatter radiation produced within the patient.
nostic imaging and is responsible for most of the scatter that The unrestricted primary beam is cone shaped and proj-
fogs the image. The probability of Compton scattering does ects a round field on the patient and IR (Figure 11-1). If not
not depend on the atomic number of atoms involved. Comp- restricted in some way, the primary beam goes beyond the
ton scattering may occur in both soft tissue and bone. The boundaries of the anatomic area of interest and IR size, re-
probability of Compton scattering is related to the energy of
sulting in unnecessary patient exposure. Any time the x-ray
the photon. As x-ray photon energy increases, the probability
of that photon penetrating a given tissue without interaction
field extends beyond the anatomic area of interest, the patient
increases. However, with this increase in photon energy, the receives unnecessary exposure. Limiting the x-ray beam field
likelihood of Compton interactions relative to photoelectric size is accomplished with a beam-restricting device. Located
interactions also increases. just below the x-ray tube housing, the beam-restricting
device changes the shape and size of the primary beam. The
terms beam restriction and collimation are used inter-
Chapter 9 introduces the characteristics of a quality image changeably; they refer to a decrease in the size of the pro-
and explains that scatter radiation provides no useful infor- jected radiation field. The term collimation is used more often
mation about the anatomic area of interest. Controlling the than beam restriction because collimators are the most popu-
amount of scatter radiation produced in the patient and ulti- lar type of beam-restricting device. Increasing collimation
mately reaching the image receptor (IR) is essential in creat- means decreasing field size, and decreasing collimation means
ing a diagnostic-quality image. Scatter radiation is detrimen- increasing field size.
tal to radiographic quality because it adds unwanted exposure
(fog) to the image without adding any patient information.
CRITICAL CONCEPT
Digital IRs are more sensitive to lower energy levels of radia-
tion such as scatter, which results in increased fog in the im- Beam Restriction and Patient Dose
age. Additionally, scatter radiation decreases radiographic Collimating to the appropriate field size is a basic method for
contrast for both digital and film-screen images. Increased protecting the patient from unnecessary exposure. As beam
scatter radiation either produced within the patient or restriction or collimation increases, field size decreases and
higher-energy scatter exiting the patient affects the exposure patient dose decreases. As beam restriction or collimation
to the patient and anyone within close proximity. Therefore, decreases, field size increases and patient dose increases.
the radiographer must act to minimize the amount of scatter
radiation produced and reaching the IR.
Beam Restriction and Scatter Radiation
In addition to decreasing patient dose, beam-restricting de-
CRITICAL CONCEPT
vices also reduce the amount of scatter radiation produced
Factors Affecting the Amount of Scatter within the patient, reducing the amount of scatter the IR is
Radiation exposed to and thereby increasing the radiographic contrast.
The greater the volume of tissue irradiated because of part The relationship between collimation (field size) and
thickness or x-ray beam field size, the greater the amount of quantity of scatter radiation is illustrated in Figure 11-2. As
scatter radiation produced. The higher the kVp used, the stated previously, collimation means decreasing the size of
greater the energy of scattered x-rays exiting the patient. the projected field, so increasing collimation means decreas-
ing field size, and decreasing collimation means increasing
field size.
Beam-restricting devices and radiographic grids are tools
the radiographer can use to limit the amount of scatter radia-
tion that affects the radiographic image and exposure to the CRITICAL CONCEPT
patient or personnel. Beam-restricting devices decrease the Collimation and Scatter Radiation
x-ray beam field size and the amount of tissue irradiated,
As collimation increases, the field size decreases and the
thereby reducing the amount of scatter radiation produced.
quantity of scatter radiation decreases; as collimation de-
Radiographic grids are used to improve radiographic image
creases, the field size increases and the quantity of scatter
quality by absorbing scatter radiation that exits the patient, radiation increases.
reducing the amount of scatter reaching the IR. It should be
 CHAPTER 11  Scatter Control 141

X-ray tube

Primary beam

Primary beam

Image receptor
Image receptor

A B
FIG 11-1  ​The Unrestricted Primary Beam. The unrestricted primary beam is cone shaped,
projecting a circular field. A, Side view. B, View from above.

CRITICAL CONCEPT
Collimation and Radiographic Contrast
of scatter radiation
Relative intensity

As collimation increases, the quantity of scatter radiation

decreases and radiographic contrast increases; as collimation
decreases, the quantity of scatter radiation increases and
radiographic contrast decreases.

Image receptor size

8 × 8 8 × 10 10 × 12 14 × 17
Compensating for Collimation
0 50 100 150 200 250 An increase in collimation also affects the number of x-ray
Field size (square inches) photons reaching the IR to produce the latent image. Increas-
ing collimation decreases the number of photons that strike
FIG 11-2  ​X-ray Field Size and Scatter Radiation. As the
the patient and decreases the amount of scatter radiation
field size increases, the relative quantity of scatter radiation
produced. Therefore, exposure factors should be increased
increases.
when increasing collimation. For example, when collimating
significantly (changing from an 11 3 14-inch field size to a
small, 4-inch-diameter cone), the radiographer must increase
exposure to compensate for the decrease in the number of
Collimation and Contrast x-ray photons that otherwise occurs. The kVp is typically not
Because collimation decreases the x-ray beam field size, less increased because it increases the proportion of scatter pro-
scatter radiation is produced within the patient. Therefore, less duced in the patient and results in decreased image contrast.
scatter radiation reaches the IR. As described in Chapter 9, this To maintain exposure to the IR, the mAs (milliamperes/
affects the radiographic contrast. second) should be altered.
 142 SECTION II  Image Production and Evaluation

TABLE 11-1  Restricting the Primary the diaphragm and cutting the center to create the shape and
Beam size of the aperture.
Although the aperture’s size and shape can be changed,
Increased Factor Result the aperture cannot be adjusted from the designed size.
Collimation Patient dose decreases. Therefore, the projected field size is not adjustable. In addi-
Scatter radiation decreases. tion, because of the aperture’s proximity to the radiation
Radiographic contrast increases. source (focal spot), a large area of unsharpness surrounds the
Film-screen: Radiographic density
radiographic image (Figure 11-4). Although aperture dia-
decreases.
Digital: Quantum noise increases.
phragms are still used in some applications, their use is not as
Field Size Patient dose increases. widespread as that of other types of beam-restricting devices.
Scatter radiation increases.
Radiographic contrast decreases. Cones and Cylinders. ​Cones and cylinders are shaped dif-
Film-screen: Radiographic density ferently (Figure 11-5), but they have many of the same attri-
increases. butes. A cone or cylinder is essentially an aperture dia-
Digital: Quantum noise decreases. phragm that has an extended flange attached to it. The flange
can vary in length and can be shaped as either a cone or a
cylinder. The flange can also be made to telescope, thereby
Important relationships regarding the restriction of the increasing its total length (Figure 11-6). Like aperture dia-
primary beam are summarized in Table 11-1. phragms, cones and cylinders are easy to use. They slide onto
the tube directly below the window. Cones and cylinders
Types of Beam-Restricting Devices limit unsharpness surrounding the radiographic image more
Several types of beam-restricting devices are available; they than aperture diaphragms do, with cylinders accomplishing
differ in sophistication and utility. All beam-restricting de- this task slightly better than cones (Figure 11-7). However,
vices are made of a metal or a combination of metals that they are limited in terms of the sizes that are available,
readily absorb x-rays. and they are not necessarily interchangeable among tube
housings. Cones have a particular disadvantage compared
Aperture Diaphragms. ​The simplest type of beam-restrict-
ing device is the aperture diaphragm. An aperture dia-
phragm is a flat piece of lead (diaphragm) that has a hole
(aperture) in it. Commercially made aperture diaphragms
are available (Figure 11-3), as are those that are “homemade”
(hospital-made) for purposes specific to a radiographic unit.
Aperture diaphragms are easy to use. They are placed directly
below the x-ray tube window. An aperture diaphragm can be
made by cutting rubberized lead to the size needed to create

Aperture
diaphragm

Aperture
phragm

Aperture
Radiographic
image

Image receptor

Area of unsharpness Area of unsharpness

Image receptor
FIG 11-4  ​Image Unsharpness and Aperture Diaphragm.
FIG 11-3  ​Aperture Diaphragm. A commercially made aper- Radiographic image unsharpness using an aperture
ture diaphragm. diaphragm.
 CHAPTER 11  Scatter Control 143

A B
Cylinder Cone

FIG 11-5  ​Cylinders and Cones. A, A cylinder. B, A cone.

A B

Area of Area of
unsharpness unsharpness
FIG 11-7  ​Cylinder/Cone and Unsharpness. A cylinder (A) is
better at limiting unsharpness than a cone (B).

FIG 11-6  ​Telescoping Cylinder. A telescoping cylinder.

with cylinders. If the angle of the flange of the cone is greater A B

than the angle of divergence of the primary beam, the base
FIG 11-8  ​Images with and Without a Cylinder. Radiograph
plate or aperture diaphragm of the cone is the only metal
of the frontal and maxillary sinuses. A, Not using a cylinder.
actually restricting the primary beam. Therefore, cylinders B, Using a cylinder. (From Mosby’s radiographic instructional
generally are more useful than cones. Cones and cylinders are series: radiographic imaging, St Louis, 1998, Mosby.)
almost always made to produce a circular projected field, and
they can be used to advantage for particular radiographic
procedures (Figure 11-8). shutters are located 3 to 7 inches (8 to 18 cm) below the tube.
These shutters consist of longitudinal and lateral leaves or
Collimators. ​The most sophisticated, useful, and accepted blades, each with its own control. This makes the collimator
beam-restricting device is the collimator. Collimators are adjustable in that it can produce projected fields of varying
considered the best beam-restricting device available for ra- sizes. The field shape produced by a collimator is always rect-
diography. Beam restriction accomplished with the use of a angular or square unless using a lead mask, cone, or cylinder
collimator is referred to as collimation. Again, the terms col- placed below the collimator. A lead mask is similar to an
limation and beam restriction are used interchangeably. aperture diaphragm in that it will change the shape and size
A collimator has two or three sets of lead shutters of the projected x-ray field. Collimators are equipped with a
(Figure 11-9). Located immediately below the tube window, white light source and a mirror to project a light field onto
the entrance shutters limit the x-ray beam much as the aper- the patient. This light is intended to accurately indicate where
ture diaphragm does. One or more sets of adjustable lead the primary x-ray beam will be projected during exposure.
144 SECTION II  Image Production and Evaluation

Added Entrance
filtration shutters

Light
field
Top view of shutters Mirror
Light
source

Lead
shutters

FIG 11-9  ​Collimators. Collimators have two sets of lead shutters that are used to change the
size and shape of the primary beam.

In case of failure of this light, an x-ray field measurement

guide (Figure 11-10) is present on the front of the collimator.
It indicates the projected field size based on the adjusted size
of the collimator opening at particular source-to-image re-
ceptor distances (SIDs). This helps ensure that the radiogra-
pher does not open the collimator to produce a field that is
larger than the IR. Another problem that may occur is the
lack of accuracy of the light field. The mirror that reflects the
light down toward the patient or the light bulb itself could be
slightly out of position, projecting a light field that inaccu-
rately indicates where the primary beam will be projected.
There is a means of testing the accuracy of this light field and
the location of the center of projected beam (Box 11-1).
A plastic template with crosshairs is affixed to the bottom
of the collimator to indicate where the center of the primary
beam—the central ray (CR)—will be directed. This is of great
assistance to the radiographer in accurately centering the
x-ray field to the patient.

Automatic Collimators. ​An automatic collimator, also

called a positive beam-limiting (PBL) device, automatically FIG 11-10  ​X-ray Field Measurement Guide. The x-ray field
limits the size and shape of the primary beam to the size and measurement guide on the front of a collimator.
shape of the IR. For a number of years, automatic collimators
were required by U.S. federal law on all new radiographic
installations. This law has since been rescinded, and auto- tray, just below the tabletop. Automatic collimation makes it
matic collimators are no longer a requirement on any radio- difficult for the radiographer to increase the size of the pri-
graphic equipment. However, they are still widely used. Auto- mary beam to a field larger than the IR, which would result
matic collimators mechanically adjust the primary beam size in increasing the patient’s radiation exposure. PBL devices
and shape to that of the IR when the IR is placed in the Bucky were seen as a way of protecting patients from overexposure
 CHAPTER 11  Scatter Control 145

Absorbed
BOX 11-1  Quality Control Check:
Transmitted scattered photon
Collimator and Beam Alignment photon
• Lack of congruence of the x-ray field and the exposure field, Unabsorbed
and misalignment of the light and Bucky tray, may affect scattered photon
the quality of the radiograph. In addition, if the x-ray central
ray is not perpendicular to the table and Bucky tray, radio-
graphic quality may be compromised. A collimator and
beam alignment test tool template and cylinder can easily
be radiographed and evaluated for proper alignment.
• Collimator misalignment should be less than 2% of the SID Lead
used, and the perpendicularity of the x-ray central ray must strip
be less than or equal to 1 degree misaligned.
SID, Source-to-image receptor distance. Radiolucent
Image spacer
receptor
to radiation. However, it should be noted that automatic FIG 11-11  ​Grid Absorption of Scatter. Ideally, grids would
collimators have an override mechanism that allows the absorb all scattered radiation and allow all transmitted pho-
radiographer to disengage this feature. tons to reach the image receptor. In reality, however, some
scattered photons pass through to the image receptor and
Whether or not automatic collimation is used, the ra-
some transmitted photons are absorbed.
diographer should always be sure that the size of the x-ray
field is the same as or less than the size of the IR, except for
digital flat-panel detectors. When using a flat-panel detec-
tor, the x-ray field size should be restricted to the anatomic allow all transmitted photons emitted from the patient to
area of interest. These digital IRs are typically 14 3 17 or pass from the patient to the IR. Unfortunately, this does
17 3 17 and, in many instances, are larger than the ana- not happen (Figure 11-11). When used properly, however,
tomic area of interest. It is therefore even more crucial for grids can greatly increase the contrast of the radiographic
the radiographer to collimate appropriately for the imag- image.
ing procedure so the patient is not exposed to radiation
unnecessarily. CRITICAL CONCEPT
Scatter Radiation and Image Quality
RADIOGRAPHIC GRIDS
Scatter radiation adds unwanted exposure (fog) to the radio-
The radiographic grid was invented in 1913 by Gustave graph and decreases image quality.
Bucky and continues to be the most effective means for lim-
iting the amount of scatter radiation that reaches the IR.
Approximately 1⁄4-inch thick and ranging from 8 3 10 inches Grid Construction
(20 3 25 cm) to 17 3 17 inches (43 3 43 cm), a grid is a Grids contain thin lead strips or lines that have a precise
device that has very thin lead strips with radiolucent inter- height, thickness, and space between them. Radiolucent
spaces; it is intended to absorb scatter radiation emitted interspace material separates the lead lines. Interspace mate-
from the patient. Placed between the patient and the IR, rial typically is made of aluminum. The lead lines and inter-
grids are invaluable in the practice of radiography. They space material of the grid are covered by an aluminum front
work well to improve radiographic contrast but are not and back panel.
without drawbacks. As is discussed later in this chapter, us- Grid construction can be described by grid frequency and
ing a grid requires additional mAs, resulting in a higher grid ratio. Grid frequency expresses the number of lead lines
patient dose. Therefore grids are typically used only when per unit length in inches, centimeters, or both. Grid frequen-
the anatomic part is 10 cm (4 inches) or greater in thickness cies can range in value from 25 to 45 lines/cm (60 to
and for imaging procedures requiring more than 60 kVp. 110 lines/inch). A typical value for grid frequency might be
Radiographers should follow the department protocol for 40 lines/cm or 103 lines/inch. Another way of describing grid
adding a grid due to the significant increase in patient radia- construction is by its grid ratio. Grid ratio is defined as the
tion exposure. ratio of the height of the lead strips to the distance between
As scatter radiation leaves the patient, a significant them (Figure 11-12).
amount is directed at the IR. As stated previously, scatter Grid ratio can also be expressed mathematically as
radiation is detrimental to radiographic quality because it follows:
adds unwanted exposure (fog) to the image without adding Grid ratio 5 h/D
any patient information. Scatter radiation decreases radio-
graphic contrast. Ideally, grids would absorb, or clean up, in which h is the height of the lead strips and D is the
all scattered photons directed toward the IR and would distance between them.
146 SECTION II  Image Production and Evaluation

Interspace
Lead strips material

Height

Height
Grid ratio: ________________
Width of interspace
FIG 11-12  ​Grid Ratio. Grid ratio is the ratio of the height of the lead strips to the distance
between them.

MATH APPLICATION Grid Pattern.  Grid pattern refers to the linear pattern of the
lead lines of a grid. Two types of grid pattern exist: linear and
Calculating Grid Ratio
crossed or cross-hatched. A linear grid has lead lines that run
What is the grid ratio when the lead strips are 3.2 mm high in only one direction (Figure 11-13). Linear grids are the
and separated by 0.2 mm? most popular in terms of grid pattern because they allow
Grid ratio 5 h/D angulation of the x-ray tube along the length of the lead lines.
A crossed grid or cross-hatched grid has lead lines that run
Grid ratio 5 3.2/0.2 at right angles to one another (Figure 11-14). Crossed grids
5 16 or 16:1 remove more scattered photons than linear grids because
they contain more lead strips that are oriented in two direc-
tions. However, applications are limited with a crossed grid
Grid ratios range from 4:1 to 16:1. High-ratio grids re- because the x-ray tube cannot be angled in any direction
move, or clean up, more scatter radiation than lower-ratio without producing grid cutoff (i.e., absorption of the trans-
grids and thus further increase radiographic contrast. mitted x-rays). Grid cutoff, which is undesirable, is discussed
later in this chapter.

CRITICAL CONCEPT
Grid Ratio and Radiographic Contrast
As grid ratio increases, for the same grid frequency, scatter
cleanup improves and radiographic contrast increases; as
grid ratio decreases, for the same grid frequency, scatter
cleanup is less effective and radiographic contrast decreases.

There is a relationship among grid ratio, grid frequency,

and the amount of lead content (measured in mass per unit
FIG 11-13  ​Linear Grid Pattern.
area). Increasing the grid ratio for the same grid frequency
will increase the amount of lead content and therefore
increase scatter absorption. If the grid frequency is increased
for the same grid ratio, there is overall less lead content be-
cause the width of the interspace and or the thickness of the
lead strips have been decreased. Decreasing the overall lead
content will result in decreased scatter absorption.
Information about a grid’s construction is contained on a
label placed on the tube side of the grid. This label usually
states the type of interspace material used, grid frequency,
grid ratio, grid size, and information about the range of SIDs
that can be used with the grid. The radiographer should read
this information before using the grid because these factors
influence grid performance, exposure factor selection, grid FIG 11-14  ​Crossed Grid Pattern. Crossed or cross-hatched
alignment, and image quality. grid pattern.
 CHAPTER 11  Scatter Control 147

CRITICAL CONCEPT
Focused versus Parallel Grids
Focused grids have lead lines that are angled to approxi-
mately match the divergence of the primary beam. Thus fo-
FIG 11-15  ​Parallel Grid. Parallel or nonfocused grid. cused grids allow more transmitted photons to reach the IR
than parallel grids.

As seen in Figure 11-18, if imaginary lines were drawn

from each of the lead lines in a linear focused grid, these lines
would meet to form an imaginary point, called the conver-
gent point. If points were connected along the length of the
FIG 11-16  ​Focused Grid. Focused grid.
grid, they would form an imaginary line, called the conver-
gent line. Both the convergent line and convergent point are
important because they determine the focal distance of a fo-
Grid Focus.  Grid focus refers to the orientation of the cused grid. The focal distance (sometimes referred to as grid
lead lines to one another. Two types of grid focus exist: radius) is the distance between the grid and the convergent
parallel (nonfocused) and focused. A parallel grid or non- line or point. The focal distance is important because it is
focused grid has lead lines that run parallel to one another used to determine the focal range of a focused grid. The focal
(Figure 11-15). Parallel grids are used primarily in fluoros- range is the recommended range of SIDs that can be used
copy and mobile imaging. A focused grid has lead lines with a focused grid. The convergent line or point always falls
that are angled, or canted, to approximately match the an- within the focal range (Figure 11-19). For example, a com-
gle of divergence of the primary beam (Figure 11-16). The mon focal range is 36 to 42 inches (90 to 105 cm), with a focal
advantage of focused grids compared with parallel grids is distance of 40 inches (100 cm). Another common focal range
that focused grids allow more transmitted photons to reach is 66 to 74 inches (165 to 185 cm), with a focal distance of
the IR. As seen in Figure 11-17, transmitted photons are 72 inches (180 cm).
more likely to pass through a focused grid to reach the IR Because the lead lines in a parallel grid are not angled, they
than they are to pass through a parallel grid. have a focal range extending from a minimum SID to infinity.

A B
FIG 11-17  ​Comparison of Parallel and Focused Grids. Comparison of transmitted photons
passing through a parallel grid (A) and a focused grid (B).
148 SECTION II  Image Production and Evaluation

is located directly below the radiographic tabletop and just

e above the tray that holds the IR. Grid motion is controlled
t lin
rgen electrically by the x-ray exposure switch. The grid moves
nve
Convergent Co slightly back and forth in a lateral direction over the IR dur-
point ing the entire exposure. These grids typically have dimen-
sions of 17 3 17 inches (43 3 43 cm) so that a 14 3 17–inch
(35 3 43 cm) cassette can be positioned under the grid
either lengthwise or crosswise, depending on the examina-
tion requirements.

Long- Versus Short-Dimension Grids. ​Linear grids can be

either constructed as long dimension or short dimension. A
long-dimension linear grid has lead strips running parallel to
the long axis of the grid. A short-dimension linear grid has
lead strips running perpendicular to the long axis of the grid
FIG 11-18  ​Convergent Line. Imaginary lines drawn above a (Figure 11-20). For example, a 14 3 17–inch (35 3 43 cm–)
linear focused grid from each lead strip meet to form a con- long-dimension grid has lead strips 17 inches (43 cm) long,
vergent point. The points form a convergent line along the whereas a short-dimension grid has lead strips 14 inches
length of the grid. (35 cm) long. A short-dimension grid may be useful for ex-
aminations in which it is difficult to center the CR correctly
for the long-dimension grid.

Focal Convergent Grid Performance

range line or point The purpose of using grids in radiography is to increase ra-
diographic contrast. In addition to improving contrast by
cleaning up scatter, grids reduce the total amount of x-rays
reaching the IR. The better the grid is at absorbing scattered
photons, such as with a higher-ratio grid, the fewer the pho-
tons reaching the IR. To compensate for this reduction,
Grid additional mAs must be used to produce diagnostic images.
The grid conversion factor (GCF), or Bucky factor, can be
Image receptor used to determine the adjustment in mAs needed when
FIG 11-19  ​Convergent Point. The convergent line or point of changing from using a grid to nongrid (or vice-versa) or for
a focused grid falls within a focal range. changing to grids with different grid ratios.

Types of Grids
Grids are available for use by the radiographer in several
Short dimension

forms and can be stationary or moving. Stationary, nonmov-

ing grids include the wafer or slip-on grid, grid cassette, and
grid cap. A wafer grid matches the size of the cassette and is
used by placing it on top of the IR. Wafer grids typically are
taped to the IR to prevent them from sliding during the ra-
diographic procedure. A grid cassette is an IR that has a grid
permanently mounted to its front surface. A grid cap con-
tains a permanently mounted grid and allows the IR to slide
in behind it. This is useful because the grid is secure, and
many IRs can be interchanged behind the grid before
processing the image.

Stationary and Reciprocating Grids. ​When grids are sta-

tionary, it is possible to closely examine and see the grid lines
on the radiographic image. Slightly moving the grid during
the x-ray exposure blurs the grid lines. Long dimension
Moving or reciprocating grids are part of the Bucky, FIG 11-20  ​Long- Versus Short-Dimension Grid. Orienta-
more accurately called the Potter-Bucky diaphragm. The grid tion of lead strips for a long- and short-dimension grid.
 CHAPTER 11  Scatter Control 149

TABLE 11-2  The Grid Conversion (Bucky) when a grid is used, the mAs must be decreased by the GCF.
Factor This requires division by the GCF for the particular grid
ratio.
Grid Ratio GCF
No grid 1
5:1 2 MATH APPLICATION
6:1 3
Removing a Grid
8:1 4
12:1 5 If a radiographer produces a knee radiograph using a 16:1
16:1 6 ratio grid and 18 mAs, and on the next exposure wants to use
GCF, Grid conversion factor.
a nongrid exposure, what mAs should be used to produce a
radiograph with comparable quality?

Grid exposure 5 18 mAs

CRITICAL CONCEPT GCF (for 16:1) 5 6 (from Table 11–2)
Grid Ratio and Radiographic Density
mAs with the grid
As grid ratio increases, radiation exposure to the IR de-
GCF 5
mAs without the grid
creases; as grid ratio decreases, radiation exposure to the IR
increases.
18
6 5
mAs without the grid

The GCF can be expressed mathematically as: 3 5 mAs without the grid

When removing a 16:1 ratio grid, the mAs must be de-

mAs with the grid creased by a factor of 6, in this case to 3 mAs.
GCF 5
mAs without the grid

Table 11-2 presents specific grid ratios and grid conver- The GCF is also useful when changing between grids with
sion factors. When a grid is added to the IR, mAs must different grid ratios.
be increased by the factor indicated to maintain the When changing from one grid ratio to another, the follow-
same number of x-ray photons reaching the IR. This re- ing formula should be used to adjust the mAs:
quires multiplication by the GCF for the particular grid
ratio. mAs1 GCF1
5
mAs2 GCF2

MATH APPLICATION
Adding a Grid MATH APPLICATION
If a radiographer produces a knee radiograph with a nongrid Increasing the Grid Ratio
exposure using 2 mAs and next wants to use an 8:1 ratio If a radiographer performs a routine portable abdomen ex-
grid, what mAs should be used to produce a comparable- amination using 30 mAs with a 6:1 ratio grid, what mAs
quality radiograph? should be used if a 12:1 ratio grid is substituted?
Nongrid exposure 5 2 mAs Exposure 1: 30 mAs, 6:1 grid, GCF 5 3
Exposure 2: __mAs, 12:1 grid, GCF 5 5
GCF (for 8:1 grid) 5 4 (from Table 11–2)
mAs1 GCF1
mAs with the grid 5
GCF 5 mAs2 GCF2
mAs without the grid
30 3
mAs with the grid 5
4 5 mAs2 5
2
mAs2 5 50
8 5 mAs with the grid
Increasing the grid ratio requires additional mAs.
When adding an 8:1 ratio grid, the mAs must be increased by
a factor of 4, in this case to 8 mAs.
The increase in the mAs required to maintain the same
exposure to the IR results in an increase in patient dose. This
Likewise, if a radiographer chooses to not use a grid increase in patient dose is significant, as the numbers for the
during a procedure, but only knows the appropriate mAs GCF indicate.
150 SECTION II  Image Production and Evaluation

MATH APPLICATION
Decreasing the Grid Ratio
If a radiographer uses 40 mAs with an 8:1 ratio grid, what
mAs should be used with a 5:1 ratio grid to maintain the
same exposure to the IR?
Exposure 1: 40 mAs, 8:1 grid, GCF 5 4
Exposure 2: __mAs, 5:1 grid, GCF 5 2

mAs1 GCF1
5
mAs2 GCF2
40 4
5
mAs2 2
mAs2 5 20
Decreasing the grid ratio requires a lower mAs.

CRITICAL CONCEPT
Grid Ratio and Patient Dose
FIG 11-21  ​Image of Upside-Down Focused Grid. Radio-
As grid ratio increases, patient dose increases; as grid ratio graph produced with an upside-down focused grid.  (From
decreases, patient dose decreases. Fauber TL: Radiographic imaging and exposure, ed 3, St Louis,
2009, Mosby.)
It is important to remember that patient dose is increased
because of the following: Photons easily pass through the center of the grid because the
1. Using a grid compared with not using a grid lead lines are perpendicular to the IR surface. Lead lines that are
2. Using a higher-ratio grid more peripheral to the center are angled more and thus absorb
Decisions regarding the use of a grid and grid ratio should the transmitted photons. Upside-down focused grid error is
be made by balancing image quality and patient protection. easily avoided because every focused grid should have a label
To keep patient exposure as low as possible, grids should be indicating “tube side.” This side of the grid should always face
used only when appropriate, and the grid ratio should be the the tube, away from the IR.
lowest that will provide sufficient contrast improvement.
Off-Level. ​Off-level grid cutoff results when the x-ray beam
Grid Cutoff is angled across the lead strips. It is the most common type of
In addition to the disadvantage of increased patient dose as- cutoff and can occur from either the tube or grid being an-
sociated with grid use, another disadvantage is the possibility gled (Figure 11-22). Off-level grid cutoff can often be seen
of grid cutoff. Grid cutoff is defined as a decrease in the with mobile radiographic studies or horizontal beam exami-
number of transmitted photons that reach the IR because of nations and appears as a loss of exposure across the entire IR.
some misalignment of the grid. The primary radiographic This type of grid cutoff is the only type that occurs with both
effect of grid cutoff is a further reduction in the number of focused and parallel grids.
photons reaching the IR, resulting in a decrease in radio-
graphic density for a film image or increase in noise caused Off-Center. ​Also called lateral decentering, off-center grid
by a decrease in x-ray photons reaching the digital IR. Grid cutoff occurs when the CR of the x-ray beam is not aligned
cutoff may require that the radiographer repeat the image, from side to side with the center of a focused grid. Because of
thereby increasing patient dose yet again. Grid ratio has a the arrangement of the lead lines of the focused grid, the di-
significant effect on grid cutoff, with higher grid ratios result- vergence of the primary beam does not match the angle of
ing in more potential cutoff. these lead strips when not centered (Figure 11-23). Off-
Grid cutoff can occur as a result of four types of errors in center grid cutoff appears radiographically as an overall loss
grid use. To reduce or eliminate grid cutoff, the radiographer of exposure to the IR (Figure 11-24).
must have a thorough understanding of the importance of
proper grid alignment in relation to the IR and x-ray tube. Off-Focus. ​Off-focus grid cutoff occurs when using an SID
outside of the recommended focal range. Grid cutoff occurs
Upside-Down Focused. ​Upside-down focused grid cutoff oc- if the SID is less than or greater than the focal range. Radio-
curs when a focused grid is placed upside down on the IR, re- graphically, both appear the same—that is, as a loss of expo-
sulting in the grid lines going opposite the angle of divergence sure at the periphery of the image.
of the x-ray beam. This appears radiographically as significant A radiographic image that is underexposed can be the
loss of exposure along the edges of the image (Figure 11-21). result of many factors, one of which is grid cutoff. Before
 CHAPTER 11  Scatter Control 151

Central
axis

Proper position Off-level

FIG 11-22  ​Off-Level Grid. An off-level grid can cause grid cutoff.

Central
axis

Proper position Off-center

FIG 11-23  ​Off-Centered Grid. Centering to one side of a focused grid can cause grid cutoff.

assuming that an underexposed image is due to insufficient error. In addition, if a grid cassette is placed in a Bucky, imag-
mAs and then reexposing the patient with the mAs in- ing the double grids creates a zebra pattern on the radiograph
creased, the radiographer should evaluate grid alignment. If (Figure 11-25).
misalignment is the cause of the underexposure, the patient
can be protected from repeating the image with increased Grid Usage
mAs. Table 11-3 summarizes grid cutoff errors and their The radiographer must consider a number of factors when
radiographic effect. Table 11-4 summarizes important rela- deciding which type of grid, if any, to use for an examination.
tionships regarding the use of radiographic grids. Although quite efficient at preventing scatter radiation from
reaching the IR, grids are not appropriate for all examina-
Moiré Effect tions. When appropriate, selection of a grid involves consid-
The Moiré effect, or zebra pattern, is an artifact that can oc- eration of contrast improvement, patient dose, and the likeli-
cur when a stationary grid is used during CR imaging. If the hood of grid cutoff. Radiographers typically choose between
grid frequency is similar to the laser scanning frequency dur- parallel and focused grids, high- and low-ratio grids, grids
ing CR image processing, then a zebra pattern can result on with different focal ranges, and whether to use a grid at all.
the digital image. Use of a higher grid frequency or a moving As indicated earlier, the choice of whether to use a grid is
grid with CR digital imaging eliminates this type of grid based on the kVp necessary for the examination and the
152 SECTION II  Image Production and Evaluation

FIG 11-24  ​Off-Center Grid Cutoff. Radiograph demonstrat-

ing grid cutoff caused by off-centering.  (From Fauber TL:
Radiographic imaging and exposure, ed 3, St Louis, 2009,
Mosby.)

Table 11-3  Grid Cut-off Errors and Their

FIG 11-25  ​Moiré Effect. Radiograph demonstrating the zebra
Radiographic Effects
pattern as a result of the Moiré effect. Rights were not
Grid Error Radiographic Effect granted to include this content in electronic media. Please
Upside-Down Focused Grid: Significant underexposure to refer to the printed book. (From Cesar LI, et al: Artifacts found
Placing a focused grid the lateral edges of the IR in computed radiography, Br J Radiol 74:195-202, 2001. Used
upside down on the IR with permission from the British Institute of Radiology. Per-
Off-Level Error: Angling the Decrease in radiation mission conveyed through Copyright Clearance Center, Inc.)
x-ray tube across the grid exposure to the IR
lines or angling the grid
itself during exposure thickness of the part. Parts 10 cm (4 inches) or larger, to-
Off-Center Error: The center Decrease in radiation gether with a kVp higher than 60, produce enough scatter to
of the x-ray beam is not exposure to the IR necessitate the use of a grid. The next decision is which grid
aligned from side to to use. There is no single best grid for all situations. A 16:1
side with the center of a focused grid provides excellent contrast improvement, but
focused grid the patient’s dose will be high and the radiographer must
Off-Focus Error: Using an A loss of exposure at the ensure that the grid and x-ray tube are perfectly aligned to
SID outside of the focal periphery of the IR
prevent grid cutoff. The 5:1 parallel grid will do a mediocre
range
job of scatter cleanup, especially at 80 kVp or more. However,
IR, Image receptor; SID, source-to-image receptor distance. the patient dose will be significantly lower, and the radiogra-
pher need not be concerned with cutoff caused by being off-
center, SID used, or having the grid upside down. Selection
between grids with different focal ranges depends on the ra-
TABLE 11-4  Radiographic Grid Ratio diographic examination. Supine abdomen studies should use
a grid that includes 40 inches (100 cm) in the focal range;
Increased Factor Result
upright chest studies should have grids that include 72 inches
Grid ratio* Contrast increases. (180 cm). In general, most radiographic rooms are equipped
Patient dose increases.
with a 10:1 or 12:1 focused grid, which provides a compro-
The likelihood of grid cutoff
mise between contrast improvement and patient dose. Sta-
increases.
tionary grids for mobile examinations, in particular, may be
*Milliamperage/second adjusted to maintain exposure to image lower ratio, parallel, or both to allow the radiographer greater
receptor. positioning latitude.
Grids differ from one another in performance, especially
in the areas of grid ratio and focal distance. Before using a
 CHAPTER 11  Scatter Control 153

grid, the radiographer must determine the grid ratio so that BOX 11-2  The Typical Grid:
the appropriate exposure factors can be selected. Also, the
• Is long-dimension linear instead of crossed.
radiographer must be aware of the focal range of focused
• Is focused instead of parallel.
grids so that the appropriate SID is selected. Box 11-2 lists
• Is of mid-ratio (8:1 to 12:1).
attributes of the grid typically used in radiography. • Has a focal range that includes an SID of 40 or 72 inches
Box 11-3 provides information on quality-control checks (100 or 180 cm).
for grid uniformity and alignment.
SID, Source-to-image receptor distance.
Radiation Protection
Limiting the size of the x-ray field to the anatomic area inter-
est will decrease scatter production and reduce patient expo- BOX 11-3  Quality Control Check:
sure. Although the mAs may be increased to compensate for Grid Uniformity and Alignment
decreasing the size of the x-ray field, the tissues located clos- • Nonuniformity of a grid (lack of uniform lead strips) may
est to the lateral edge or outside of the collimated x-ray beam create artifacts on the image. Grid uniformity can be easily
will receive the least amount of radiation exposure. Those evaluated by film-screen imaging a grid and measuring
tissues that lie inside the collimated edge of the x-ray beam optical densities throughout the image. Optical density
will receive the greatest amount of radiation exposure. Col- readings should be within 1/2 0.1 for proper uniformity.
• Misalignment of a focused grid (off center) can reduce the
limating to the anatomic area of interest is an important ra-
exposure to the IR because of grid cut-off. A grid alignment
diation safety practice that should be routinely performed. tool made of radiopaque material with cut-out holes in a
The use of grids requires an increase in mAs to maintain line can be film-screen imaged to evaluate correct align-
exposure to the image receptor. As a result, patient radiation ment of the grid with the x-ray field. A properly aligned grid
exposure is increased when using grids. The higher the grid produces a greater center-holed optical density than the
ratio, the greater the mAs needed to maintain exposure to the optical densities of the side holes.
image receptor. increasing patient radiation exposure. Limit- IR, Image receptor.
ing the use of grids or using a grid with a lower grid ratio will
decrease the radiation exposure to the patient.
IR. The air gap technique is based on the simple concept that
The Air Gap Technique much of the scatter will miss the IR if there is increased dis-
The radiographer may use the grid most often to prevent scat- tance between the patient and IR (increased object-to-image
ter from reaching the IR, but the grid is not the only available receptor distance [OID]) (Figure 11-26). The greater the gap
tool. Although limited in its usefulness, the air gap technique the greater the reduction in scatter reaching the IR. Similar to
provides another method for limiting the scatter reaching the a grid, contrast is increased, the number of photons reaching

15 cm

FIG 11-26  ​Air Gap Technique. The air gap technique showing scatter radiation missing the
image receptor.
154 SECTION II  Image Production and Evaluation

the IR is reduced because less scatter reaches the IR, and the
mAs must be increased to compensate.
The air gap technique is limited in its usefulness because
the necessary OID results in decreased spatial resolution.
To overcome this decrease in sharpness, an increase in SID
is required, which may not always be feasible. The air gap
technique has found some use in magnification film-screen
radiography, in which increased OID is already present, as
well as in some institutions where chest radiography is per-
formed with a 10-inch (25 cm) air gap and a 120-inch (300 Lead mat on table-top
cm) SID. It is estimated that, for a small body part (10 cm or
4 inches), a 10-inch (25 cm) air gap will clean up scatter as
well as a 15:1 grid. The cleanup is not as efficient for a larger
body part (20 cm or 8 inches).* The air gap technique results
in patient dose that is the same as, or slightly less than, using FIG 11-27  ​Shielding Accessory. Lead shield placed to
a comparable grid. Exposure may be slightly less because a absorb scatter radiation from patient.  (From Bontrager KL,
grid absorbs some of the transmitted photons (grid cutoff) Lampignano JP: Textbook of radiographic positioning and
whereas the air gap technique does not. related anatomy, ed 7, St Louis, 2010, Mosby.)

CRITICAL CONCEPT are situations in which it is beneficial to use shielding devices

Air Gap Technique and Scatter Control to absorb scatter radiation exiting the patient. Placing a lead
shield on the x-ray table close to the edge of the area of inter-
The air gap technique is an alternative to using a grid to con-
est absorbs scatter exiting the patient that could degrade
trol scatter reaching the IR. By moving the IR away from the
image quality. The lateral lumbar spine projection and the
patient, more of the scatter radiation misses the IR. The
greater the gap, the less scatter reaches the IR. lateral spot are projections in which a significant amount of
scatter exits the patient. Placing a lead shield behind the pa-
tient’s lower back absorbs the scatter and reduces the amount
Using an increased OID is necessary for the air gap tech- striking the IR (Figure 11-27). It is important to note that
nique. However, this decreases image quality. To decrease placing a lead shield on the table to limit the scatter radiation
unsharpness and increase spatial resolution, the radiographer reaching the IR does not reduce the exposure to the patient.
must increase SID. Because the patient is the greatest source of scatter radia-
tion, any individual remaining in the radiographic room dur-
ing an exposure must wear a lead apron. Wearing a lead apron
SHIELDING ACCESSORIES and standing as far from the patient as possible decreases the
Efforts to control the amount of scatter radiation produced amount of occupational exposure to scatter radiation.
within the patient and reaching the IR are important consid- It is the radiographer’s responsibility to reduce the amount
erations during radiography. Restricting the size of the x-ray of scatter radiation produced and reaching the IR. Reducing
beam to the anatomic area of interest reduces the radiation the amount of scatter produced through beam restriction,
exposure to the patient and improves image quality. There reducing the amount of scatter reaching the IR by using a
grid, avoiding grid cutoff errors, and making appropriate
* Curry TS, Dowdy JE, Murry RC: Christensen’s physics of diagnos- exposure adjustments as needed all help produce good-
tic radiology, ed 4, Philadelphia, 1990, Lea & Febiger. quality radiographic images.

SUMMARY
• Scatter radiation, the result of Compton interactions, is produced in the patient. Aperture diaphragms, cones and
detrimental to radiographic image quality. Excessive scat- cylinders, and collimators are types of beam restrictors.
ter results in additional unwanted x-ray exposure (fog) to • Increasing collimation reduces the volume of anatomic
the IR and reduced contrast. tissue irradiated and reduces patient exposure.
• The effect of scatter radiation can be reduced by limiting • Radiographic grids are devices placed between the patient
the amount produced and by absorbing the scatter before and IR to absorb scatter radiation. Consisting of a series of
it reaches the IR. lead strips and radiolucent interspaces, grids allow trans-
• The amount of scatter exiting the patient increases as the mitted radiation to pass through while scatter radiation is
volume of irradiated tissue increases. absorbed.
• A higher kVp increases the energy of scatter radiation ex- • Grid designs include linear parallel, focused parallel,
iting the patient. Beam restriction limits the area exposed crossed, long and short dimension, each with advantages
to radiation, the patient dose, and the amount of scatter and disadvantages.
 CHAPTER 11  Scatter Control 155

S U M M A R Y — cont’d
• The use of a grid in a radiographic examination results in • Adding a grid will require an increase in mAs to maintain
fewer x-ray photons reaching the IR. The grid conversion exposure to the image receptor and therefore, increase the
or Bucky factor is used to calculate the increase in expo- radiation exposure to the patient.
sure needed when grids are used. • The air gap technique is another method, although sel-
• Grid errors that produce grid cutoff include using a fo- dom used, for reducing the amount of scatter reaching
cused grid upside down and errors caused by off-level, the IR.
off-center, and off-focus misalignment. • Scatter control is of the same, or greater, importance in
• The type of grid used depends on the thickness of the part, digital imaging because of the IR’s increased sensitivity to
the kVp, patient dose, contrast improvement, and the like- low-energy radiation.
lihood of grid errors.

CRITICAL THINKING QUESTIONS

1. What are the advantages and disadvantages of beam 3. What are the advantages and disadvantages of using a
restriction? grid?
2. How can patient exposure be reduced when restricting the
x-ray beam if exposure factors are increased to maintain
image quality?

REVIEW QUESTIONS
1. Which of the following will decrease the amount of scatter 7. What type of grid has lead strips running parallel to the
radiation produced? long axis of the grid?
a. increasing the x-ray field size a. focused
b. decreasing the x-ray field size b. short dimension
c. increasing the grid ratio c. cross hatched
d. decreasing the grid ratio d. long dimension
2. Which of the following is not a type of beam restrictor? 8. Angling the x-ray tube along the long axis of a crossed
a. aperture diaphragm grid would result in:
b. positive beam-limiting device a. increased scatter absorption.
c. cylinder b. grid cutoff.
d. lead shield c. Moiré effect.
3. As collimation decreases, the quantity of scatter radiation d. lateral decentering.
decreases. 9. In order for the Air Gap Technique to be effective in re-
a. True ducing scatter radiation reaching the image receptor,
b. False what must be increased?
4. What type of beam-restricting device provides the most a. SID
flexibility in adjusting the x-ray field size? b. focal spot size
a. cylinder c. kVp
b. aperture diaphragm d. OID
c. collimator 10. With exposure technique compensation, _____ the grid
d. cone ratio will _____ patient radiation exposure.
5. What describes the number of lead lines per unit length? a. decreasing, increase
a. grid frequency b. increasing, decrease
b. grid pattern c. increasing, increase
c. grid convergent point d. decreasing, will not effect
d. grid ratio
6. A radiographic image was created using a 12:1 grid and 70
kVp at 10 mAs. What exposure technique change would
maintain a similar exposure to the image receptor when
converting to a 6:1 ratio grid?
a. 81 kVp at 5 mAs
b. 70 kVp at 16.7 mAs
c. 70 kVp at 6 mAs
d. 60 kVp at 20 mAs
12
Image Receptors

OUTLINE
Introduction Radiographic Film
Digital Receptors Film Construction
Detector Types Latent Image Formation
Image Acquisition, Extraction and Processing, and Display Film Characteristics
Acquisition Intensifying Screen Characteristics
Extraction and Processing Automatic Film Processing
Display Components
Using Digital Receptors Systems
Quality Assurance and Quality Control Quality Control
Daily Silver Recovery
Monthly or Quarterly Summary
Picture Archiving and Communication Systems

OBJECTIVES
• Describe the design of computed radiography detectors. • Describe the Picture Archiving and Communication S
• Describe the design of direct radiography detectors. ystem, including its role, principal systems, and challenges.
• Explain the process of image acquisition using computed • Explain how the latent image is formed in film.
radiography detectors. • Describe film characteristics, including speed, contrast,
• Explain the process of image acquisition using the three latitude, and spectral sensitivity.
general types of direct radiography detectors. • Describe the purpose and function of intensifying
• Explain the process of image extraction and processing screens.
for computed radiography and direct radiography • Explain how intensifying screens can be characterized
systems. based on the type of phosphor, spectral emission, and
• Describe digital image display and postprocessing screen speed.
functions. • Describe factors that affect intensifying screen speed.
• Explain the use of exposure indicators for computed • State the automatic film processing stages and their
radiography systems and dose-area product for direct function.
radiography systems. • Discuss the purpose of replenishment, recirculation, and
• Correctly identify the role of kVp, mAs, and sharpness temperature control during automatic film processing.
factors with digital systems. • Identify important quality control measures to ensure
• Identify quality control tests and test patterns used with good radiographic quality.
digital systems. • State the importance of and methods for silver recovery.

KEY TERMS
automatic film processor diffusion film-screen contact
cassette Digital Imaging and Communica- fixing agent
computed radiography systems tions in Medicine (DICOM) fluorescence
direct radiography systems dose-area product (DAP) histogram analysis
charge-coupled device double-emulsion film hydroquinone
complimentary metal oxide semi- dynamic range immersion heater
conductor emulsion intensifying screen
detective quantum efficiency (DQE) exposure indicator latent image
detector array exposure latitude latent image centers
developing agents feed tray luminescence

156
 CHAPTER 12  Image Receptors 157

K E Y T E R M S — cont’d
manifest image plate reader spectral emission
modulation transfer function (MTF) rare earth elements spectral matching
phenidone recirculation system spectral sensitivity
phosphor layer reducing agents speed
photoconductor relative speed standby control
photodetector replenishment teleradiology
photostimulable luminescence screen film thin-film transistor (TFT)
photostimulable phosphor (PSP) screen speed values of interest (VOI)
plate silver halide x-ray scintillator
Picture Archiving and Communica- silver recovery
tion System (PACS) single-emulsion screen film

INTRODUCTION Detector Types

This chapter covers both digital detectors and film as image Computed Radiography Systems.  Computed radiography
receptors. Radiography is changing. Although the transition (CR) systems (Figure 12-1), can be integrated with existing
to digital is almost complete in the United States, we still have radiographic equipment without physical modification of
facilities that use film-screen, and this material is still covered the x-ray unit itself. The automatic exposure control (AEC)
in the optional content area of the American Society of must be recalibrated, and preprogrammed techniques in the
Radiologic Technologists (ASRT) curriculum and on the anatomic program system and technique charts must be ad-
American Registry of Radiologic Technologists (ARRT) radi- justed. Beyond that, little else changes inside the radiographic
ography examination.This chapter places a major emphasis suite. A cassette is taken into the suite and exposed to obtain
on digital receptors but still covers film-screen technology in an image. The primary parts of a CR system are the cassette,
what may be the final stages of transition. Radiography is the the photostimulable phosphor (PSP) plate that goes inside
last of the medical imaging modalities to make this transi- the cassette, the plate reader, and a computer workstation.
tion. Certainly, the age of film-screen will soon enter the The cassette, made of a lightweight plastic, is simply a
annals of medical imaging history, but for now it remains a container for the PSP plate. The inside of the cassette is lined
part of practice. with a felt material to prevent static buildup and dust collec-
As digital radiography advances, new and experienced tion. The backing, a sheet of aluminum to absorb x-rays that
radiographers alike must learn a few new concepts and prac- penetrate the plate, reduces the amount of backscatter radia-
tices. But it is equally important that they learn what remains tion that strikes the plate.
the same. Digital receptors bring many benefits to medical The PSP plate is made up of several layers similar to an
imaging, but they also bring challenges as to how to use them intensifying screen of a film-screen system. The layers are as
in the best interest of the patient and the profession. follows (Figure 12-2). The protective layer is a thin layer of

DIGITAL RECEPTORS
Digital imaging is not a new concept. CT, sonography, nu-
clear medicine, and MRI, for example, have been digital for
some time in that they display the initial image on a com-
puter monitor. However, historically these images have been
converted to a familiar form: film. But this too has changed
as medical imaging moves to an entirely digital environment.
Radiography has joined the digital trend only relatively re-
cently. Digital radiography may be divided into two groups
by the digital receptor type. Digital receptors may either be
computed radiography (CR) or direct radiography (DR). In
keeping with the American Registry of Radiologic Technolo-
gists’ Standard Definitions, computed radiography (CR) sys-
tems are those that use storage phosphors to temporarily FIG 12-1  ​Computed Radiography Reader, Cassette, and
store energy representing the image signal. The Phosphor Viewing Station. Desktop computed radiography reader and
then undergoes a process to extract the latent image. Direct viewing station. The cassette is placed in the reader, which
radiography (DR) systems are those that have detectors that removes and scans the plate, clears it, and returns it to the
directly capture and read out an electronic image signal. cassette.
158 SECTION II  Image Production and Evaluation

Protective layer the liberated electrons is proportional to the x-ray exposure

Phosphor layer (turbid) received in each particular area of the plate. The liberated
Reflective layer electrons remain trapped in the conduction band for hours
Conductive layer (although deterioration begins immediately) and these
Support layer trapped electrons represent the latent image. At the time of
Cross section of PSP plate processing, the energy of these trapped electrons is released
by exposure to a laser in a process called photostimulable
FIG 12-2  ​Cross Section of a PSP Plate.
luminescence. The reader processes the PSP plate.

plastic to protect the phosphor layer. The phosphor layer is CRITICAL CONCEPT
the heart of the plate and contains the phosphor, which is Photostimulable Phosphor Plate Response
usually of the barium fluorohalide family and europium ac-
When the PSP plate is exposed to x-rays, phosphor atoms
tivated. The phosphor may be either a turbid or structured
are ionized. Approximately half of the removed electrons are
phosphor layer. A turbid phosphor has a random distribution “trapped” in the conduction band. The quantity and distribu-
of phosphor crystals within the active layer and can be used tion are proportional to exposure and represent the latent
with both CR and DR systems. A structured phosphor layer image. When the PSP plate is exposed to the laser of the
has columnar phosphor crystals within the active layer re- reader, the energy is released and converted to a digital sig-
sembling needles standing on end and packed together. The nal, becoming a manifest image.
reflective layer reflects light released during the reading phase
toward the photodetector. The conductive layer reduces and
conducts away static electricity. The color layer may be in The reader design may vary somewhat from one vendor to
some newer plates to absorb stimulating light and reflect the next but generally has the same major components. A
emitted light. The support layer is a sturdy material to give drive mechanism moves the plate through the laser-scanning
some rigidity to the plate. Finally, the soft backing layer pro- process. An optical system made up of a laser, beam-shaping
tects the back of the plate. optics, light-collecting optics, and optical filters is designed to
An understanding of how the plate responds to x-ray project and guide a precisely controlled laser beam back and
exposure is necessary before the reader can be described. forth across the plate as the plate moves through the scan
When the PSP plate is exposed to x-rays, some electrons are area. (In some systems the plate is stationary and the laser
removed from the phosphor atoms, and approximately 50% and optical system move.) A photodetector is used to sense
of those liberated are trapped in the conduction band the light released from the PSP plate during scanning. The
(Figure 12-3). The conduction band is an energy level just photodetector amplifies this light but it is in an analog elec-
beyond the valence band (the outermost energy band of an tronic signal form. To make it digital, this amplified signal is
atom). The remainder returns immediately and emits the sent to an analog-to-digital converter (ADC) that converts it
excess energy as light (stimulated light). Europium is a to a digital electronic signal for the display computer. Finally,
silvery rare earth metal used as an activator for the phos- a computer is used to process and display the image.
phor. The role of europium is to capture some of the energy To summarize this process, the PSP plate is exposed to
in the interaction process. The europium-activated barium x-ray energy and many electrons are trapped in the conduc-
fluorohalide of the phosphor layer emits some light imme- tion bands as a latent image. When the cassette is inserted
diately in response to x-ray stimulus. But because of the into the reader, the plate is removed and fed into the scanning
presence of europium, it will also store some of the x-ray area at a controlled and precise speed. As the plate moves
energy as the latent image. The quantity and distribution of forward, a laser beam is projected onto the phosphor layer.
The laser energy releases the trapped electrons from the con-
duction band. As these electrons return to their respective
valence shells, the excess energy is given off as spontaneous
light energy. This light energy is directed to the photodetector
via a fiberoptic bundle or a solid, light-conducting material.
The photodetector sends this light to the ADC, where it is
converted to a digital electronic signal that is sent to the com-
Conduction band puter for processing and display. The computer’s role in this
Valence band process is discussed later in this chapter.
Phosphor atoms
Direct Radiography Systems. ​With direct radiography
Phosphor layer of a PSP (DR) a detector array (Figure 12-4) replaces the Bucky
plate during exposure assembly and generally requires a complete x-ray unit
FIG 12-3  ​Phosphor Layers of a PSP Plate During Expo- replacement if transitioning from film technology. With
sure. these systems, the image-forming radiation is captured and
 CHAPTER 12  Image Receptors 159

consist of an array of closely spaced CCDs. One challenge of

this design is the seams at which the CCDs are joined (called
tiling or tiled). Tiling is a process in which several CCD detec-
tors abut to create one larger detector. This process results in
seams with unequal response. This is addressed with com-
puter correction software that interpolates (averages) the
pixel values along the seams (flat-field correction), in effect
making the seams disappear.
Serving a similar purpose as the CCD is the complimen-
FIG 12-4  ​Direct Radiography System Detector Assembly. tary metal oxide semiconductor (CMOS). CMOS devices
The detector assembly replaces the Bucky tray and cassettes
are scintillators made up of a crystalline silicon matrix. Each
and serves as the image receptor.
detector element has its own amplifier, photodiode, and stor-
age capacitor and is surrounded by transistors. They do not
transferred to a computer from the detector array for have quite the light sensitivity or resolution of CCDs but they
almost instant viewing at the control panel. The two general use a fraction of the power to run, are very inexpensive to
categories of DR systems are referred to as indirect capture manufacture, and are improving. The newest versions have
and direct capture. very fast image acquisition times because of their random
Currently there are two forms of indirect capture. One pixel access capabilities. This feature also makes for auto-
uses a charge-coupled device (CCD) (Figure 12-5), an x-ray matic exposure control (AEC) functions that are not as easy
scintillator, and optics. The CCD is a light-sensitive device to achieve with CCDs. Creation of CMOS detectors of suffi-
first developed by the military that has since been incorpo- cient size for general radiongraphy have not been available,
rated into digital cameras and other applications. The CCD is but this is changing. Recent advances in CMOS technology,
very light sensitive and can respond to very low light intensi- particularly the creation of crystal light tubes that prevent
ties. It also has a wide dynamic range and can respond to a light spread and methods for increasing their size, make them
wide range of light intensities. The scintillator for this form future possibilities. They are currently options for mammog-
of indirect capture is a cesium iodide phosphor plate. A scin- raphy and dental radiography machines.
tillator is a material that absorbs x-ray energy and emits vis- The other indirect capture method also uses a scintillator
ible light in response. Cesium iodide is a hygroscopic material with cesium iodide or gadolinium oxysulfide as the phos-
(it readily absorbs moisture) that must be hermetically sealed phor, photodetectors, and a thin-film transistor (TFT) array.
to avoid water absorption and prevent rapid degradation, but Gadolinium oxysulfide is commonly used as the phosphor
is otherwise a high-efficiency scintillation material. The ce- material in conventional intensifying screens of film-screen
sium iodide phosphor plate may be coupled to the CCD us- systems. As a scintillator, it is also a high-efficiency material
ing either a fiberoptic bundle or an optical lens system. With but with significantly more light spread than cesium iodide.
this form of indirect capture, x-rays are absorbed by the scin- The photodetector is generally an amorphous silicon (a-Si)
tillator and converted to light. This light energy is then trans- photodiode. Amorphous silicon, a liquid that can be painted
mitted to the CCD, where it is converted to an electronic onto a substrate (foundation or underlying layer), is the ma-
signal and sent to the computer work station for processing terial that makes flat-panel detectors possible. Earlier semi-
and display. Because there are currently technical limits to conductor technology required a single-crystal structure,
how large a single CCD device can be, an x-ray receptor may which limited the size of the electrical component to the size

Csl phosphor

Fiberoptic taper

CCD array

FIG 12-5  ​Charge-Coupled Device. The basic components of a charge-coupled device (CCD)
detector array. The cesium iodide phosphor plate is connected to the CCD array using fiberoptic
bundles.
160 SECTION II  Image Production and Evaluation

Scintillation phosphor

a-Si

Address drives
Amplifiers/
multiplexer
Glass substrate

Computer A/D converter

FIG 12-6  ​Thin-Film Transistor Array. This cutaway view of the thin-film transistor (TFT) array
reveals the detector elements, consisting of a photodetector and a TFT layered on a glass
substrate.

of the crystal. The final component is the TFT array. TFTs are X-rays
electronic components layered onto a glass substrate that
include the readout, charge collector, and light-sensitive
Top electrode
elements. The panel is configured into a network of pixels
(or detector elements [DELs]) covered by the scintillator
plate with each pixel containing a photodetector and a TFT
(Figure 12-6). With this form of indirect capture, x-ray en-
ergy is absorbed by the scintillator and converted to light a-Se
energy. This light is then absorbed by the photodetectors and
converted to electric charges. These electric charges are in
turn captured and transmitted by the TFT array to the com-
puter workstation for processing and display. TFT

CRITICAL CONCEPT Pixel electrode Storage

capacitor
Glass substrate
DR Indirect-Capture Methods
DR indirect-capture methods capture the remnant beam FIG 12-7  ​Direct Capture Array. Cross-section of the compo-
through a detector array and transfer it to a computer for nents of a direct-capture array.
almost immediate processing and viewing. The DR indirect
capture methods both involve the use of a scintillator that
converts x-rays to light and then to an electronic signal. This are less ordered across larger distances, thereby providing
process results in some loss of resolution. uniform x-ray detection ability across the large surface areas
needed by flat-panel detectors. This detector design is also
layered. The top layer is a bias electrode (with dielectric
One problem with the indirect-capture methods is that layer), followed by the amorphous selenium, and then the
there is an extra step during which x-rays are converted to TFTs connected to storage capacitors. Before exposure, an
light, and then to electrons, which causes a loss of resolution. electric field is applied through the bias electrode across the
The direct-capture method avoids the extra step and the surface of the amorphous selenium layer. Once exposure be-
problem by not using a scintillator. Instead it uses a photo- gins, x-rays are absorbed by the amorphous selenium and
conductor and a TFT array (Figure 12-7). The photoconduc- electric charges are created in proportion to the x-ray expo-
tor is amorphous selenium (a-Se), and the TFT is the same as sure received. Under the influence of the electric field, the
described previously. Amorphous selenium layers have the charges migrate toward the TFT array. These charges are
same single-crystal layer structure across short distances but stored in the storage capacitors, where they are amplified and
 CHAPTER 12  Image Receptors 161

converted to digital code by the underlying electronics. The analysis. The other method of analysis is the neural analysis
TFTs then read the signal and transmit it to the computer model, which determines optimal minimum and maximum
workstation for processing and display. VOI locations. The method used does affect the way the im-
age displays.
CRITICAL CONCEPT
CRITICAL CONCEPT
DR Direct-Capture Method
Digital Image Acquisition
The DR direct-capture method does not use a scintillator.
Rather, it uses a photoconductor and TFT array, thereby avoid- With digital systems, the computer creates a histogram of
ing the loss of resolution caused by indirect capture. the data set. The data set is the exposure received to the
pixel elements and the prevalence of those exposures within
the image. This created histogram is compared with a stored
histogram model for that anatomic part; VOI are identified
IMAGE ACQUISITION, EXTRACTION and the image is displayed.
AND PROCESSING, AND DISPLAY
Acquisition
During image acquisition the computer creates a histogram Extraction and Processing
(Figure 12-8). A histogram is a graphic representation of a Image extraction for CR systems is discussed first. Recall that
data set. This graph represents the number of digital pixel when the PSP plate is exposed to x-rays, phosphor atoms are
values versus the relative prevalence of those values in the ionized and the liberated electrons are trapped in the con-
image. The x-axis represents the amount of exposure and duction band and represent the latent image. When the plate
the y-axis the incidence of pixels for each exposure level. The is processed, it is removed from the cassette by the reader and
computer then analyzes the histogram using processing algo- moved through the scanning area at a very precise speed by
rithms and compares it to a preestablished histogram specific the drive system (Figure 12-9). This movement through the
to the anatomic part being imaged. This process is called reader is called a “slow scan.” As the plate moves through the
histogram analysis. The computer software has histogram reader, it is exposed to a laser that sweeps back and forth
models for all menu choices. These stored histogram models across the plate, releasing the trapped electrons. The laser is
have values of interest (VOI) and determine what section of deflected back and forth by a rotating polygon or oscillating
the histogram data set should be included in the displayed mirrors and blanked on each retrace. This scanning move-
image. During this process of “recognition” the computer ment by the laser is called a “fast scan.” The scanning of the
identifies the exposure field and the edges of the image, and plate must be very precise to avoid image artifacts. The toler-
all exposure data outside this field are excluded from the his- ance is a fraction of a pixel.
togram. Ideally, all four edges of a collimated field are recog- As the electrons that have been liberated by the laser re-
nized. If at least three edges are not identified, then all data, turn to their shells, they release excess energy as light. This
including raw exposure or scatter outside the field, may be light is directed to the photodetector via a fiberoptic bundle
included in the histogram, resulting in a histogram analysis or a solid, light-conducting material. The photodetector then
error. This is discussed in greater detail shortly. More specifi- amplifies the light energy and converts it to an electronic
cally, this is a description of the a priori model of histogram analog signal. This signal is then passed through an ADC,
where it is digitized. As the analog signal is digitized, it is di-
vided into a matrix or series of squares; each square is a pic-
ture element called a pixel. The detector size or field of view
Max describes the useful imaging area of the digital receptor. The
size of the matrix determines the resolution: the larger the
matrix, the greater the number of pixels (because each pixel
is smaller) and the greater the resolution. Sampling is a time-
Count
based event of the signal that is being sent from the photode-
tector to the ADC. The scanning of the plate results in a
continuous signal being sent to the photodetector and onto
the ADC for sampling and quantization. The sampling oc-
0
289 Pixel value 2817 curs along the extracted signal. The closer the samples are to
each other, the greater the sampling frequency. The sampling
VOI frequency is the frequency at which a data sample is acquired
FIG 12-8  ​Histogram. Example of a histogram representing from the detector and is expressed as sampling pitch. Sam-
an image data set. The x-axis represents the amount of expo- pling pitch describes how digital detectors sample the x-ray
sure and the y-axis the incidence of pixels for each exposure exposure. They do so discretely—that is, at specific locations
level. Note that the values of interest are indicated by the separated by specific intervals. For CR systems, the sampling
bracket. pitch is the distance between laser beam positions during
162 SECTION II  Image Production and Evaluation

Rotating polygon mirror

or OPTICAL COMPONENTS
oscillating mirror
Intensity
Laser
control

Beam shaping
Optical Photo
filter dectector
Light collection
optics Signal shaping
Imaging plate
Sampling and
quantization

Imaging plate
transport

Control
Fast scan computer

Slow scan
FIG 12-9  ​Cassette Reader Operation. The general steps of a computed radiographic scanning
process.

processing of the plate, and for DR systems it is the distance This analog signal is passed through an ADC, in which it is
between adjacent DELs. The distance between the center of digitized in the manner described previously. The use of a
one pixel and the center of an adjacent pixel is called pixel CMOS system follows the same steps and would be in place
pitch and is measured in microns. of the CCD. The other indirect method uses either a cesium
The image is digitized by both location (spatial resolution) iodide or gadolinium oxysulfide scintillator, which is coupled
and intensity (grayscale) of each part of the signal. Grayscale to a photodetector, usually an amorphous silicon photodi-
is assigned during the process of digitizing the image. Bit ode, and a TFT. The panel is configured as a network of
depth is the available grayscale and refers to the number of pixels, with each pixel containing a photodetector and a TFT.
shades of gray that can be displayed within a pixel. Depend- With this system, the x-rays are absorbed by the scintillator
ing on the software, CR systems have bit depths of up to 214 and converted to light. The light is absorbed by the photode-
or 16,384 shades of gray. The number of photons detected tectors and converted to an analog electronic signal that
within a given pixel determines the shade of gray it displays; is collected by the DELs and then digitized by an ADC as
the greater the number of photons, the darker the shade of described previously.
gray. In addition, the greater the bit depth of the digital sys- The direct method does not use a scintillator. With this
tem, the more shades of gray available to display the attenu- approach, an amorphous selenium photoconductor and a
ated anatomic tissue. The computer of the CR reader is in TFT array are used. Before exposure, an electric field is ap-
control of the entire process and puts the image data through plied via the bias electrode across the surface of the amor-
a series of steps to create the displayed image. phous selenium layer. During exposure, x-rays are absorbed
by the amorphous selenium and electric charges are created
in proportion to the x-ray exposure received. These charges
CRITICAL CONCEPT are stored in the storage capacitors attached to the TFTs,
CR Image Extraction where they are amplified and converted to digital code by the
underlying electronics. The TFTs first read the signal and
In CR systems, the image is stored in the plate and
then pass it through an ADC, as described previously.
“extracted” when the plate is exposed to the laser of the
From this point, all three DR systems go through the same
reader. The energy liberated by the reader is passed through
an ADC, in which it is digitized. The digitized signal is basic image-forming steps previously described: A histogram
converted to a matrix and assigned gray-scale values. is created and analyzed, the exposure field is recognized and
the histogram analysis occurs, and finally automatic rescaling
takes place. However, with these systems only those detector
In DR systems there are two indirect methods and one pixels that were exposed contribute to the image. DR systems
direct method. One indirect method uses a cesium iodide also have the same bit depth and gray scale as CR systems.
phosphor plate as the scintillator coupled to a CCD by a
fiberoptic bundle or optical lenses. The x-ray energy is ab- Display
sorbed by the scintillator and converted to light. The light is The display of a digital image illustrates perhaps the most
transmitted to the CCD, and an electronic signal is created. significant difference between digital detectors and film. It is
 CHAPTER 12  Image Receptors 163

stored histogram in a process called histogram analysis. Auto-

A matic rescaling also occurs during this process. The computer
rescales the image based on the comparison of the histo-
grams, which is actually a process of mapping the grayscale to
B
Latitude
the VOI to present a specific display of brightness.
Display workstation guidelines apply to primary display
workstations (those used for official interpretation of the im-
ages). Secondary workstations do not have to adhere to the
established guidelines so long as they are not used for inter-
pretation. Among these guidelines are maximum luminance
Exposure
levels of at least 171 candelas per meter squared, contrast re-
FIG 12-10  ​Digital Receptor Versus Film Response. In this sponse that meets the requirements of the American Associa-
comparison of film and digital receptors, A represents the tion of Physicists in Medicine (AAPM) Task Group 18, a
Hurter and Driffield curve of a film and B represents the linear minimum of 8-bit luminance resolution, minimal veiling
response line of a digital receptor. glare, and minimal reflections from and levels of ambient
light sources. Some of the test patterns used are discussed
later, as is information for obtaining a complete list of quality
easier to understand the difference by comparing the two us- control requirements that the medical physicist follows in
ing Figure 12-10. In this figure, A represents the Hurter and evaluation of the equipment.
Driffield (H&D) curve of a film and B represents the linear One great advantage of digital radiography versus film-
response line of a digital receptor. The exposure latitude be- screen radiography is that with digital it is possible to prepro-
tween the two is different. Exposure latitude is the range of cess and postprocess the image. Preprocessing is generally an
exposure values to the receptor that produce an acceptable automatic function of the system and occurs before the im-
range of densities for diagnostic purposes and are consistent age is displayed. In addition to the histogram analysis and
with exposure rates as low as reasonably achievable (ALARA). automatic rescaling, the system corrects for variations in
Similarly, film latitude is the exposures that deliver optical pixel, row, and column responses. Other automatic calibra-
densities on the film. During the manufacturing of film, the tion functions may be performed by the system to make the
latitude can be made to be wider or narrower, but the useful receptor response more uniform.
range of densities is always defined by the body of the H&D Postprocessing functions are computer software opera-
curve. The toe and shoulder of the H&D curve represent tions available to the radiographer and radiologist that allow
densities that are too light and too dark, respectively, to be manual manipulation of the displayed image. These func-
useful. Exposure latitude is different from film latitude in that tions allow the operator to manually adjust many presenta-
it represents the digital receptor’s ability to record a much tion features of the image to enhance the diagnostic value.
wider range of exposure values, a range that is much nar- Box 12-1 presents some of the most common functions.
rower with film. Also recall that with digital systems the Window width and window level are discussed further here
brightness is a separate function of display. Brightness levels because they are particularly valuable tools. Digital radiogra-
can be windowed and leveled (changed) as a postprocessing phy uses a 14-bit dynamic range, which equates to 16,384
function. With digital receptors, the response to exposure is distinct shades of gray. The human eye can only appreciate
linear and the range of exposures is very wide. This may be approximately 30 shades of gray at any particular level. The
described as dynamic range. Dynamic range is the range of windowing-leveling function allows the radiographer to ex-
exposure intensities that an image receptor can respond to pand any region of the grayscale to one that can be seen and
and use to acquire image data. Ultimately this means that differentiated. Think of the 16,384 shades of gray as a con-
digital receptors can respond to exposure levels much lower tinuum scale viewed through a window and stretched out
and much higher than film and process them to display them from left to right. This window allows the viewer to look only
as visible shades of gray. The result is that more anatomic at a small segment of the continuum directly in front, but
information can be captured and displayed. expands that segment to a visible black and white scale. The
window may move from left to right as far as the viewer likes,
but the window allows the viewer to see and expand only
CRITICAL CONCEPT what is directly in front. Leveling “moves the window” to the
Digital Image place specified on the continuum, and windowing expands
that portion of the grayscale to a visible black and white scale.
The digital image has a linear response to x-ray exposure and
A word of caution regarding postprocessing: Overuse of
can respond to a wider range of x-ray energy and display a
much wider range of densities than a film image.
these functions can drastically and negatively alter the data
set that is the digital image. Doing so reduces the diagnostic
and archival quality of the data. One should also keep
As previously described, prior to display, the computer in mind that in many facilities the radiographer’s worksta-
creates a histogram of the data set and compares it with a tions use monitors of significantly lower quality and viewing
164 SECTION II  Image Production and Evaluation

BOX 12-1  Postprocessing Functions to the plate. The optimal range when using this system is ap-
proximately 250 to 300 for the torso and 75 to 125 for the
• Window width and window level: A technique to take
advantage of the more than 16,000 shades of gray.
extremities. Carestream (Kodak) uses exposure index (EI)
Windowing refers to the shade of gray displayed (contrast numbers, and the value is directly related to the exposure to
of the image) and leveling refers to where on the scale the the plate and the changes are logarithmic expressions. For
window is set (brightness of the image). example, a change in EI from 1500 to 1800, a difference of
• Annotation: Allows text to be added to the image to iden- 300, is equal to a factor of 2 and represents twice as much
tify areas of interest or add information important for diag- exposure to the plate. The optimal range of EI values for grid
nosis. This should not be used in place of anatomic side or Bucky examinations is 1800 to 1900. Agfa uses log mean
markers. (lgM) numbers; the value is directly related to exposure to the
• Image flip: Allows for the flipping of the image so that it is plate and changes are also logarithmic expressions. For ex-
oriented properly for interpretation. ample, a change in lgM from 2 to 2.3, a change of 0.3, is equal
• Image inversion: Allows for the changing of the image from
to a factor of 2 and represents twice as much exposure to the
negative (bone is white) to positive (bone is dark). Some
pathologic conditions are better identified in this way.
plate. The optimal range of lgM values is 1.9 to 2.1. When
• Magnification: Just as a magnifying glass is used to better using CR systems, the radiographer should monitor the ex-
see small structures on film-screen, an electronic magnify- posure indicator values as a guide for optimum technique. If
ing glass is available for use with digital images. With very the exposure indicator value is within the acceptable range,
high-resolution monitors, such as those used by the radi- adjustments can be made for contrast and brightness with
ologist, magnification to see fine detail is possible. postprocessing functions and will not degrade the image. If,
• Edge enhancement: Increases the contrast along the edge however, the exposure is outside of the acceptable range,
of a structure through a sophisticated software function. attempting to adjust the image data with postprocessing
The part must have been sufficiently exposed and have a functions will not correct for improper receptor exposure
low signal-to-noise ratio because noise is also enhanced. and may result in noisy or suboptimal images that should not
• Smoothing: A software function to suppress noise. Image
be submitted for interpretation. It should also be noted that
noise is considered a high-frequency variation in the histo-
gram, and postprocessing adjustment of these high fre-
for CR systems, histogram analysis is the basis for determin-
quencies can reduce noise. ing the exposure indicator value. The radiographer has a role
• Equalization: Software-weighted processing function in the selection of the appropriate anatomic part and projec-
whereby underexposed areas (light areas) are made darker tion before processing the PSP plate. This step tells the com-
and overexposed areas (dark areas) are made lighter. The puter which histogram to use. If the radiographer selects a
effect is an image that appears to have lower contrast so part other than the one imaged, a histogram analysis error
that dense and lucent structures are better seen within the may occur.
same image.
• Region of interest: A quantitative function of digital imaging CRITICAL CONCEPT
that allows for the pixel value of a selected area of interest
to be calculated. This value can then help characterize
CR Exposure Indicators
disease. The radiographer should use exposure indicators of CR sys-
tems as indicators of optimal technique and strive to keep
selected exposures within the indicated optimal range for
that system.
conditions that are very different than the radiologist’s work-
stations. How an image looks on the radiographer’s worksta-
tion in a brightly lit work area may be very different from DR systems use dose-area product (DAP) as an indicator
the way it looks on the radiologist’s high-resolution monitor of exposure. DAP is a measure of exposure in air, followed by
in a darkened reading room. So care should be taken in computation to estimate absorbed dose to the patient. It
the postprocessing of an image before forwarding it for ismeasured by a DAP meter embedded in the collimator. The
interpretation. DAP value depends on the exposure factors and field size and
is expressed in centigray-meter squared (cGY-m2). DAP re-
flects both the dose to the patient and the total volume of
USING DIGITAL RECEPTORS tissue being irradiated.
The use of digital receptors requires an understanding of Standardization of exposure values is making some head-
several new concepts and an understanding of how tradi- way, and the following would apply to all digital radiography
tional concepts still apply. We begin with exposure indica- systems. In 2008 the International Electotechnial Commission
tors. In CR systems, the exposure indicator value represents (IEC) published an exposure terminology standard. In 2009
the exposure level to the PSP plate and the values are vendor- the American Association of Physicists in Medicne (AAPM)
specific. Fuji, Philips, and Konica use sensitivity (S) numbers, published its report. At the 2010 summit of the Image Gently
and the value is inversely related to the exposure to the plate consortium, all stakeholders agreed to adopt the IEC 62494-1
(Philips also has an exposure index (EI) value; however, S is standard, which presents three terms of value to radiogra-
not equal to EI). A 200 S number is equal to 1 mR of exposure phers: exposure index (EI), target exposure index (EIT), and
 CHAPTER 12  Image Receptors 165

deviation index (DI). EI represents the exposure at the detec- 400-speed system (using the film-screen speed class numbers
tor relevant to the region being imaged and is defined by the as a basis for comparison). With digital systems the radiogra-
signal-to-noise ratio (SNR). EI will respond linearly to pher should keep in mind that, as the operating speed class
changes in mAs when the kVp is held constant. EIT is the increases, the potential for image noise increases, but as the
target reference exposure obtained from a properly exposed operating speed class decreases, patient dose increases. Ideally
image receptor. EIT values will vary with each anatomic area the digital system should be operated at a higher speed class
of interest. Finally, DI is a measure of the deviation of the EI to strike a balance between the ability to use a lower mAs
from projection-specific EIT values. It is the DI value that value and apply postprocessing functions for optimization of
indicates to the radiographer proper exposure for the body the image. Overexposing patients by selecting a lower speed
part being examined by indicating the deviation (above or class and then applying postprocessing functions is unethical
below) the ideal value determined for that part. and violates the ALARA principle.
The detective quantum efficiency (DQE) of the detector
is an expression of the potential “speed class” or radiation
CRITICAL CONCEPT
exposure level that is required to produce an optimal image.
It “predicts” patient dose. A higher DQE indicates a poten- Detective Quantum Efficiency and Speed Class
tially lower patient dose. However, if the DQE is too high, the DQE is an expression of the exposure level required to pro-
patient dose will be very low, but the image will also be very duce an image. Speed class may be related to this concept.
noisy (grainy) because there was an insufficient quantity of Speed is an inaccurate term for digital systems because they
radiation to create the image. DQE is evaluated by comparing may be operated at any speed class and should be avoided
the image noise of a detector with that of an “ideal” detector when referencing digital systems.
with the same signal-response characteristics. DQE is a mea-
sure of how well the signal-to-noise ratio (SNR) is preserved
in an image. SNR is an expression of how clearly a very faint Image noise and resolution are additional considerations
object appears in an image. in digital systems. Image noise is any undesirable fluctuations
Related to this concept is “speed class.” The term speed in the brightness of an image (Figure 12-11). In addition to
originated with film-screen systems and represents the expo- the inherent x-ray quantum noise, the electronic components
sure necessary to produce a desired level of density. For ex- of digital imaging systems also contribute undesirable noise.
ample a 50-speed film-screen system requires a higher mAs Spatial resolution is a characteristic of a digital system and by
value to produce a given density than a 400-speed system. definition is equal to one-half the Nyquist frequency. The
Because digital systems can be used with a much wider range Nyquist frequency is the highest spatial frequency that a digi-
of exposure values, the term speed is inaccurate. Speed class tal detector can record and is determined by the sampling
refers to the exposure level at which the system is operated, frequency of CR systems and the DEL spacing of DR systems
and digital systems can be operated at almost any “speed (recall that DEL is the smallest resolvable area of a DR sys-
class” because the amount of radiation exposure determines tem). There are two measures of spatial resolution: limiting
only the level of quantum mottle and not the brightness of spatial resolution (LSR) and modulation transfer function
the image. For example, AEC devices and technique charts (MTF). LSR is the ability of a detector to resolve small struc-
can be calibrated to operate the system as a 50-, 100-, 200-, or tures and is measured using a bar pattern. But because it

A B
FIG 12-11  ​Image Noise. A, Excessive noise caused by an insufficient mAs. B, The same part
with a sufficient mAs. An optimal mAs should be selected to provide sufficient quanta to expose
the receptor and avoid excessive noise. (Courtesy Andrew Woodward R.T.(R) and The University
of North Carolina at Chapel Hill.)
166 SECTION II  Image Production and Evaluation

depends on the contrast of the target and the exposure and linear response to exposure. Because more shades can be
display conditions, it is not as accurate as MTF. MTF is a clearly displayed, the matching of the kVp setting to the sub-
measure of the ability of the system to preserve signal con- ject and receptor is less important with digital systems. The
trast as a function of spatial resolution and describes the primary factor influencing contrast with digital is the lookup
fraction of each component that preserves the captured im- table (LUT). LUTs are histograms of luminance values used
age. It is considered the ideal expression of digital detector as a reference to evaluate the input intensities and assign pre-
image resolution. determined grayscale values—VOI, as previously mentioned.
With the introduction of digital imaging in radiography Rescaling occurs at this stage. Rescaling is the adjusting of the
and on-the-job in-service training on these new systems, image by the computer program to present an image of pre-
many myths have developed. It is important to separate fact determined image brightness (Figure 12-12). An image re-
from myth, beginning with the most important differences ceptor that is overexposed is rescaled lighter, and an image
between film-screen and digital imaging. First, with digital receptor that is underexposed is rescaled darker. In this way,
imaging, the mAs no longer controls density of the image the display computer presents a consistent and uniform
(not to be confused with quantity of radiation). With film- image over a wide range of exposures.
screen imaging, film is both the means of capture and of Because image contrast is now primarily controlled by
display of the image (that which captures the image also dis- LUTs, kVp values may be increased in an effort to reduce
plays it). The capture and display in digital imaging are sepa- patient exposure. Remember that by using the 15% rule, a
rate. The detector, whether it is CR or DR, captures the rem- higher kVp and lower mAs can be used and still maintain the
nant beam (imaging-forming radiation), and the computer overall exposure to the receptor. In the days of film, using this
monitor displays the image. It is the computer displaying the approach changed the scale of contrast, but with digital re-
image that adjusts the brightness (formerly called density). ceptors this is not a problem. However, digital receptors are
The role of mAs is still very important and still ultimately much more sensitive to scatter radiation and low-energy ra-
determines the quantity of radiation exposing the patient. diation in general, which can be problematic. Recall that the
This quantity of radiation represents patient dose and kVp determines how the photons interact in the body by
amount of radiation available to form the image. If there is controlling photon energy; increasing the kVp increases the
too little radiation (quanta) exposing the digital image recep- opportunities for scatter production. With all of this in mind,
tor, excessive quantum noise results (see Figure 12-11). An adjusting technique by the 15% rule (increasing the kVp and
optimal mAs should be selected to provide sufficient quanta reducing the mAs by one-half) can be applied once and, in
to expose the receptor and avoid excessive noise. The idea some cases, twice, but after that the lack of sufficient radia-
that excessive mAs can be used to avoid repeats is flawed logic tion exposure and increase in scatter begins to negatively af-
and a violation of the ARRT/ASRT codes of ethics and the fect the image. Before adjusting the kVp and reducing the
ALARA principle. Although the computer can rescale and mAs on the technique charts, the processing codes (how
adjust for overexposure, it does not change the fact that the computer software processes and displays the image) of
the patient receives a higher-than-necessary dose of radia- the digital system must be changed to maintain optimum
tion. Historically, radiographers using film-screen systems image quality.
maintained a 5% or less repeat rate for all causes of repeat
(positioning error, exposure, equipment malfunction, etc.). CRITICAL CONCEPT
Assuming the same level of competence in a digital environ- Role of Kilovoltage Peak Values and Digital
ment, to overexpose 95% of the patient population to avoid Systems
the very small percentage of repeats due to exposure factors
The kVp still influences contrast, but digital systems have a
is flawed logic.
much wider dynamic range. Because the imaging-processing
software is capable of producing an image with a specified
CRITICAL CONCEPT level of contrast even when higher kVp values are used for an
examination, a higher kVp can be used (adjusted by the 15%
Role of Milliamperage/Second in Digital
rule) and a quality image still produced. In digital systems, the
Systems primary factor influencing image contrast is the LUT.
With digital systems, mAs no longer controls density. That is
the role of the display computer and is referred to as bright-
ness. However, the mAs is still very important in that it still ul- Therefore, the radiographer using a digital system must
timately determines the quantity of radiation exposing the pa- continue to select kVp for optimum penetration of the part
tient, which represents patient dose and the quantity of (aside from the 15% rule adjustment) and mAs for sufficient
radiation available to form the image. The idea of using a high quanta to create the image, although for slightly different
mAs value for all images to avoid repeats is flawed logic and
reasons than those which applied to film-screen imaging.
results in a higher-than-necessary patient dose.
Excessive kVp results in excessive scatter radiation produc-
tion and a loss of contrast. Insufficient mAs results in noise
Kilovoltage peak (kVp) still controls contrast, but digital (quantum mottle appearance) caused by insufficient quanta
image receptors have a much wider dynamic range and a to produce the image.
 CHAPTER 12  Image Receptors 167

Lookup table Contrast processing to look like image

recorded on high contrast film
2048 2048

Processed image (pixel values)

Processed image (pixel values)

High
contrast B

1024 1024

0 0

0 1024 2048 0 1024 2048

Original image (pixel values) Original image (pixel values)

FIG 12-12  ​Rescaling. The illustration on the left is a graphic representation of rescaling. The
illustration on the right includes radiographs to further illustrate the concept. A, An example of
what an image may look like before rescaling. B, An example of what an image may look like
after rescaling. (Modified from Sprawls: Physical principles of medical imaging online, ed 2, http://
www.sprawls.org/ppmi2/)

Scatter control is more important in digital imaging than The sharpness factors that affect image quality remain the
in film-screen imaging. Digital receptors are more sensitive to same for digital systems as well. The smaller the focal spot,
low-energy radiation. They capture and record the low- the sharper the image. One should strive to minimize object-
energy scatter photons, and the image suffers as a result. to-image receptor distance (OID) and maximize source-to-
There are two ways to effectively control scatter radiation’s image receptor distance (SID) (within reason). Changes in
effect on the image: collimation and grid use. Precise collima- distance require adjustments in the mAs.. Accurate position-
tion limits the area of exposed tissues and, with it, the effec- ing of the part and proper alignment of the part with the
tive dose and amount of scatter that can be produced. The AEC (if used) also remains critical. Digital receptors can
use of postprocessing masks and cropping tools to give the make dramatic improvements in image quality and provide
appearance of collimation of the finished radiograph does many additional tools to make adjustments, but sound phys-
not serve the same purpose and is unethical. The use of these ics and ethics still apply. Box 12-2 presents useful tips to keep
tools does not reduce patient dose as with actual collimation; in mind when using digital systems.
furthermore, it removes from display image data that may be Just because digital systems automatically rescale overex-
important to the diagnostic quality. The use of a grid reduces posed images does not mean one should take advantage of this
the amount of scatter reaching the image receptor by taking in an effort to avoid repeats. This is flawed logic and violates
advantage of the greater divergent angle of scatter (scatter is the radiographers’ code of ethics and the ALARA principle.
absorbed by the lead strips of the grid and useful photons Finally, troubleshooting with digital imaging involves the
pass between). For digital systems, a fairly high-frequency recognition of those image processing errors that can degrade
grid is recommended. image clarity. As has been discussed previously, the image ac-
quisition and display functions in digital systems are separated,
and those visual cues of exposure error present in film-screen
CRITICAL CONCEPT systems are lost. With these systems, the radiographer must pay
Digital Systems and Low-Energy Radiation attention to the exposure indicator values as an indicator of
proper exposure. No amount of postprocessing will correct
Digital systems are more sensitive to low-energy radiation
“for poor image-acquisition procedures. Next, the radiogra-
and are therefore more sensitive to scatter radiation.
pher must review those factors that may result in a histogram
168 SECTION II  Image Production and Evaluation

BOX 12-2  Tips for Digital Systems online report, Report No. OR-03, to provide guidelines for
proper performance of display devices intended for medical
When using digital systems, keep the following in mind:
use. This report presents 26 test patterns that can be used to
• Digital systems are neither kVp- nor mAs-driven, but rather
assess display device performance. The complete report with
are exposure-driven. Therefore, the radiographer is able to
use higher kVp and lower mAs techniques as long as a list of tests, test procedures, necessary tools, acceptance
excessive scatter is not produced. criteria, and corrective action may be found online at http://
• Digital systems are very sensitive to scatter and back- www.aapm.org/pubs/reports/OR_03.pdf.
ground radiation, which causes histogram analysis errors The following tests may be performed by a quality control
and poor-quality images. radiographer. Additional tests are performed annually by a
• Precise collimation should be used with digital systems to qualified medical physicist (see AAPM Report No. OR-03 for
prevent excessive scatter from reaching the receptor, a complete list).
causing histogram analysis errors.
• Grids should be used just as they are for film-screen Daily
systems. Grids help remove scatter radiation before it can
• Overall visual assessment: Uses the TG18-QC test pattern.
expose the receptor and degrade the image.
This test looks at general image quality and for the pres-
kVp, Kilovoltage peak; mAs, milliamperes/second. ence of any artifacts (Figure 12-13).

Monthly or Quarterly
analysis error. Exposure field recognition errors, proper colli- • Geometric distortion: Uses the TG18-QC test pattern (see
mation, excessive scatter radiation, processing under the cor- Figure 12-13). This test looks for a variation in the shape
rect menu, and proper technical factor selection must be con- of the displayed image from the original image.
sidered. Finally, the radiographer must evaluate proper • Reflection: Uses a TG18-AD test pattern. This test evalu-
positioning and tube-part-receptor alignment; the importance ates the ambient light contribution to the light reflected by
of these factors does not change with digital systems. the display monitor (Figure 12-14).
• Luminance response: Uses the TG18-LN01, TG18-LN08,
QUALITY ASSURANCE AND QUALITY and TG18-LN18 test patterns. This test assesses the dis-
played luminance values versus the input values from the
CONTROL display system (Figure 12-15, A, B, and C). Luminance
Digital imaging quality control focuses on the display moni- may also be evaluated visually using the TG18-CT test
tors and viewing environment. The AAPM published an pattern (Figure 12-15, D).

FIG 12-13  ​TG18-QC Test Pattern. The TG18-QC Test Pattern is used to evaluate general image
quality. It also looks for artifacts and evaluates geometric distortion and resolution. (From Samei E,
et al: Assessment of display performance for medical imaging systems. Draft report of the
American Association of Physicists in Medicine [AAPM] Task Group 18, Version 10.0, August
2004.)
 CHAPTER 12  Image Receptors 169

storage (archive server) systems. Storage, in particular, is an

ever-increasing challenge because of the increased use of
multislice modalities (CT, MRI, ultrasound) and the increas-
ing detail of all digital modalities. With increasing size and
number of examination files comes an increased demand for
storage. For example, the average size of a digital radiography
study is 35 MB. Each of the major systems of a PACS is dis-
cussed here, as are trends and challenges.
PACS is an electronic network for communication be-
tween the image acquisition modalities, display stations, and
storage. For these different systems to communicate with
each other, a common language is necessary. The Digital
Imaging and Communications in Medicine (DICOM) stan-
dard was first formulated in 1983 for this purpose and has
been refined over time. This standard allows for the exchange
of medical images and information among modalities,
display stations, and storage. With the introduction of a com-
mon language, equipment has been designed and manufac-
tured to be DICOM-compatible as well.
As previously mentioned, many modalities have been
FIG 12-14  ​TG18-AD Test Pattern. The TG18-AD test pattern digital for some time. CT, MRI, nuclear medicine, and ultra-
is used to evaluate ambient light contribution. (From Samei E, sound all acquire images in a digital format. Radiography is
et al: Assessment of display performance for medical imag- the latecomer to this digital environment. The process of
ing systems. Draft report of the American Association of digital acquisition for radiography has already been dis-
Physicists in Medicine [AAPM] Task Group 18, Version 10.0, cussed. The digital format is necessary for radiography to be
August 2004.) integrated as a part of the PACS. The role of the PACS is to
allow for the display and storage of these medical images.
Now that this information is in a digital form and DICOM
• Luminance dependencies: Uses the TG18-UNL10 and allows for it to be transferred to a display and storage me-
TG18-UNL80 test patterns. This test evaluates the image dium, radiography can occur in an environment that is
for nonuniformity and effects of viewing at different completely digital. The patient’s medical information and
angles (Figure 12-16, A and B). imaging studies can be viewed and stored as an electronic file.
• Resolution: Uses the TG18-QC (see Figure 12-13) and Through teleradiology, image files can be accessed from
TG18-CX (Figure 12-17) test patterns. This test assesses various workstations located throughout the facility or even
the system’s ability to display images of different parts of by clients outside the facility if they are given access to the
an image with high fidelity. system. The radiologist, operating room staff, and emergency
The following are a few additional notes of consideration department staff can access image files at the same time if
regarding quality assurance and quality control. First, those needed. For example, this system allows an ordering physi-
using CR systems should create a maintenance schedule for cian to log into the network from his or her office outside of
the plates. The plates should be cleaned and inspected every the facility and view a patient’s radiographic images without
3 months or as needed based on workload and conditions, printing films or burning and sending over a CD. In addition
using approved cleaning products only. The plates should to the images, information management systems such as the
also be erased every 48 hours if unused. Furthermore, for all Radiology Information System (RIS) serve to handle textual
digital systems within a facility, identical processing codes and other information portions stored on the PACS. All such
should be used to ensure the consistency of image appear- systems are networked on the PACS so that information and
ance. Finally, the radiographer should realize that when a images are integrated and can be retrieved from any number
digital image is printed to film, the dynamic range is sacri- of locations.
ficed and film used for this purpose is very sensitive to heat
and moisture, much more so than analog film.
CRITICAL CONCEPT
PICTURE ARCHIVING AND COMMUNICATION Picture Archiving and Communication System
SYSTEMS PACS is an electronic network for communication between
The Picture Archiving and Communication System (PACS) the image acquisition modalities, display stations, and stor-
is an integral part of the digital radiology imaging depart- age, using the common language of DICOM. Its role is to
allow for the display and storage of medical images and
ment. A PACS can generally be divided into acquisition (im-
information.
aging modalities), display (viewing and workstations), and
170 SECTION II  Image Production and Evaluation

A B

C D
FIG 12-15  ​TG18-LN01, TG18-LN08, TG18-LN18, and TG18-CT Test Patterns. TG18-LN01 (A),
TG18-LN08 (B), and TG18-LN18 (C) test patterns are used to evaluate the displayed luminance
values versus the input values from the display system. The TG18-CT (D) test pattern may also
be used to visually evaluate luminance. (From Samei E, et al: Assessment of display performance
for medical imaging systems. Draft report of the American Association of Physicists in Medicine
[AAPM] Task Group 18, Version 10.0, August 2004.)

A display station is simply a desktop computer that allows general interpretation by the radiologist or viewing for qual-
for the retrieval and viewing of medical images from one of ity control by the technologist. A 5-Mp (2048 3 2560 pixel)
the modalities or storage components of the PACS. The qual- monitor is necessary for interpretation of digital mammo-
ity and function of one of these stations depends on the user. grams.
The quality of the display monitor and the complexity of the The software loaded to each display station also depends
software are major variables. A 1-megapixel (Mp) (1280 3 on the user. For general viewing by noninterpreting physi-
1024 pixel) monitor is sufficient for general viewing by non- cians and other health care workers, a very basic package
interpreting physicians and other health care workers, allowing minimal adjustment may be all that is available.
whereas a 2-Mp (1600 3 1200 pixel) monitor is necessary for Quality control display stations and reading stations have
 CHAPTER 12  Image Receptors 171

A TG18-UNL10 B TG18-UNL80
FIG 12-16  ​TG18-UNL10 and TG18-UNL80 Test Patterns. The TG18-UNL10 (A) and TG18-
UNL80 (B) test patterns are used to evaluate the image for nonuniformity and effects of viewing
at different angles. (From Samei E, et al: Assessment of display performance for medical imaging
systems. Draft report of the American Association of Physicists in Medicine [AAPM] Task
Group 18, Version 10.0, August 2004.)

greater function and capability, such as more advanced image

manipulation (windowing and leveling), annotation, patient
demographic information, cropping, and magnification
(zoom). Even among technologists, each may have access to
different functions protected by login and password to limit
which aspects of a medical image may be changed, and by
whom, so as to prevent accidentally damaging or negatively
altering the record.
As previously mentioned, one of the biggest challenges of
a PACS is storage. With increasingly complex modalities feed-
ing large image files into the system, the demand for storage
is ever increasing. Current research indicates that 10 terabytes
(TB) of storage will be needed annually per 225,000 radio-
logic procedures performed.
The archiving component of PACS is composed of the im-
age manager and image storage. The image manager is the
component that handles the workflow of the system moving
images back and forth between viewing stations and storage.
The storage component is that portion that archives the data
on a storage medium, such as magnetic tape or optical disk.
Storage is usually classified as:
FIG 12-17  ​TG18-CX Test Pattern. The TG18-CX test pattern
• Online: Data are stored on magnetic hard drives with ac-
(along with the TG18-QC test pattern) is used to assess the
system’s ability to display images of different parts of an im-
cess times in milliseconds and transfer times in the range
age with high fidelity.  (From Samei E, et al: Assessment of of tens and hundreds of megabytes per second.
display performance for medical imaging systems. Draft • Nearline: A tape or jukebox uses robotic arms to retrieve
report of the American Association of Physicists in Medicine the tapes automatically and insert them into a drive
[AAPM] Task Group 18, Version 10.0, August 2004.) to read or write data. This type can access data within
60 seconds and is able to transfer data at a few megabytes
per second.
172 SECTION II  Image Production and Evaluation

• Offline: A removable tape or optical media is stored on a application, film manufacturers produce film in a variety of
shelf in a catalog and is retrieved manually. sizes ranging from 20 3 25 cm (8 3 10 inches) to 35 3 43 cm
The online storage component is networked to the PACS (14 3 17 inches). The composition of film can be described
via direct attached storage, network attached storage (NAS), in layers (Box 12-3). The most important layer for creating
or storage area network (SAN). The direct attached storage the image is the emulsion layer. The emulsion layer is the
has hard drives directly on the server. The NAS is a free- radiation-sensitive and light-sensitive layer of the film. The
standing storage attached to the network. SAN is a dedicated emulsion of film consists of silver halide crystals suspended
network for connecting the storage devices to computers in gelatin. Silver halide is the material that is sensitive to ra-
(network to the PACS). diation and light. The emulsion layer is fairly fragile and must
Magnetic tape is the oldest storage technology and is a have a layer composed of a polyester base so that the film can
linear storage medium; that is, a ferromagnetic material is be handled and processed, yet remain physically strong after
bonded to a length of plastic “tape.” As the medium is passed processing. Most film used in radiographic procedures has a
by an electromagnet, it is modulated (varied) by an electronic blue dye or tint added to the base layer to decrease eye strain
signal and magnetizes the medium accordingly. In a read when viewed on a view (illuminator) box.
mode, an electric field is induced in the electromagnet by the Screen film is the most widely used radiographic film. As
moving magnetic field of the tape. its name implies, it is intended to be used with one or two
Optical disk is the other common storage technology. An intensifying screens. Screen film is more sensitive to light and
optical disk (a compact disk-CD) has a reflective surface layer less sensitive to x-rays. Screen film can have either a single- or
followed by a photosensitive layer that is “burned” by light double-emulsion coating (sometimes referred to as du-
from a laser, creating a series of light and dark spots on the plitized). Double-emulsion film has an emulsion coating on
disk modulated by the data signal. Recall that the digital sig- both sides of the base. Film-screen imaging typically uses
nal is a series of 1s (ones) and 0s (zeros). The light spots double-emulsion film with two intensifying screens.
represent 1s and the dark spots represent 0s. The data are Single-emulsion screen film, with only one emulsion
recorded in a spiral from the center of the disk outward. In layer, is used with a single intensifying screen. It has many
read mode, a laser light is aimed on the disk following the uses, including duplication, subtraction, computed tomogra-
spiral, beginning at any point on it according to where the file phy (CT), magnetic resonance imaging (MRI), sonography,
is stored. If the laser light hits a light spot, it is reflected to the nuclear medicine, mammography, and laser printing.
optical reader and is transmitted as a 1 (one); if it hits a dark
spot, it is transmitted as a 0 (zero). These disks may be ar- Latent Image Formation
ranged as an array and referred to as a redundant array of The term latent image refers to that image that exists on film
independent disks (RAID). The data are stored across the after that film has been exposed but before it has been chem-
array to create backups and maximize efficiency of retrieval ically processed. Film processing changes the latent image
and storage. into a manifest image. The term manifest image refers to the
As the demand for data storage space increases, research image that exists on film after exposure and processing. The
continues for ways to store more in a smaller space. Optical manifest image typically is called the radiographic image.
disk technology improves, but the spiral can be only so tight. The specific way in which the latent image is formed is not
Ways of compressing the data files without loss of data are really known, but the Gurney-Mott theory of latent image
also being researched, but this is also self-limiting. Recently formation is most widely believed to best explain the manner
introduced potential solutions include the use of high-capac- in which this process happens. To explain latent image
ity flash drive arrays. The flash drives are available in 73-GB formation, it is necessary to describe what happens at the
and 146-GB capacities. They are arranged as an array and
used in much the same way as an array of optical disks. An-
other solution recently introduced is the holographic storage BOX 12-3  Composition of Radiographic
device. This technology makes use of a special recording me- Film
dium and laser technology to record data throughout the
Supercoat
depth of the medium. A holographic disk device stores data
Emulsion
through its entire depth rather than just the surface. This ap-
Adhesive
proach has the potential of storing 1 TB per cubic centimeter.
Film base

RADIOGRAPHIC FILM
Film Construction
Radiographic film acquires the image and must then be
Supercoat: durable protection layer
chemically processed before it is visible. As a result, film
Adhesive: adheres layers together
serves as the medium for image acquisition, processing, and
Emulsion: radiation and light-sensitive layer
display. Several types of radiographic film are still used in Film base: polyester layer that gives the film physical stability
medical imaging departments. Depending on the specific
 CHAPTER 12  Image Receptors 173

molecular level in the emulsion layer of film, specifically what manipulating both of these factors in the production of spe-
happens to silver halide crystals when exposed to x-rays and cific speeds of radiographic film.
light.

CRITICAL CONCEPT
MAKE THE PHYSICS CONNECTION
Silver Halide and Film Sensitivity
Chapter 3
As the number of silver halide crystals increases, film sensi-
X-rays and gamma rays have characteristics of both waves tivity or speed increases; as the size of the silver halide
and particles, but because of their high energy, they exhibit crystals increases, film sensitivity or speed increases. The
more particulate characteristics than those at the other end faster the speed of a film, the less radiation exposure needed
of the electromagnetic spectrum. One additional particulate to produce a specific density.
characteristic that is unique to the highest two members of
the electromagnetic spectrum (x-rays and gamma rays) is the
ability to ionize matter. When a photon possesses sufficient Film Contrast and Film Latitude. ​Film contrast refers to the
energy, it can remove electrons from the orbit of atoms ability of radiographic film to provide a certain level of image
during interactions. This removal of an electron from an atom contrast. High-contrast film accentuates more black and
is called ionization. The atom and the electron that was
white areas, whereas low-contrast film primarily shows
removed from it are called an ion pair.
shades of gray. As discussed in Chapter 9, film latitude is
closely related to film contrast. The latitude of film affects the
Physical imperfections in the silver halide crystals are the range of radiation exposures that can provide diagnostic op-
site of the latent image formation and are described in detail tical densities. Films manufactured to display higher contrast
in Box 12-4. have a narrow exposure latitude compared with low-contrast
Several sensitivity specks with many silver ions attracted films, which have a wider exposure latitude.
to them become latent image centers. These latent image
centers appear as radiographic density on the manifest image Spectral Sensitivity.  Spectral sensitivity refers to the color of
after processing. It is believed that for a latent image center to light to which a particular film is most sensitive. In radiography
appear, it must contain at least three sensitivity specks that there are generally two categories of spectral sensitivity films:
have at least three silver atoms each. With more exposure to blue-sensitive and green-sensitive (orthochromatic). When ra-
the film, more metallic silver is visualized as radiographic diographic film is used with intensifying screens, it is important
density. to match the spectral sensitivity of the film with the spectral
emission of the screens. Spectral emission refers to the color of
light produced by a particular intensifying screen. In radiogra-
CRITICAL CONCEPT phy, two categories of spectral emission generally exist: blue
Sensitivity Specks and Latent Image Centers light–emitting screens and green light–emitting screens. It is
Sensitivity specks serve as the focal point for the develop- critical to use blue-sensitive film with blue light–emitting
ment of latent image centers. After exposure, these specks screens and green-sensitive film with green light–emitting
trap the free electrons and then attract and neutralize the screens. Spectral matching refers to correctly matching the
positive silver ions. After enough silver is neutralized, the color sensitivity of the film to the color emission of the intensi-
specks become a latent image center and are converted to fying screen. An incorrect match of film and screens based on
black metallic silver after chemical processing. spectral emission and sensitivity results in radiographs that
display inappropriate levels of radiographic density.

Film Characteristics Intensifying Screen Characteristics

Current manufacturers of medical imaging film offer a wide An intensifying screen is a device found in radiographic cas-
variety of films. These differ not only in size and general type, settes that contains phosphors that convert x-ray energy into
but also in film speed, film contrast, exposure latitude, and light, which then exposes the radiographic film. Its purpose is
spectral sensitivity. to intensify the action of the x-rays and thus permit much
lower x-ray exposures compared with film alone.
Film Speed. ​Film speed is the degree to which the emulsion As with radiographic film, the construction of screens can
is sensitive to x-rays or light. The greater the speed of a film, be described in layers (Box 12-5). The phosphor layer, or ac-
the more sensitive it is. Because sensitivity increases, less tive layer, is the most important screen component because it
exposure is necessary to produce a specific density. Two pri- contains the phosphor material that absorbs the transmitted
mary factors, both relating to the silver halide crystals found x-rays and converts them to visible light. The most common
in the emulsion layers, affect the speed of radiographic film. phosphor materials consist of chemical compounds of ele-
The first factor is the number of silver halide crystals present, ments from the rare earth group of elements. Rare earth ele-
and the second factor is the size of these silver halide crystals. ments are those that range in atomic number from 57 to 71
Radiographic film manufacturers manipulate film speed by on the periodic table of the elements; they are referred to as
174 SECTION II  Image Production and Evaluation

BOX 12-4  The Gurney-Mott Theory of Latent Image Formation

Silver halide is made up of both silver bromide and silver iodide. Physical imperfections in the lattice or architecture of the
However, because silver bromide (AgBr) is the primary con- AgBr crystals occur during the film—manufacturing process.
stituent of the silver halide in the emulsion layer of film, only These imperfections are called sensitivity specks. Each sensi-
silver bromide is discussed. The process by which the latent tivity speck serves as an electron trap, trapping the electrons
image is formed is precisely the same for silver iodide as it is lost by the bromine when x-ray or light exposure occurs. There-
for silver bromide. Silver (Ag) and bromine (Br) are bound to- fore these sensitivity specks become negatively charged (4).
gether as a molecule in such a way that they share an electron Because the sensitivity specks are negatively charged, the
(1). This electron is shared through ionic bonding because silver positive silver ions that are liberated from the AgBr molecules
is a transitional atom, having only one electron in its outer shell, are attracted to them (5). Every silver ion that is attracted to an
and it tends to either lose it or share it. The silver in AgBr is in electron becomes neutralized by that electron, therefore be-
effect an ion because it shares only its outer-shell electron with coming metallic silver (6). The more x-ray or light exposure in a
bromine. Energy in the form of x-rays or light is absorbed by the particular area of the film, the more electrons and silver avail-
emulsion layers of radiographic film. This energy absorption able to be attracted to the sensitivity specks. The bromine liber-
raises the conductivity level of the electrons in the AgBr mole- ated by x-ray or light exposure is neutral and is simply absorbed
cules, and these electrons move faster as a result. If enough into the gelatin of the emulsion.
energy is absorbed by a particular AgBr molecule, it becomes a
positive ion of silver, neutral bromine, and a free electron (2, 3).

1
Before exposure, silver halide
(primarily silver bromide, AgBr)
Sensitivity AgBr
is suspended in gelatin in the
speck
emulsion layer. Sensitivity
specks exist as physical
imperfections in the film lattice.
AgBr AgBr

X-rays
and light
2
Exposure to x-rays and light
Silver ion
ionizes the silver halide.

Electron

Silver
particles

3 4 5 6
Negatively charged
electrons and positively Sensitivity specks trap Each trapped electron Metallic silver clumps
charged silver ions float electrons. attracts a silver ion. around the sensitivity
freely in the emulsion specks.
gelatin.
 CHAPTER 12  Image Receptors 175

BOX 12-5  Composition of Intensifying CRITICAL CONCEPT

Screen Screen Speed and Recorded Detail

Protective layer As screen speed increases, recorded detail is decreased; as

screen speed decreases, recorded detail increases.
Phosphor layer
Reflecting or
absorbing layer
Screen manufacturers produce a variety of intensifying
Base
screens that differ in how well they intensify the action of the
x-rays and therefore differ in their capacity to produce accu-
rate recorded detail.
Protective layer: Plastic protects the phosphor. The capability of a screen to produce visible light is called
Phosphor layer: Absorbs radiation and converts to light. screen speed. A faster screen produces more light than a
Reflecting layer: Reflects light toward film. slower screen given the same exposure. Although very fast
Absorbing layer: Absorbs light directed toward it.
screens reduce patient exposure, they also degrade image
Base: Provides support and stability for phosphor layer.
resolution and increase quantum noise, so a balance must be
chosen.

rare earth elements because they are relatively difficult and

expensive to extract from the earth. CRITICAL CONCEPT
Intensifying screen systems used in cassettes generally in- Screen Speed, Light Emission, and Patient
clude two screens. The screen that is mounted in the side of Dose
the cassette facing the x-ray tube is called the front screen, and
The faster an intensifying screen, the more light is emitted
the screen that is mounted in the opposite side is called the
for the same intensity of x-ray exposure. As screen speed
back screen. With two screens, the film (double-emulsion) is increases, less radiation is necessary and radiation dose to
exposed to approximately twice as much light as a single- the patient decreases; as screen speed decreases, more
screen system because the film is exposed to light from both radiation is necessary and radiation dose to the patient
sides. Some screen systems use only a single screen and increases.
are used with single-emulsion film. When a single screen is
used, it is mounted as a back screen on the side of the cassette
that is opposite from the tube side. When loading a single- Several factors affect how fast or slow an intensifying
emulsion film into the appropriate cassette with a single screen is, including absorption efficiency, conversion effi-
screen, the emulsion side of the film must be placed against ciency, thickness of the phosphor layer, and size of the phos-
the intensifying screen. phor crystal (Table 12-1). The presence of a reflecting layer,
Film is much more sensitive to visible light than to x-rays. an absorbing layer, or dye in the phosphor layer also affects
By converting each absorbed high-energy x-ray photon into screen speed.
thousands of visible light photons, intensifying screens Absorption efficiency refers to the screen’s ability to absorb
amplify film optical density. Without screens, the total the incident x-ray photons. A rare earth phosphor screen
amount of energy to which the film is exposed consists of absorbs approximately 60% of the incident photons. Conver-
only x-rays. With screens, the total amount of energy to sion efficiency describes how well the screen phosphor takes
which the film is exposed is divided between x-rays and light.
When intensifying screens are used, approximately 90% to
99% of the total energy to which the film is exposed is light. TABLE 12-1  Factors Affecting Screen
X-rays account for the remaining 1% to 10% of the energy. Speed, Recorded Detail, and Patient Dose
Intensifying screens operate by a process known as lumi- Screen Recorded Patient
nescence. Luminescence is the emission of light from the Factor Speed Detail Dose
screen when stimulated by radiation. The desired type of Phosphor Layer Thickness
luminescence in imaging is fluorescence. Fluorescence refers •  Thicker Increased Decreased Decreased
to the ability of phosphors to emit visible light only while •  Thinner Decreased Increased Increased
exposed to x-rays.
Phosphor Crystal Size
Screen Speed. ​The purpose of intensifying screens is to •  Larger Increased Decreased Decreased
decrease the radiation dose to the patient. Because screen •  Smaller Decreased Increased Increased
phosphors can intensify the action of the x-rays by convert- Reflecting layer Increased Decreased Decreased
Absorbing layer Decreased Increased Increased
ing them to visible light, the use of screens allows the radiog-
Dye in phosphor Decreased Increased Increased
rapher to use considerably lower mAs. The disadvantage of layer
using screens is the reduction in recorded detail.
176 SECTION II  Image Production and Evaluation

these x-ray photons and converts them to visible light. In- outside of the cassette as detail or extremity. The relative
creased absorption and conversion efficiency mean that rare speed of this system typically is 100. Detail or extremity
earth phosphors have increased speed when compared with a screen systems are relatively slow and therefore require
previously used screen phosphor, calcium tungstate. This in- greater exposure and result in higher patient doses. However,
creased speed allows the radiographer to substantially reduce the anatomic parts imaged with detail or extremity screen
the x-ray exposure needed to produce images with the systems generally are small; therefore, they do not require
appropriate amount of density. large exposures. Detail or extremity screen systems produce
The thickness of the phosphor layer and the size of the excellent recorded detail. The radiographer must be careful
crystal also have an effect on screen speed. A thicker phos- in selecting the appropriate screen system for the examina-
phor layer contains more phosphor material than a thinner tion ordered. Cassettes with extremity and detail screens
phosphor layer. The phosphor is the material that converts should be used only for tabletop examinations. They should
x-rays into light, so if more phosphor material is present in a never be used in the Bucky tray because of the excessive
screen, more light will be produced, increasing the screen amount of exposure needed.
speed. The size of the phosphor material crystals also affects
screen speed. Larger phosphor crystals produce more light Screen Maintenance. ​The maintenance of intensifying
than smaller phosphor crystals. Again, more light being pro- screens is significant because radiographic quality depends in
duced means that the screen is faster. large part on how well the screens are continuously main-
The final factors that affect screen speed are the presence tained. Two important maintenance procedures should be
or absence of a reflecting layer, a light-absorbing layer, or performed on intensifying screens. The first is regular clean-
light-absorbing dyes in the phosphor layer. A reflecting layer ing. The outside surface of screens comes into contact with
is used to increase screen speed by reflecting light back to- the environment and with the hands of those unloading and
ward the film (Figure 12-18). A light-absorbing layer or light- loading cassettes, which results in the natural oils on fingers
absorbing dyes present in the phosphor layer are used to de- and hands being deposited on the screen surface. These oils
crease screen speed by absorbing light that would otherwise tend to attract dust and dirt, which can build up to the point
reach and expose the film. at which they are actually imaged on radiographs as artifacts.
The ability of the screen to produce visible light can also Screen cleaning should be done routinely. The cleaning is ac-
be described in terms of its relative speed. Relative speed complished with commercially available antistatic intensify-
results from comparing screen-film systems based on the ing screen cleaner fluid and gauze pads.
amount of light produced for a given exposure. Most radiol- The second important maintenance procedure is to check
ogy departments that use film-screen technology have at cassettes for film-screen contact. Good film-screen contact
least two different speeds of intensifying screen systems. A exists when the screen or screens are in direct contact with
fast system usually is available with a relative speed of about the film. Poor film-screen contact greatly degrades recorded
400. A 400-speed system is a good compromise between the detail and is usually seen as a localized area of unsharpness
beneficial effect of decreasing the patient dose and the detri- somewhere on the radiographic image. Rarely is film-screen
mental effect of decreasing the recorded detail. A slower contact so poor that unsharpness can be seen across the en-
system is usually available, and it is sometimes labeled on the tire radiograph. A major part of testing for film-screen con-
tact is identifying problem cassettes.
The film-screen contact test is easily accomplished, but it
requires a special wire mesh test tool. The wire mesh tool is
placed on the cassette in question and radiographed with an
appropriate technique. The resultant radiograph (Figure 12-19)
is then viewed from a distance of approximately 6 feet to
determine any areas of unsharpness, which indicate poor re-
corded detail. Areas of poor contact appear darker than areas of
X-ray
good contact because of the increased spreading of the light
photon
photons.
The remaining component in the film-screen image re-
Film ceptor is the cassette. Serving as a container for both the in-
Phosphor layer tensifying screens and the film, the cassette must be light-
proof, lightweight for portability, and rigid enough not to
Reflecting layer
bend under a patient’s weight, all while allowing the maxi-
mum amount of radiation to pass through and reach the
Base
screens. Low x-ray–absorbing materials, such as thermoset
plastic, magnesium, or even graphite carbon, can be found in
FIG 12-18  ​Reflecting Layer. The reflecting layer redirects the front of cassettes. Inside the back of cassettes may be a
the visible light emitted by the screen phosphor toward the thin sheet of lead foil designed to absorb backscatter before it
film emulsion to increase screen speed. exposes the film.
 CHAPTER 12  Image Receptors 177

A B
FIG 12-19  ​Wire Mesh Test Images. Image produced with a wire mesh test tool. A, Proper film-
screen contact. B, Poor film-screen contact. (A, courtesy Fluke Biomedical; B, courtesy Barbara
Smith Pruner.)

AUTOMATIC FILM PROCESSING

The purpose of radiographic processing is to convert the la-
tent image into a manifest image. The manifest image is the
image that exists on the film after processing.
According to the Gurney-Mott theory, this process is the first
step toward creating a visible image on radiographic film. Expo-
sure of the silver bromide crystal in the film emulsion by light
or x-ray photons initiates the conversion process. Chemical
processing of the exposed film completes the conversion pro-
cess and transforms the image into a permanent visible image.

Components
An automatic film processor (Figure 12-20) is a device that
encompasses chemical tanks, a roller transport system, and a
dryer system for the processing of radiographic film. The
processing of a radiograph occurs in four stages: developing,
fixing, washing, and drying. Each stage has its specific func-
tion and processing method (Table 12-2).

Developing. ​The primary function of developing is to con-

FIG 12-20  ​Automatic Film Processor. A type of automatic
vert the latent image into a manifest, or visible, image. The
film processor used in radiography.
purpose of the developing or reducing agents is to reduce
exposed silver halide to metallic silver and to add electrons to
exposed silver halide. Two chemicals are used to accomplish
this purpose: phenidone and hydroquinone. Phenidone is TABLE 12-2  Processing Stages
said to be a fast reducer, producing gray (lower) densities. Automatic Film Processing Stages
Hydroquinone is said to be a slow reducer, producing black Developing: Converts latent image to a manifest or visible
(higher) densities. image.
Developing or Reducing Agents
CRITICAL CONCEPT Phenidone: Faster and produces gray densities.
Hydroquinone: Slower and produces black densities.
Developing or Reducing Agents Fixing: Removes the unexposed silver halide from the film;
The developing agents are responsible for reducing the ex- stops the development process; hardens the emulsion.
posed silver halide crystals to metallic silver, visualized as Fixing Agent
radiographic densities. Phenidone is responsible for creating Ammonium thiosulfate
the lower densities, and hydroquinone is responsible for cre- Washing: Removes fixing solution from the surface of the
ating the higher densities. Their combined effect results in film.
the range of visible densities on the radiograph. Drying: Removes 85%-90% of the moisture from the film.
178 SECTION II  Image Production and Evaluation

Both phenidone and hydroquinone also act to soften and remove enough so that the radiograph can be used for an
swell the emulsion layers. Phenidone and hydroquinone are extended period.
said to be synergistic, or to have superadditivity. Superadditiv-
ity means that together these chemicals produce a greater
CRITICAL CONCEPT
effect on the film than they would individually. This is used
to advantage by using both chemicals in combination to Archival Quality of Radiographs
develop or reduce the exposed silver halide. The developer Maintaining the archival (long-term) quality of radiographs
solution needs an alkaline pH environment for the chemicals requires that most of the fixing agent be removed (washed)
to function properly. from the film. Staining or fading of the permanent image
During the development process, developer solution do- results when too much thiosulfate remains on the film.
nates additional electrons to the sensitivity specks, or elec-
tron traps, in the emulsion layers of the film. These additional
electrons attract more silver to these areas, thereby amplify- The process by which washing works is referred to as diffu-
ing the amount of atomic silver at each latent image center. sion. Diffusion exposes the film to water that contains less
Exposed silver halide is reduced to metallic silver when bro- thiosulfate than the film. Because the film contains more fixing
mide and iodide ions are removed from the emulsion. The agent than the water, the fixing agent diffuses into the water.
atomic silver that was exposed to radiant energy (light and Eventually, thiosulfate concentrations in the wash water
x-rays) is converted to metallic silver and presented as radio- can become greater than those in the films being processed;
graphic densities. Unexposed silver halide does not react im- therefore, the wash water must be replaced frequently. Water
mediately to developer because it has not been ionized and flows freely from the input water supply through the wash
does not accept electrons from the developer. Given extended tank and down the drain while the roller transport system is
exposure to developing solution or exposure to excessively operating. This type of system provides a constant supply of
heated developing solution, however, even unexposed areas fresh wash water to aid in the diffusion process. The moving
of film can react to developing solution. Exposed silver halide water also causes agitation and increases diffusion.
reacts to developer by accepting electrons because neutral
atomic silver that was previously bonded to either bromide or Drying. ​The final process in automatic processing is drying.
iodide has room to accept electrons in its outermost electron The purpose of drying films is to remove 85% to 90% of the
shell (the O shell). moisture from the film so that it can be handled easily and
stored while maintaining the quality of the diagnostic image.
Fixing. ​The primary functions of the fixing stage are to re- As a result, finished radiographs should retain 10% to 15% of
move unexposed silver halide from the film and to make the their moisture when processing is complete. If films are dried
remaining image permanent. There are also two secondary excessively, the emulsion layers can crack, which decreases the
functions of fixing. One is to stop the development process; diagnostic quality of the radiograph.
the other is to further harden the emulsions. Fixing solution
must remove all undeveloped silver halide while not affecting
the metallic silver image. CRITICAL CONCEPT
The purpose of the fixing agent is to clear undeveloped Archival Quality of Radiographs
silver halide from the film. A thiosulfate (sometimes also
Permanent radiographs must retain moisture of 10% to 15%
called hypo), such as ammonium thiosulfate, is the chemical
to maintain archival quality. Excessive drying can cause the
used as this agent. The fixer solution needs an acidic pH emulsion layers to crack.
environment for the chemicals to function properly.

Increased relative humidity decreases the efficiency of dry-

CRITICAL CONCEPT ers in processors, so an increased drying temperature is nec-
Clearing the Unexposed Crystals essary. Processors are equipped with thermostatic controls to
The fixing agent ammonium thiosulfate is responsible for allow selection of a wide range of dryer temperatures.
removing the unexposed crystals from the emulsion. To chemically process a radiographic image, specialized
equipment and systems must perform concurrently to move
the film through the processing stages according to the
Washing. ​The purpose of the washing process is to remove manufacturer’s specifications.
fixing solution from the surface of the film. This is a further
step in making the manifest image permanent. If not prop- Systems
erly washed, the resulting radiograph shows a brown staining Automatic processors use a vertical transport system of roll-
of the image, resulting in image loss and a decrease in its di- ers that advance the film through the various stages of film
agnostic value. This staining is caused by thiosulfate (fixing processing (Figure 12-21). A film is introduced into the pro-
agent) that remains in the emulsion layers. Some thiosulfate cessor on the feed tray. The feed tray is a flat metal surface
always remains within the film, but the goal of washing is to with an edge on either side that permits the film to enter the
 CHAPTER 12  Image Receptors 179

Feed tray Developing Fixing Washing

Drying
chamber

Receiving
bin

FIG 12-21  ​Processing Stages. Cross-section of an automatic film processor showing the stages
of processing and the vertical transport system of rollers.

processor easily and correctly align. Automatic processors use The amount of solution that is replenished is preset and
different types of rollers to move the film through the proces- based on the size of the film or occurs at timed intervals.
sor. Transport and crossover rollers ensure the film is moved Replenishment systems usually are adjusted so that more
into and through the tanks at a constant speed. fixer solution is replenished per film in comparison with de-
An electric motor provides power for the roller assemblies veloper solution.
to transport the film through the processor. The on-off Automatic processors have a recirculation system for the
switch that provides electrical power to the processor acti- developer and fixer tanks. Each tank has a separate system
vates this motor. Most processors are also equipped with a that consists of a pump and connecting tubing. The recircu-
standby control. The standby control is an electric circuit lation system circulates the solutions in each of these tanks
that shuts off power to the roller assemblies when the proces- by pumping solution out of one portion of the tank and re-
sor is not being used. Pushing the standby control switch turning it to a different location within the same tank from
when one is ready to process a film can reactivate the roller which it was removed. The recirculation system keeps the
assemblies and water intake. chemicals mixed, which helps maintain solution activity and
Replenishment refers to the replacement of fresh chemi- provides agitation of the chemicals around the film to facili-
cals after the loss of chemicals during processing, specifically tate fast processing.
developer solution and fixer solution. The replenishment of Recirculation also helps maintain the proper temperature
chemicals used in the automatic processor is necessary be- of the developer solution. The developer recirculation system
cause these chemicals eventually become exhausted or inac- includes an in-line filter that removes impurities as the devel-
tive, and their ability to perform their functions decreases. oper solution is being recirculated.
Developing solution becomes exhausted from both use and Temperature control of the developer solution is important
exposure to air, which reduces its chemical strength. because the activity of this solution depends directly on its
Fixer solution becomes exhausted for several reasons: It temperature. An increase or decrease in developer temperature
becomes weakened from use as a result of accumulations of can adversely affect the quality of the radiographic image.
silver halide that are removed from the film during the fixing
process and because developer solution remains in the film, CRITICAL CONCEPT
which decreases the strength and activity of the fixer solution.
Developer Temperature and Radiographic
Quality
CRITICAL CONCEPT
Variations in developer temperature adversely affect the
Replenishment and Solution Performance
quality of the radiographic image. Increasing developer tem-
The replenishment system provides fresh chemicals to the perature increases the density, and decreasing developer
developing and fixing solutions to maintain their chemical temperature decreases the density. Radiographic contrast
activity and volume when they become depleted during also may be adversely affected by changes in the developer
processing. temperature.
180 SECTION II  Image Production and Evaluation

In most 90-second automatic processors, developer tem- on the film. Film should be stored away from heat sources and
perature must be maintained at 93° to 95° F (33.8° to 35° C). ionizing radiation. Both heat and radiation can cause the sil-
An immersion heater is a heating coil that is immersed in the ver halide in film emulsion to break down, which results in
bottom of the developer and fixer tank. Most automatic pro- fogged film. The shelf life of film, as expressed by its expira-
cessors are thermostatically controlled to heat the developer tion date, must be observed. Film should not be used beyond
solution to its proper temperature and maintain that tem- this date.
perature as long as the processor is turned on. How film is handled in the darkroom can have a profound
Radiographs must be properly dried to be viewed and effect on the radiographs. Common hazards to radiographic
stored. The film is dried by hot air that is blown onto both quality that can be found in the darkroom are white-light
surfaces of the film as it moves through the dryer. This air is exposure, safelight exposure, ionizing radiation exposure,
forced through the dryer by a blower and is directed onto the and other potential hazards.
film by air tubes. The temperature of the air that is used to Darkrooms must be free from all outside white-light ex-
dry films is thermostatically monitored to accurately control posure. A white-light source may be located inside the dark-
moisture removal from the film. room, but it should be connected to an interlock system
Inadequate processing is evidenced by certain appearances whereby the film bin may not be opened as long as the dark-
of the finished radiograph. Particular problems can be pin- room white-light source is on. In addition, the temperature
pointed by analyzing the radiographs. These problems and and humidity can adversely affect the film. Film should be
the radiographic appearances that indicate them are sum- stored and handled at temperatures ranging from 55° to 75° F
marized in Table 12-3. (14° to 24° C) with a relative humidity of 30% to 60%. With-
out moisture in the air (low humidity), any buildup of static
Quality Control charges can expose the film.
Unexposed film should be stored in its original packaging so Countertops must be clean and static-free to avoid the
that important information about the film can be maintained, formation of radiographic artifacts on the films. There are
such as expiration date and lot number. Film boxes should be several brands of commercial cleaning fluids that contain an
stored vertically, not horizontally, to prevent pressure artifacts antistatic component ideal for cleaning darkroom counter-
tops and processor feed trays.
Other potential hazards to film in the darkroom include
TABLE 12-3  Indicators of Inadequate heat and chemical exposure. Film stored within the dark-
Processing room should not be near any heat source. Processing chemi-
cals must be kept away from film and film-handling areas to
Radiographic Appearance Processing Problem
prevent exposure and contamination of these areas.
Decrease in density Developer exhausted Ionizing radiation exposure to film in the darkroom is a
Developer underreplenish-
potential hazard because many darkrooms share common
ment
Processor running too fast
walls with radiographic rooms. The walls that are common
Low developer temperature with the darkroom and a radiographic room must be lined
Developer improperly mixed with lead as required by law for standard protection from
Increase in density Developer overreplenish- radiographic exposures. The film bin where film is stored and
ment available for immediate use should also be lined with lead to
High developer temperature prevent fog that may result from radiation exposure.
Light leak in processor Safelights used in the darkroom must be equipped with a
Developer improperly mixed safelight filter appropriate for the type of film being handled
Pinkish stain (dichroic fog) Contamination of developer in the darkroom. Commonly used filters include Kodak
by fixer Wratten 6B for blue-sensitive film and Kodak GBX for ortho-
Developer or fixer under-
chromatic film, which is sensitive to both blue-violet and
replenishment
Brown stain (thiosulfate Inadequate washing
green visible light. Safelight filters must be free of cracks be-
stain) cause white light that leaks from the safelight could expose
Emulsion removed by Insufficient hardener in the film. The power rating of the light bulbs used in safelights
developer developer should be no greater than that recommended by film manu-
Milky appearance Fixer exhausted facturers (generally 7.5 to 15 W), which is indicated on the
Inadequate washing outside of the box of radiographic film.
Streaks Dirty processor rollers Good radiographic quality cannot be achieved when film
Inadequate washing is improperly stored, mishandled before or after exposure, or
Inadequate drying incorrectly processed. Common film artifacts resulting from
Water spots Inadequate drying improper storage, darkroom handling, or improper process-
Minus-density scratches Scratches from guide plates
ing are shown in Figure 12-22. A quality control program also
caused by roller or plate
misalignment
must be implemented and systematically followed to ensure
proper processing of radiographic film. Box 12-6 describes
 CHAPTER 12  Image Receptors 181

A B

C D E
FIG 12-22  ​Film Artifacts. A, Plus-density half-moon artifacts can be caused by bending or kink-
ing the film (arrow). B, Plus-density scratch artifacts can be caused by a fingernail (arrow).
C, Plus-density static discharge artifact can be caused by sliding the film over a flat surface.
D, Minus-density caused by moisture on finger. E, Dirty screens or cassettes can cause nonspe-
cific minus-density artifacts. (From Fauber TL: Radiographic imaging and exposure, ed 3, St Louis,
2009, Mosby.)
182 SECTION II  Image Production and Evaluation

BOX 12-6  Quality Control: Darkroom and must be used when radiographic processing accumulates high
Film Processor concentrations of silver. Silver recovery refers to the removal
of silver from used fixer solution. For some facilities that regu-
A quality control program must be implemented and system-
larly process large volumes of radiographs, the financial
atically followed to ensure proper processing of radiographic
rewards of silver recovery may be an added incentive.
film. A good quality control program should include steps for
monitoring all of the equipment and activities required for Silver-recovery units are available for on-site silver recov-
the production of quality radiographic images. These steps ery and generally require servicing by an outside contractor
include but are not limited to: familiar with the equipment and its method of removing
• Sensitometric monitoring of the film processor to provide silver. These silver-recovery units are connected directly to
valuable information on the daily functioning of the the drain system of the fixer tank to remove silver as used
processor. fixer solution passes through the unit. After the silver has
• Following the establishment of baseline measurements, been recovered, the used fixer is drained.
expose and process a sensitometric strip daily, measure Silver-recovery units work by one of two methods. One
the appropriate optical density points with a densitometer, method of silver recovery is called metallic replacement. There
and plot on a control chart with predetermined upper and
are two types of metallic replacement silver-recovery units:
lower acceptable limits. The graph provides a visual indica-
One uses steel wool and the other uses a silver-extraction
tor of any acute or evolving processor malfunction.
• Typically, a processor control chart monitors base 1 fog, filter. A steel wool metallic replacement unit uses steel wool
medium optical density or speed, and upper and lower to filter the used fixer solution. Silver replaces the iron in the
density differences to evaluate contrast. steel wool and can then be removed easily after significant
• Speed and contrast indicators should not vary more than accumulation in a canister or replacement cartridge occurs. A
6 0.15 optical density from baseline measurements. silver-extraction unit uses a foam filter that is impregnated
• Base 1 fog should not be greater than 10.05 optical with steel wool. Again, the silver from used fixer solution re-
density from the baseline measurement. places the iron in the steel wool. A silver-extraction filter is
• Developer temperature should be measured daily with a more efficient at removing silver from used fixer and lasts
digital thermometer and should not vary more than 6 0.5° F longer than a simple steel wool metallic replacement unit.
(0.3° C).
Another method of silver recovery is the electrolytic
• The darkroom environment should be well ventilated,
method. It is the most efficient method, but the units needed
clean, organized, and safe.
• A safelight fog test should be performed semiannually and for this process are also more expensive than metallic replace-
result in less than 10.05 optical density of added fog. ment units. Electrolytic units have an electrically charged
• Replenishment rates should be checked weekly and fall drum or disk that attracts silver. The silver plates onto the
within 6 5% of the manufacturer’s specification. drum or disk and can be removed when a substantial amount
• Recommended quarterly quality control checks include: of silver has been collected.
• Developer solution pH should be maintained between Silver is considered a heavy metal, and its disposal is regu-
10-11.5. lated by local and state agencies. In many locales, strict limits
• Fixer pH should be maintained between 4-4.5. are placed on the concentrations of silver in used fixer that
• Developer-specific gravity should not vary more than can be disposed of via the sewer system. Silver recovery is an
0.004 from the manufacturer’s specifications.
important process in radiology because it is a natural re-
source, can be toxic to the environment, and has monetary
value.
quality control methods for evaluating the darkroom and
film processor. CRITICAL CONCEPT
Silver Recovery
Silver Recovery
Because fixer solution is used to remove unexposed silver ha- Silver is a natural resource, is a heavy metal that can be toxic
to the environment, and needs to be removed from the used
lide from the film, used fixer solution contains a high concen-
fixer.
tration of accumulated silver. Some type of silver recovery

SUMMARY
• The PSP plate of a CR system contains a phosphor that is forms of DR systems: indirect and direct capture. The two
ionized when exposed to x-rays. Approximately half of the forms of indirect capture use a scintillator that converts rem-
liberated electrons are trapped in the conduction band. nant radiation to light and then to an electronic signal, which
When the plate is scanned in the reader, the energy is re- causes some loss of resolution. The direct-capture method
leased and converted to an electronic signal, becoming a does not use a scintillator, instead using amorphous selenium
manifest image. and TFT array, thereby avoiding the loss of resolution.
• DR systems use a detector array that converts the remnant • During image acquisition a histogram is created from
beam to a signal for almost immediate viewing. There are two the exposure received to the detector. This histogram is
 CHAPTER 12  Image Receptors 183

S U M M A R Y — cont’d
compared with a stored histogram (a priori model) for • The radiographer using a digital system must select the
that anatomic part and VOI identified. From the VOI, the kVp for optimum penetration of the part (aside from the
computer determines what section of the histogram will 15% rule adjustment) and the mAs for sufficient quanta to
be included in the displayed image. create the image, although for slightly different reasons
• In CR systems, the image is stored in the plate as trapped than applied to film-screen systems. Excessive kVp results
electrons in the conduction bands. This “image” is ex- in excessive scatter radiation production and a loss of con-
tracted by exposing the plate to a laser. The released en- trast. Insufficient mAs result in noise (quantum mottle
ergy is in the form of light and is passed through an ADC, appearance) caused by insufficient quanta to produce the
where it is digitized. The digitized signal is converted to a image.
matrix and assigned grayscale values. • The sharpness factors of SID, OID, focal spot size, and
• In DR systems, the image-forming radiation is processed tube-part-receptor alignment affect digital systems in the
as it exposes the detector array and digitized. The digitized same way as film-screen systems.
signal is then converted to a matrix and assigned grayscale • Troubleshooting with digital systems involves the recogni-
values. tion of those image-processing errors that can degrade
• The digital image has a linear response to x-ray exposure image visibility, and the radiographer should consider
and a wide dynamic range. Digital receptors can respond exposure field recognition errors, proper collimation, ex-
to exposure levels much lower and much higher than film cessive scatter radiation, processing under the correct
and display many more shades of gray. menu, and proper technical factor selection.
• Postprocessing functions are those manual manipulation • Digital imaging quality control focuses on the display
functions of the displayed image available to the technolo- monitors and viewing environment.
gist and radiologist. Care should be taken in the use of • The PACS is an integral part of the digital radiology imag-
these so as not to negatively alter the digital data set. ing department and is generally divided into acquisition,
• In CR systems, the exposure indicators should be moni- display, and storage systems.
tored as a guide for optimal technical factor selection. In • PACS is an electronic network for communication be-
DR systems, the DAP should be used for the same purpose. tween the image acquisition modalities, display stations,
• DQE is a measure of how well the signal-to-noise ratio is and storage using the common language, DICOM. Its role
preserved. It is related to the radiation exposure level is to allow for the display and storage of medical images
required to produce an optimal image. and information.
• When using digital systems, the radiographer should keep • A display station is simply a desktop computer that allows
in mind that as the operating speed class increases, the for the retrieval and viewing of medical images from one
potential for image noise increases but as the operating of the modalities or storage components of the PACS. The
speed class decreases, patient dose increases. Ideally, the quality and function of these stations depends on the user.
digital system should be operated at a higher speed class to • One of the biggest challenges of a PACS is storage. With
strike a balance between the ability to use a lower mAs increasingly complex modalities feeding large image files
value and apply postprocessing functions for optimization into the system, the demand for storage is ever-increasing.
of the image, and the term speed class should be avoided in • Storage of a PACS is generally classified as online, nearline,
reference to digital systems. or offline.
• Image noise is any undesirable fluctuation in the bright- • Radiographic film serves as the medium for image acqui-
ness of an image and is caused by the inherent x-ray sition, processing, and display.
quantum noise and electronic components of the digital • The emulsion layer of film is sensitive to radiant energy
system. and consists of silver halide crystals suspended in gelatin.
• Spatial resolution of digital systems is equal to one-half of • Imperfections in the silver halide crystals, called sensitivity
the Nyquist frequency and is best measured using MTF. specks, are the latent image centers and appear as density
• In digital systems, mAs no longer controls density; that is on the chemically processed film.
the role of the display computer and is referred to as • Film speed is the degree to which the emulsion is sensitive
brightness. However, mAs is still very important in that it to x-rays or light.
still ultimately determines the quantity of radiation expo- • The number and size of silver halide crystals in the film’s
sure to the patient, which represents patient dose and the emulsion determines the relative speed of the film. Faster-
quantity of radiation available to form the image. An op- speed film requires less radiation exposure to create the
timal mAs should be selected to provide sufficient quanta image.
to create the image. • Films manufactured to display higher contrast have a nar-
• The kVp still influences contrast in digital systems, but row exposure latitude compared with low-contrast films,
these systems can display a much wider range of grayscale; which have a wider exposure latitude.
because of this, a higher kVp (adjusted using the 15% • Spectral matching means the spectral sensitivity of film
rule) can be used and still produce a quality image. must match the spectral emission of its intensifying screen.
Continued
184 SECTION II  Image Production and Evaluation

S U M M A R Y — cont’d
• Rare earth elements are used in the phosphor layer of in- • Automatic film processing converts the latent image to a
tensifying screens to convert the transmitted x-rays to manifest or visible image and occurs in four stages: devel-
visible light. oping, fixing, washing, and drying.
• Using intensifying screen light emission to expose the film • Developing or reducing agents convert the exposed silver
reduces the amount of radiation needed to create the la- halide crystals to metallic silver that is presented as densi-
tent image and decreases patient exposure. ties on the film.
• Intensifying screen speed is affected by the phosphor’s • Fixing removes the unexposed silver halide from the film.
absorption and conversion efficiency, thickness of the • Washing removes the fixing solution from the surface of
phosphor layer, and size of the phosphor crystal. the film.
• Factors that increase a screen’s speed decrease recorded • Drying removes 85% to 90% of the moisture from the film.
detail and decrease patient exposure. • Replenishment replaces fresh developing and fixing chem-
• Factors that decrease a screen’s speed increase recorded icals after their loss during processing.
detail and increase patient exposure. • Radiographic quality may be jeopardized if the film is
• Intensifying screens should be cleaned with an antistatic improperly stored, handled, or processed.
cleaning solution regularly and checked for adequate film- • Silver is a natural resource that can be toxic to the environ-
screen contact. ment and should be removed from used fixer solution.

CRITICAL THINKING QUESTIONS

1. What are the considerations for determining kVp in a 3. How is the latent film image created and then converted to
digital environment? a visible image?
2. What are the physics and ethical problems associated with 4. How can the construction of film and intensifying screens
processing an image under the wrong histogram? affect exposure factor selection and patient exposure?

REVIEW QUESTIONS
1 . What represents the latent image in a PSP CR system? 5. Rescaling a digital image adjusts the histogram to reflect
a. electrons trapped in conduction band which of the following?
b. ionized silver halide crystals a. kVp
c. scattered photons in the patient b. mAs
d. chemical reaction in the processor c. LUT
2. Which PACS storage option offers the fastest retrieval of d. VOI
data? 6. Which of the following is used by both forms of indirect
a. offline cassetteless systems?
b. nearline a. scintillator
c. online b. CCD
d. All are equal in retrieval speed. c. optics
3. If increasing number value represents faster speed class, d. TFT
which digital speed class will allow for the lowest patient 7. Which of the following does not involve the conversion of
dose? x-rays to light?
a. 100 a. direct capture DR system
b. 200 b. indirect capture DR system
c. 300 c. CR system
d. 400 d. film-screen system
4. Which of the following controls brightness of a digital 8. Which component of the CR reader digitizes the signal?
system? a. photodetector
a. mAs b. ADC
b. kVp c. optics
c. the display monitor d. laser
d. room lighting
 CHAPTER 12  Image Receptors 185

R E V I E W Q U E S T I O N S — cont’d
9. What is this test pattern used for? 1 2. Intensifying screens are used to _____.
a. decrease patient exposure
b. increase recorded detail
c. increase film latitude
d. decrease contrast
13. The ability to emit light only when stimulated by x-rays
is known as _____.
a. phosphorescence
b. sensitometry
(From Mosby’s radiography online: radiographic imaging, c. conversion efficiency
ed 2, St Louis, 2009, Mosby.) d. fluorescence
14. Increasing the developer temperature during automatic
a. luminance response film processing results in:
b. luminance dependence a. decreased density.
c. reflection b. increased contrast.
d. resolution c. increased density.
10. Which of the following is the latent image center for d. decreased recorded detail.
radiographic film? 15. If film is primarily used for imaging, silver recovery is
a. detector element important because:
b. phosphor layer a. it has monetary value.
c. sensitivity speck b. it can be toxic.
d. polyester base c. it is a natural resource.
11. What term describes a film’s sensitivity to light? d. all of the above.
a. latitude
b. gamma
c. contrast
d. speed
13
Exposure Technique Selection

OUTLINE
Introduction Collimation
Radiation Detectors Image Receptor Variations
Phototimers Anatomically Programmed Radiography
Ionization Chamber Systems Quality Control
Milliamperage/Second Readout Calibration
Kilovoltage Peak and Milliamperage/Second Selection Quality Control Testing
Minimum Response Time Exposure Technique Charts
Backup Time Conditions
Density Adjustment Design Characteristics
Alignment and Positioning Considerations Types of Technique Charts
Detector Selection Exposure Technique Chart Development
Patient Centering Special Considerations
Detector Size Summary
Compensating Issues
Patient Considerations

OBJECTIVES
• State the purpose of automatic exposure control (AEC) • Recognize the effect of the type of image receptor on
in radiography. AEC calibration, its use, and image quality.
• Differentiate among the types of radiation detectors used • Describe patient protection issues associated with AEC.
in AEC systems. • State the importance of calibration of the AEC system to
• Recognize how the detector size and configuration affect the type of image receptor used.
the response of the AEC device. • List the quality control tests used to evaluate AEC.
• Explain how alignment and positioning affect the • Differentiate between the types of exposure technique
response of the AEC device. charts.
• Discuss patient and exposure technique factors and their • State exposure technique modifications for the following
effect on the response of the AEC device. considerations: projections and positions, soft tissue,
• Define anatomically programmed radiography (APR). casts and splints, contrast media, and pathologic condi-
• Analyze unacceptable images produced using AEC and tions.
identify possible causes.

KEY TERMS
anatomically programmed radiogra- density controls minimum response time
phy (APR) detectors optimal kVp
automatic exposure control (AEC) exposure technique chart photomultiplier (PM) tube
backup time fixed kVp–variable mAs technique phototimer
calipers chart variable kVp–fixed mAs technique
comparative anatomy ionization or ion chamber chart
contrast medium mAs readout

186
 CHAPTER 13  Exposure Technique Selection 187

INTRODUCTION
The radiographer is tasked with selecting exposure factor
techniques to produce quality radiographs for a wide variety
of equipment and patients. There are many thousands of
possible combinations of kilovoltage peak (kVp), milliam-
perage (mA), source-to-image receptor distance (SID), expo-
sure time, image receptors, and grid ratios. When combined
with patients of various sizes and with various pathologic
conditions, the selection of proper exposure factors becomes
a formidable task. An automatic exposure control (AEC)
system is a tool available on most modern radiographic units
to assist the radiographer.
AEC is a system used to consistently control the amount
of radiation reaching the image receptor by terminating the FIG 13-1  ​Automatic Exposure Control Detectors. Arrange-
length of exposure. AEC systems also are called automatic ment of three automatic exposure control detectors on an
exposure devices, and sometimes they are erroneously re- upright Bucky unit.
ferred to as phototiming. Technique charts make setting tech-
nical factors much more manageable, but there are always not common today. Therefore, the use of the term pho-
patient factors that require the radiographer’s assessment and totiming is usually in error. The more common type of AEC
judgment. When using AEC systems, the radiographer must system uses ionization chambers. Regardless of the specific
still use individual discretion to select an appropriate kVp, type of AEC system used, almost all systems use a set of
mA, image receptor, and grid. However, the AEC device de- three radiation-measuring detectors arranged in some spe-
termines the exposure time (and therefore total exposure). cific manner (Figure 13-1). The radiographer selects the
configuration of these devices, determining which of the
CRITICAL CONCEPT three individually or in combination actually measures ra-
Principle of Automatic Exposure Control diation exposure reaching the image receptor. These devices
Operation are variously referred to as sensors, chambers, cells, or detec-
tors. These radiation-measuring devices are referred to here
Once a predetermined amount of radiation is transmitted for the remainder of the discussion as detectors.
through a patient, the x-ray exposure is terminated. This de-
termines the exposure time and therefore the total amount
CRITICAL CONCEPT
of radiation exposure to the image receptor.
Radiation-Measuring Devices

AEC systems are excellent at producing consistent levels of Detectors are the AEC devices that measure the amount of
radiation transmitted. The radiographer selects the combina-
exposure when used properly, but the radiographer should
tion of three detectors.
also be aware of the technical limitations of using an AEC
system.
Phototimers
Phototimers use a fluorescent (light-producing) screen and a
RADIATION DETECTORS device that converts the light to electricity. A photomultiplier
All AEC devices work by the same principle: Radiation is (PM) tube is an electronic device that converts visible light
transmitted through the patient and converted into an elec- energy into electrical energy. A photodiode is a solid-state
trical signal, terminating the exposure time. This occurs device that performs the same function. Phototimer AEC
when a predetermined amount of radiation has been de- devices are considered exit-type devices because the detectors
tected, as indicated by the level of electrical signal that has are positioned behind the image receptor (Figure 13-2) so
been produced. The predetermined level of radiation is cali- that radiation must exit the image receptor before it is mea-
brated by service personnel to meet the departmental stan- sured by the detectors. Light paddles, coated with a fluores-
dards of image quality. cent material, serve as the detectors, and the radiation inter-
The difference in AEC systems lies in the type of device acts with the paddles, producing visible light. This light is
used to convert radiation into electricity. Two types of AEC transmitted to remote PM tubes or photodiodes that convert
systems have been used: phototimers and ionization cham- this light into electricity. The timer is tripped and the radio-
bers. Phototimers represent the first generation of AEC graphic exposure is terminated when a sufficiently large
systems used in radiography, and it is from this type of sys- charge has been received. This electrical charge is in propor-
tem that the term phototiming has evolved. Phototiming tion to the radiation to which the light paddles have been ex-
specifically refers to the use of an AEC device that uses pho- posed. Phototimers have largely been replaced with ionization
tomultiplier tubes or photodiodes, and these systems are chamber systems.
188 SECTION II  Image Production and Evaluation

Image receptor
Light paddles
Light paddles, together with photomultiplier
tubes, measure radiation exposure after
it passes through the image receptor.
FIG 13-2  ​Phototimer Automatic Exposure Control. In the phototimer automatic exposure
control system, the detectors are located directly below the image receptor. This is an exit-type
device in that the x-rays must exit the image receptor before they are measured by the detectors.

Ionization Chamber Systems becomes ionized, creating an electrical charge. This charge
An ionization or ion chamber is a hollow cell that contains travels along the wire to the timer circuit. The timer is
air and is connected to the timer circuit via an electrical wire. tripped and the radiographic exposure is terminated when a
Ionization-chamber AEC devices are considered entrance- sufficiently large charge has been received. This electrical
type devices because the detectors are positioned in front of charge is in proportion to the radiation to which the ioniza-
the image receptor (Figure 13-3) so that radiation interacts tion chamber has been exposed. Compared with phototim-
with the detectors just before interacting with the image re- ers, ion chambers are less sophisticated and less accurate, but
ceptor. When the ionization chamber is exposed to radiation they are less prone to failure. Most of today’s AEC systems use
from a radiographic exposure, the air inside the chamber ionization chambers.

Ionization chamber Ionization

measures radiation chamber
exposure before it
Image receptor
reaches the image
receptor.
FIG 13-3  ​Ionization Chamber Automatic Exposure Control. The ionization chamber automatic
exposure control system has the detectors located directly in front of the image receptor. This is
an entrance-type device because the x-ray exposure is measured just before entering the image
receptor.
 CHAPTER 13  Exposure Technique Selection 189

MAKE THE PHYSICS CONNECTION device is used. The radiographer must select the kVp level
that provides an appropriate scale of contrast and is at least
Chapter 4
the minimum kVp to penetrate the part. Although contrast
The AEC serves the same role as the exposure timer in the can be computer manipulated in digital imaging, the kVp
primary circuit. The AEC is programed to terminate exposure should still be selected to best visualize the area of interest. In
when a predetermined level of electric charge is received addition, the higher the kVp value used, the shorter the expo-
from the detector. sure time needed by the AEC device. Because high kVp radia-
tion is more penetrating (reducing the total amount of x-ray
exposure to the patient because more x-ray photons exit the
CRITICAL CONCEPT patient) and the detectors are measuring quantity of radia-
Function of the Ionization Chamber tion, the preset amount of radiation exposure is reached
sooner with high kVp. Using higher kVp with AEC decreases
The ionization chamber interacts with exit radiation before it
the exposure time and overall mAs needed to produce a diag-
reaches the image receptor. Air in the chamber is ionized, and
an electric charge that is proportional to the amount of radia-
nostic image, significantly reducing the patient’s exposure.
tion is created.
CRITICAL CONCEPT
Kilovoltage Peak and Automatic Exposure
MILLIAMPERAGE/SECOND READOUT Control Response
The radiographer must be sure to set the kVp value as
When a radiographic study is performed using an AEC de-
needed to ensure adequate penetration and to produce the
vice, the total amount of radiation (milliamperage/second
appropriate scale of contrast. The kVp selected determines
[mAs]) required to produce the appropriate exposure to the the length of exposure time when using AEC. A low kVp re-
image receptor is determined by the system. Many radio- quires more exposure time to reach the predetermined
graphic units include a mAs readout display, on which the amount of exposure. A high kVp decreases the exposure
actual amount of mAs used for that image is displayed im- time to reach the predetermined amount of exposure and
mediately after the exposure, sometimes for only a few sec- reduces the overall radiation exposure to the patient.
onds. It is critical for the radiographer to take note of this
information when it is available. Knowledge of the mAs read-
out has a number of advantages. It allows the radiographer to The kVp selected for an examination should produce the
become more familiar with manual exposure technique fac- desired radiographic contrast for the part examined and be as
tors. If the image is suboptimal, knowing the mAs readout high as possible to minimize the patient’s radiation exposure.
provides a basis from which the radiographer can make ex- When the radiographer uses a control panel that allows
posure adjustments by switching to manual technique. There the mA and time to be set independently, he or she should
may be studies with different positions in which AEC and select the mA without regard to whether an AEC device is
manual techniques are combined because of difficulty with used. The mA selected has a direct effect on the exposure
accurate centering. For example, knowing the mAs readout time needed by the AEC device. Therefore, if the radiogra-
for the anteroposterior lumbar spine gives the radiographer pher wants to decrease exposure time for a particular exami-
an option to switch to manual technique for the oblique ex- nation, he or she may easily do so by increasing the mA. For
posures, making technique adjustments based on reliable a given procedure, increasing the mA on the control panel
mAs information. shortens the exposure time and decreasing the mA increases
the exposure time.
CRITICAL CONCEPT
Automatic Exposure Control and CRITICAL CONCEPT
Milliamperage/Second Readout Milliamperage and Automatic Exposure Control
If the radiographic unit has a mAs readout display, the radiog-
Response
rapher should observe the reading after the exposure is If the radiographer can set the mA when using AEC, it affects
made. This information can be invaluable. the time of exposure for a given procedure. Increasing the
mA decreases the exposure time to reach the predetermined
amount of exposure. Decreasing the mA increases exposure
time to reach the predetermined amount of exposure.
KILOVOLTAGE PEAK AND MILLIAMPERAGE/
SECOND SELECTION
MINIMUM RESPONSE TIME
AEC controls only the quantity of radiation reaching the im-
age receptor and therefore has no effect on other image char- The term minimum response time refers to the shortest ex-
acteristics such as contrast. The kVp for a particular exami- posure time that the system can produce. Minimum response
nation should be selected without regard to whether an AEC time (1 ms with modern AEC systems) usually is longer with
190 SECTION II  Image Production and Evaluation

AEC systems than with other types of radiographic timers CRITICAL CONCEPT
(i.e., other types of radiographic timers usually are able to
Setting Backup Time
produce shorter exposure times than AEC devices). This can
be a problem with some segments of the patient population, Backup time should be set at 150% to 200% of the expected
such as pediatric patients and uncooperative patients. Typi- exposure time. This allows the properly used AEC system to
cally, the radiographer increases the mA so the time of expo- appropriately terminate the exposure but protects the patient
sure terminates more quickly. If the minimum response time and tube from excessive exposure if a problem occurs.
is longer than the amount of time needed to terminate the
preset exposure, an increased amount of radiation reaches
the image receptor. With pediatric patients and others who To minimize patient exposure, the backup time should be
cannot or will not cooperate with the radiographer by hold- neither too long nor too short. A backup time that is too
ing still or holding their breath during the exposure, AEC short results in the exposure being stopped prematurely and
devices may not be the technology of choice. the image may need to be repeated because of poor image
quality. A backup time that is too long results in the patient
receiving unnecessary radiation if a problem occurs and the
BACKUP TIME exposure does not end until the backup time is reached. In
Backup time refers to the maximum length of time the addition, the image may have to be repeated because of poor
x-ray exposure continues when using an AEC system. The image quality.
backup time may be set by the radiographer or may be
controlled automatically by the radiographic unit. It may
be set as backup exposure time or as backup mAs (the
DENSITY ADJUSTMENT
product of mA and exposure time). The role of the backup AEC devices are equipped with density controls that allow
time is to act as a safety mechanism when an AEC system the radiographer to adjust the amount of preset radiation
fails or the equipment is not used properly. In either case, detection values. These generally are in the form of buttons
the backup time protects the patient from receiving unnec- on the control panel that are numbered –2, –1, 11, and 12.
essary exposure and protects the x-ray tube from reaching The actual numbers presented on density controls vary, but
or exceeding its heat-loading capacity. If the backup time is each of these buttons changes exposure time by some prede-
controlled automatically, it should terminate at a maxi- termined amount or increment expressed as a percentage.
mum of 600 mAs when equipment is operated at or above A common increment is 25%, meaning that the predeter-
50 kVp. mined exposure level needed to terminate the timer can be
either increased or decreased from normal in one increment
CRITICAL CONCEPT (125% or –25%) or two increments (150% or –50%).
Function of Backup Time Manufacturers usually provide information on how these
density controls should be used. Common sense and practi-
Backup time, the maximum exposure time allowed during an
cal experience should also serve as guidelines for the radiog-
AEC examination, serves as a safety mechanism when the
AEC is not used properly or is malfunctioning.
rapher. Routinely using plus or minus density settings to
produce an acceptable radiograph indicates that a problem
exists, possibly a problem with the AEC device.
The backup time might be reached as the result of opera-
tor oversight when an AEC examination, such as a chest ALIGNMENT AND POSITIONING
x-ray, is done at the upright Bucky and the radiographer has CONSIDERATIONS
set the control panel for table Bucky. The table detectors are
forced to wait an excessively long time to measure enough Detector Selection
radiation to terminate the exposure. The backup time is Selection of the detector or detectors to be used for a particu-
reached and the exposure terminated, limiting the patient’s lar examination is critical when using an AEC system. AEC
exposure and keeping the tube from overloading. However, systems with multiple detectors typically allow the radiogra-
newer x-ray units with AEC include a sensor in the Bucky pher to select any combination of one, two, or all three detec-
tray for the image receptor and will not allow an exposure to tors. The selected detectors actively measure radiation during
activate if the table Bucky detectors are selected but the x-ray exposure, and the electrical signals are averaged. Typically,
tube is centered to the upright Bucky. When controlled by the the detector that receives the greatest amount of exposure has
radiographer, the backup time should be set high enough to a greater effect on the total exposure.
be greater than the exposure needed but low enough to pro- Measuring radiation that passes through the anatomic
tect the patient from excessive exposure in case of a problem. area of interest is important. The general guideline is to select
Setting the backup time at 150% of the expected exposure the detectors that will be superimposed by the anatomic
time is appropriate. If the backup timer periodically or rou- structures of greatest interest that need to be visualized on
tinely terminates the exposure, higher mA values should be the radiograph. Failure to use the proper detectors could
used to shorten the exposure time. result in either underexposure or overexposure to the image
 CHAPTER 13  Exposure Technique Selection 191

receptor. In the case of a posteroanterior (PA) chest radio- certain to select the correct Bucky before making an expo-
graph, the area of radiographic interest includes the lungs sure. Failure to do so results in the patient and image receptor
and heart; therefore, one or two outside detectors should be being exposed to excessive radiation. The backup time is
selected to place the detectors directly beneath the critical reached, the exposure terminated, and a repeat radiographic
anatomic area. If the center detector is mistakenly selected, study must be done, thereby increasing the patient’s dose.
the anatomy superimposing this detector includes the tho- A similar problem can occur when not using a Bucky, such
racic spine. If the exposure is made, the resultant image will as with cross-table, tabletop, or stretcher or wheelchair stud-
demonstrate sufficient exposure in the spine, with the lungs ies. If the AEC system is activated with these types of exami-
overexposed (Figure 13-4). AEC device manufacturers nations, an unusually long exposure results because the de-
provide recommendations for which detectors to use for spe- tectors are not being exposed to radiation. Again, the backup
cific examinations. Recommendations for detector combina- time will probably be reached, and the patient’s dose will be
tion also can be found in many radiographic procedures excessive. Some radiographic units are designed so that an
textbooks. exposure does not occur if the AEC device has been selected
Many radiographic units have AEC devices in both the and there is no image receptor detected in the Bucky.
table Bucky and an upright Bucky. If more than one Bucky
per radiographic unit uses AEC, the radiographer must be CRITICAL CONCEPT
Detector Selection
The combination of detectors affects the amount of exposure
reaching the image receptor. If the area of radiographic inter-
est is not directly over the selected detectors, that area prob-
ably will be over- or underexposed. When performing any ra-
diographic study in which the image receptor is located
outside of the Bucky, the AEC system should be deactivated
and a manual technique used.

Patient Centering
Proper centering of the part being examined is crucial when
using an AEC system. The anatomic area of interest must be
centered properly over the detectors that the radiographer
has selected. Improper centering of the part over the selected
detectors may either underexpose or overexpose the image
A receptor. For example, when an AEC device is used for a lat-
eral lumbar spine image, if the central ray is too far posterior
and the center detector is selected (as appropriate), the soft
tissue will superimpose the detector rather than the spine. In
this case, the soft tissue behind the spine will demonstrate
sufficient exposure, but the spine itself will be underexposed
(Figure 13-5). Inaccurate centering is probably the most
common cause of suboptimal film-screen images when AEC
is used. When the anatomy of interest is not centered directly
over the detector, the image will be underexposed or overex-
posed, possibly requiring the image to be repeated and the
patient to receive more radiation than necessary.

CRITICAL CONCEPT
Patient Centering
B Accurate centering of the area of interest over the detectors
is critical to ensure proper exposure to the image receptor. If
FIG 13-4  ​Detector Selection. A, The center detector was the area of interest is not properly centered to the image re-
inappropriately selected for a posteroanterior chest radio- ceptor, over- or underexposure may occur.
graph, placing the thoracic spine directly over the detector.
B, The resulting chest radiograph demonstrates appropriate
density in the area of the spine, but the lungs are notably If a digital image receptor is underexposed or overex-
overexposed.  (B from Fauber TL: Radiographic imaging and posed, the computer adjusts for the exposure error, but the
exposure, ed 3, St Louis, 2009, Mosby.) image quality and patient exposure are compromised.
192 SECTION II  Image Production and Evaluation

B
A
FIG 13-5  ​Centering. A, The center detector was selected with the centering for this lateral lum-
bar spine posterior to the lumbar vertebral bodies. B, The resulting radiograph demonstrates
appropriate density just posterior to the vertebral bodies, but the bodies themselves are under-
exposed. (B, from Fauber TL: Radiographic Imaging and Exposure, ed 3, St Louis, 2009, Mosby.)

Underexposure may result in the visibility of quantum noise the patient’s size, the exposure time will lengthen to reach the
and overexposure increases patient exposure and may preset exposure to the detectors. AEC systems that do not
decrease contrast. adequately compensate for changes in patient thickness may
need to be calibrated.
Detector Size Some patients may require greater technical consideration
The size of the detectors manufactured within an AEC system when AEC is used for their radiographic procedures. For ex-
is fixed and cannot be adjusted. Therefore, it is important for ample, abdominal examinations using AEC can be compro-
the radiographer to determine whether AEC should be used mised if a patient has an excessive amount of bowel gas. If a
during the radiographic procedure. The radiographer must detector is superimposed by an area of the abdomen with
first determine whether the patient’s anatomic area of interest excessive gas, the timer will terminate the exposure prema-
can adequately cover the detector combination. For example, if turely, resulting in an underexposed radiograph. Likewise,
the patient for a procedure is very small, such as a toddler, his destructive pathologic conditions can cause underexposure
or her chest may not adequately cover the outer two detectors. of the area of radiographic interest. The presence of positive
In this case, the patient’s chest is smaller than the dimensions contrast media, an additive pathologic condition, or a pros-
of the selected detectors. If a portion of the detector is exposed thetic device that superimposes the detector can cause exces-
directly to the primary beam, the radiation exposure level nec- sive exposure.
essary to terminate the exposure is reached almost immedi-
ately, resulting in underexposure of the area of interest.
It is therefore critical that the radiographer determine CRITICAL CONCEPT
whether the anatomic area of interest can adequately super-
impose the dimension of the detector combination. If the Patient Consideration
detector combination is larger than the area of interest, a Patient factors affect the time the exposure takes to reach
manual exposure technique should be used. the image receptor and ultimately affect image quality. Varia-
tions in patient thickness result in changes in the time of ex-
posure accordingly if the AEC system is functioning properly.
COMPENSATING ISSUES Pathologic conditions, contrast media, foreign objects, or
Patient Considerations pockets of gas are patient variations that may affect the
proper exposure to the image receptor and ultimately image
The AEC system is designed to compensate for changes in
quality.
patient thickness. If the area of interest is thicker because of
 CHAPTER 13  Exposure Technique Selection 193

If the anatomic area directly over the detector does not The AEC device cannot sense when the radiographer uses
represent the anatomic area of interest, inappropriate expo- a different type or speed class of image receptor and instead
sure to the image receptor may result. This can happen when produces an exposure based on the system for which it was
the anatomic area over the detector contains a foreign object, calibrated, resulting in either too much or too little exposure
a pocket of air, or contrast media. The radiographer must for that image receptor. For example, if a 100-speed film-
consider these circumstances individually and determine screen system is used with an AEC device instead of the ap-
how best to image the patient or part. Using the density con- propriate 400-speed film-screen system, the resulting image
trol buttons may work in some cases, whereas in others it may will have too little density because the exposure stopped
be necessary to recenter the patient or part. Sometimes the (as preset) for the more sensitive 400-speed system. Some
best solution is a manual technique determined through use radiographic units have AEC devices that can accommodate
of a technique chart. AEC is not a replacement for a knowl- more than one speed of film-screen system. With these types
edgeable radiographer using critical thinking skills. of units, the control panel indicates which film-screen system
will be used for the next exposure.
Collimation If a different type of digital image receptor is used, the
The size of the x-ray field is a factor when AEC systems are computer adjusts for the exposure error, but again the image
used because the additional scatter radiation produced by quality and patient exposure are compromised. Underexpo-
failure to accurately restrict the beam may cause the detector sure may result in the visibility of quantum noise and overex-
to terminate the exposure prematurely. The detector is un- posure increases patient exposure and may decrease contrast.
able to distinguish transmitted radiation from scattered ra-
diation and, as always, ends the exposure when a preset ANATOMICALLY PROGRAMMED
amount of exposure has been reached. Because the detector
is measuring both types of radiation exiting the patient, the
RADIOGRAPHY
timer is turned off too soon when scatter is excessive, which Anatomic programming, or anatomically programmed radi-
results in underexposure of the area of interest. ography (APR), refers to a radiographic system that allows the
Additionally, if the x-ray field size is collimated too closely, radiographer to select a particular button on the control panel
the detector does not receive sufficient exposure initially and that represents an anatomic area for which a preprogrammed
may prolong the exposure time, which could result in overex- set of exposure factors are displayed and can be selected. The
posure. The radiographer should open the collimator to the appearance of these controls varies, depending on the unit
extent that the part being radiographed is imaged appropri- (Figure 13-6), but the operation of all APR systems is based on
ately, but not so much as to cause the AEC device to terminate the same principle. APR is controlled by an integrated circuit
the exposure before the area being imaged is properly exposed. or computer chip that has been programmed with exposure
factors for different projections and positions of different
CRITICAL CONCEPT anatomic parts. Once an anatomic part and projection or
Collimation and Automatic Exposure Control position has been selected, the radiographer can adjust the
Response exposure factors that are displayed.
APR and AEC are not related in their functions, other
Excessive or insufficient collimation may affect the amount of
than as systems for making exposures. However, these two
exposure reaching the image receptor. Insufficient collimation
may result in excessive scatter reaching the detectors, result-
ing in the exposure time terminating too quickly. Excessive
collimation may result in an exposure time that is too long.

Image Receptor Variations

Different types of image receptors cannot be interchanged
easily once an AEC device is calibrated to terminate expo-
sures at a preset level. When calibration is performed, it is
done for a particular type of image receptor, including digital.

CRITICAL CONCEPT
Type of Image Receptor and Automatic
Exposure Control Response
The AEC system is calibrated to the type and speed class of
FIG 13-6  ​Anatomically Programmed Radiography. Ana-
the image receptor used. If an image receptor of a different
tomically programmed radiography selections are displayed
type or speed is used, the detectors will not sense the differ-
on the control panel. Each selection displays the prepro-
ence, the exposure time will terminate at the preset value,
grammed exposure technique factors that the radiographer
and image quality may be jeopardized.
can decide to use or adjust.
194 SECTION II  Image Production and Evaluation

different systems are commonly combined on radiographic BOX 13-1  Manual Techniques vs
units because of their similar dependence on integrated com- Automatic Exposure Control
puter circuitry and often are used in conjunction with one
another. A radiographer can use APR to select a projection or • Manual exposure techniques require the radiographer to
select the kVp and mAs necessary for the radiographic
position for a specific anatomic part and view the kVp, mA,
procedure. This requires the radiographer to consider the
and exposure time for manual technique. When APR is used procedure, primary and secondary exposure variables, and
in conjunction with AEC on some radiographic units, the patient considerations. Different from manual exposure
APR system not only selects and displays manual exposure techniques, the use of AEC systems will terminate the
factors but also selects and displays the AEC detectors to be radiation exposure exiting the patient based on the preset
used for a specific radiographic examination. For example, calibration of the radiation detectors; therefore, the actual
pressing the “Lungs PA” button results in selection of mAs is not set by the radiographer. The decision to select
120 kVp, the upright Bucky, and the two outside AEC detec- manual exposure techniques (whether APR or not) or use
tors. As with AEC, APR is a system that automates some of the AEC device requires the radiographer to consider many
the work of radiography. However, the individual judgment variables.
and discretion of the radiographer is still required to use the • As previously discussed, the detector(s) selected must be
adequately covered by the patient’s anatomic area of inter-
APR system correctly for the production of optimal-quality
est. In the case of a pediatric patient or distal extremities,
images (Box 13-1). the area of interest may be too small to adequately cover
the detector(s), and therefore the use of a manual expo-
QUALITY CONTROL sure technique would be more appropriate.
• Patient factors, such as pathology, contrast media, or a
As with any radiographic unit, it is imperative that systematic foreign object, may cause the AEC device to terminate
equipment testing be performed to ensure proper system prematurely or result in an excessive exposure. The radiog-
performance. Calibration and quality control testing are es- rapher must consider these patient variations individually
sential procedures to maintain the proper functioning of the and determine whether the use of a manual exposure
AEC system. technique would be best.
• There are a few anatomic regions that may be more chal-
Calibration lenging for the radiographer when using the AEC device.
For example, centering for the axial clavicle to ensure the
For an AEC device to function properly, the radiographic proper radiation exposure may be more difficult than
unit, including the image receptor, and the AEC device must selecting a manual exposure technique. In addition, any
be calibrated to meet departmental standards. When a radio- slight movement of the patient prior to the activation of
graphic unit with AEC is first installed, the AEC device is the radiation exposure could result in the area of interest
calibrated, and it is recalibrated at intervals thereafter. The not being adequately centered to the central ray, such as
purpose of calibration is to ensure that consistent and a lateral cervical spine. In these situations the radiographer
appropriate exposures to the image receptor are produced. could evaluate the mAs readout for an AP projection and
Failure to maintain regular calibration of the unit results then change to a manual exposure technique for the axial,
in the lack of consistent and reproducible exposures to the lateral, or oblique positions.
detectors and could affect image quality. This ultimately leads • For those radiographic procedures best suited, routine use
of AEC is recommended. Proper use and calibration of the
to overexposure of the patient and poor efficiency of the
AEC system will lessen the potential for overexposures.
imaging department, as well as the possibility of improper This is especially important during digital imaging because
interpretation of radiographs. computer processing will rescale image brightness, and an
excessive radiation exposure would not be easily apparent
Quality Control Testing to the radiographer.
The AEC device should provide consistent exposures to the
image receptor for variations in technique factors, patient
thicknesses, and detector selection. Several aspects of the
AEC performance can be monitored by imaging a homoge- The radiographer must use AEC accurately, regardless of
neous patient equivalent phantom plus additional thickness the type of image receptor used. Failure to do so can result in
plates. overexposure of the patient to ionizing radiation or produc-
Consistency of exposures with varying mA, kVp, part tion of an image that is of poor quality. The visual cues of
thicknesses, and detector selection can each be evaluated in- increased or decreased radiographic density present when
dividually and in combination by imaging a patient equiva- using film-screen image receptors are lacking in digital imag-
lent phantom and measuring the resultant milliroentgen ing. It cannot be overstated that, when using digital image
(mR) exposure and optical densities. Optical densities should receptors, the radiographer must be very conscientious about
be within 60.2 for proper performance of the AEC device. preventing excessive radiation exposure to the patient. If a
In addition, reproducibility of exposures for a given set of high amount of radiation reaches the digital image receptor,
exposure factors and selected detector should result in mR the image will probably appear diagnostic, but the patient
readings within 5% and optical densities within 60.1. receives unnecessary exposure.
 CHAPTER 13  Exposure Technique Selection 195

During computer processing, image brightness can be variables can affect the production of a quality radiograph.
adjusted following underexposure; however, there may be an Knowledge of these factors and of the qualities inherent in a
increase in the visibility of quantum noise. The radiographer diagnostic radiographic image helps the radiographer select
must monitor the exposure indicator as a means of detecting exposure factors for a particular radiographic examination.
AEC malfunctions for digital image receptors. Exposure technique charts are useful tools that help the
The relationship between density and imaging variables is radiographer select a manual exposure technique or when
clarified for film-screen image receptors in Table 13-1 and for using AEC regardless of the type of IR. Exposure technique
digital image receptors in Table 13-2. charts are equally valuable for film-screen or digital IRs.
Exposure technique charts are preestablished guidelines
used by the radiographer to select standardized manual or
CRITICAL CONCEPT AEC exposure factors for each type of radiographic examina-
Digital Image Receptors and the Automatic tion. Technique charts standardize the selection of exposure
Exposure Control Response factors for the typical patient so that the quality of radio-
Because the visual cues of increased or decreased radio- graphic images is consistent. Additional information such as
graphic density in film-screen imaging are lacking in digital collimation, AEC detector selection, and patient shielding
imaging, the radiographer must be very conscientious about can be included in the technique chart.
preventing excessive radiation exposure to the patient. For each radiographic procedure, the radiographer con-
sults the technique chart for the recommended exposure
variables—kVp, mAs (or detectors), type of IR, grid, and SID.
EXPOSURE TECHNIQUE CHARTS
Based on the thickness of the anatomic part to be radio-
The radiographer has the primary task of selecting the expo- graphed, the radiographer selects the exposure factors pre-
sure factors that produce a quality radiographic image. Many sented in the technique chart. For example, if a patient is

TABLE 13-1  Film-Screen Radiography and Automatic Exposure Control

An upright PA chest examination done using the following factors produces an optimal image:
400-speed film-screen system AEC with two outside detectors
120 kVp Upright Bucky
400 mA 0 (normal) density
Assuming all other factors remain the same, how will the following changes affect the density of the image?
Effect on Density in Area
Change of Interest Explanation
100-speed film-screen IR Decreased The AEC is calibrated to the 400-speed film-screen system. The
exposure ends when the exposure is sufficient for the 400-speed
IR, which is not sufficient for the 100-speed IR.
Center detector selected Increased The exposure time is increased. Because the thoracic spine lies
over the center detector, the spine has appropriate density, but
the lungs have too much density.
70 kVp No effect Changing the kVp does not affect the density, because AEC simply
waits for the right number of photons to exit the patient. The ex-
posure time is increased and results in an increase in the actual
mAs. However, the exposure to the detector remains the same.
The contrast is increased because of a lower kVp.
100 mA No effect Changing the mA does not affect the density because AEC simply
waits for the right number of photons to exit the patient. How-
ever, the length of exposure is increased.
–2 density Decreased Changing the density selector actually changes the setting of the
AEC, so it turns off the exposure much sooner, resulting in re-
duced density.
Selecting the table Bucky Increased The AEC device in the table Bucky is waiting for enough exit radia-
setting but still using the tion to strike the detectors so that the exposure can be termi-
upright Bucky nated. Because the x-ray beam is aimed at the upright Bucky, it is
a very long exposure and results in increased density.
Patient has cardiac pace- Increased The detector that is behind the pacemaker takes a long time to
maker positioned over terminate the exposure because the radiation has to pass
detector through the pacemaker. This results in increased density.

AEC, Automatic exposure control; IR, image receptor; kVp, kilovoltage peak; mA, milliamperage; mAs, milliamperage/second; PA, postero-
anterior.
196 SECTION II  Image Production and Evaluation

TABLE 13-2  Digital Imaging and Automatic Exposure Control

An upright PA chest examination is done as indicated in Table 13-1, except that now a computed radiography IP is used instead of
film-screen. Assuming all other factors remain the same unless indicated, how will the following changes affect the density of
the image?
Effect on Density in Area
Change of Interest Explanation
CR IR No effect The AEC is calibrated to the 400-speed film-screen system.
The exposure ends when the exposure is sufficient for the
400-speed IR, which is less than optimal for the CR image recep-
tor. The computer adjusts the brightness, but quantum noise is
apparent because the IP is underexposed.
Center detector selected* No effect Because the thoracic spine lies over the center detector, the IP
receives more exposure than is needed. The exposure indicator
reflects an increase in exposure to the IP. The computer adjusts
the brightness, but the image contrast is reduced because of
excessive scatter, and the patient is overexposed.
70 kVp* No effect The exposure time is increased and results in an increase in the
actual mAs. However, the exposure to the IP remains the
same, and the computer adjusts for brightness. The contrast is
increased because of the lower kVp.
100 mA* No effect The exposure to the IP remains the same, and the computer
adjusts for brightness. However, the length of exposure is
increased.
–2 density* No effect The exposure terminates much sooner, with one half of the expo-
sure to the IP. The exposure indicator reflects a decrease in expo-
sure to the IP. The computer adjusts the brightness, but quantum
noise is apparent and caused by underexposure of the IP.
Selecting the table Bucky No effect Excessive radiation reaches the IP because the detectors in the
setting but still using the table Bucky are unable to terminate the exposure. The exposure
upright Bucky* indicator reflects an increase in exposure to the IP. The computer
adjusts the brightness, but the image contrast is reduced be-
cause of excessive scatter, and the patient is overexposed.
Patient has cardiac pace- No effect The detector that is behind the pacemaker takes a long time to
maker positioned over turn the exposure off because the radiation has to pass through
detector* the pacemaker. The exposure indicator reflects an increase in
exposure to the IP. The computer adjusts the brightness, but the
image contrast is reduced because of excessive scatter, and the
patient is overexposed.

*AEC is now calibrated to the CR system.

AEC, Automatic exposure control; CR, computed radiography; IP, imaging plate; IR, imaging receptor; kVp, kilovoltage peak; mA, milliamper-
age; mAs, milliamperage/second; PA, posteroanterior.

scheduled for a routine abdominal examination, the radiog- CRITICAL CONCEPT

rapher positions the patient and aligns the CR to the patient
and IR, measures the abdomen for a manual technique or Exposure Technique Charts and Radiographic
activates the appropriate combination of detectors, and con- Quality
sults the chart for the predetermined standardized exposure A properly designed and used technique chart standardizes
variables. the selection of exposure factors to help the radiographer
Because many factors affect the selection of appropriate consistently produce quality radiographs while minimizing
exposure factors, technique charts are instrumental in the patient exposure.
production of consistent-quality radiographs, reduction in
repeat radiographic studies, and reduction in patient expo- radiographic imaging systems to maintain patient radiation
sure. The proper development and use of technique charts exposure at a level as low as reasonably achievable.
are keys to the selection of appropriate exposure factors.
Exposure technique charts are just as important for digital Conditions
imaging because digital systems have a wide dynamic range A technique chart presents exposure factors used for a par-
and can compensate for exposure technique errors. Tech- ticular examination based on the type of radiographic equip-
nique charts should be developed and used with all types of ment. Technique charts help ensure that consistent image
 CHAPTER 13  Exposure Technique Selection 197

quality is achieved throughout the entire radiology depart-

ment; they also decrease the number of repeat radiographic
studies needed and therefore decrease the patient’s exposure.
Technique charts do not replace the critical thinking skills
required of the radiographer. The radiographer must con-
tinue to use individual judgment and discretion in properly
selecting exposure factors for each patient and type of ex-
amination. The radiographer’s primary task is to produce the
highest-quality radiograph while delivering the least amount
of radiation exposure. Technique charts are designed for the
average or typical patient and do not account for unusual
circumstances. Patient variability in terms of body build,
physical condition, or the presence of a pathologic condition
requires the radiographer to problem-solve when selecting
exposure factors. These atypical conditions require accurate
patient assessment and appropriate exposure technique
adjustment by the radiographer.
A technique chart should be established for each x-ray
tube, even if a single generator is used for more than one tube.
For example, if a radiographic room has two x-ray tubes, one
for a radiographic table and one for an upright Bucky unit, FIG 13-7  ​Calipers. A caliper is used to measure part thickness.
each tube should have its own technique chart because of pos-
sible inherent differences in the exposure output produced by
each tube. Each mobile radiographic unit must also have its
own technique chart. mistakes made when one is consulting technique charts. As
For technique charts to be effective tools in producing digital imaging technology replaces film-screen imaging, mea-
consistent-quality radiographs, departmental standards for suring the anatomic part may not be practical in all depart-
radiographic quality should be established. In addition, stan- ments. Assessment of the patient’s size and weight may be
dardization of exposure factors and the use of accessory sufficient when using a well-established technique chart.
devices are needed. For example, the adult knee can be radio-
graphed adequately with or without the use of a grid. Design Characteristics
Although both radiographs might be acceptable, departmen- Technique charts can vary widely in terms of their design, but
tal standards may specify that the knee be radiographed with they share some common characteristics. The primary expo-
the use of a grid. These types of decisions should be made sure factors of kVp and mAs and common accessory devices
before technique chart development takes place so that the used, such as IR type and grid ratio, are included regardless
departmental standards can be clarified. Technique charts are of the type of technique chart used.
then constructed using these standards, and radiographers
should adhere to the departmental standards. Types of Technique Charts
For technique charts to be effective, the radiographic sys- Two primary types of exposure technique charts exist: vari-
tem must operate properly. A good quality control program able kVp–fixed mAs and fixed kVp–variable mAs. Each type
for all radiographic equipment ensures monitoring of any of chart has different characteristics, and both have advan-
variability in the equipment’s performance. tages and disadvantages.
Accurate measurement of part thickness is a critical con-
dition for the effective use of technique charts. The mea- Variable kVp–Fixed mAs Technique Chart. ​The variable
sured part thickness determines the selected kVp and mAs kVp–fixed mAs technique chart is based on the concept that
(when using manual exposure techniques) for the radio- kVp can be increased as the anatomic part size increases.
graphic examination. If the part is measured inaccurately, Specifically, the baseline kVp is increased by 2 for every 1-cm
incorrect exposure factors may be selected. Measurement of increase in part thickness, whereas the mAs is maintained
part thickness must be standardized throughout the radiol- (Table 13-3). The baseline kVp is the original kVp predeter-
ogy department. mined for the anatomic area to be radiographed. The base-
Calipers are devices that measure part thickness and line kVp is then adjusted for changes in part thickness.
should be readily accessible in every radiographic room Accurate measurement of part thickness is critical to the
(Figure 13-7). In addition, the technique chart should specify effective use of this type of technique chart. Part thickness
the exact location for measuring part thickness. Part measure- must be measured accurately to ensure that the 2-kVp adjust-
ment may be performed at the location of the CR midpoint or ment is applied appropriately. The radiographer consults the
the thickest portion of the area to be radiographed. Errors in technique chart and prepares the exposure factors specified
part thickness measurement are one of the more common for the type of radiographic examination (i.e., mAs, SID, grid
198 SECTION II  Image Production and Evaluation

TABLE 13-3  Variable kVp–Fixed mAs TABLE 13-4  Fixed kVp–Variable mAs
Technique Chart Technique Chart
Anatomic part Knee Image receptor 400 speed Anatomic part Knee Image 400 speed
Projection AP Table top/Bucky Bucky receptor
Measuring Midpatella Grid ratio 12:1 Projection AP Table top/ Bucky
point Bucky
SID 40 inches Focal spot size Small Measuring Midpatella Grid ratio 12:1
cm kVp mAs point
10 63 20 SID 40 inches Focal spot size Small
11 65 20 cm kVp mAs
12 67 20 10-13 73 10
13 69 20 14-17 73 20
14 71 20 18-21 73 40
15 73 20
16 75 20 AP, Anteroposterior; cm, centimeter
17 77 20
18 79 20
different part sizes is simple. However, because kVp is vari-
AP, Anteroposterior; cm, centimeter able, radiographic contrast may vary as well, and these types
of charts tend to be less accurate for part size extremes. In
addition, adequate penetration of the part is not necessarily
use, and type of IR). The anatomic part is measured accu- ensured.
rately, and the kVp is adjusted appropriately. For example, a
standard exposure technique for a patient’s knee measuring Fixed kVp–Variable mAs Technique Chart. ​The fixed
10 cm (4 inches) is 63 kVp at 20 mAs, 400 speed film-screen kVp–variable mAs technique chart (Table 13-4) uses the
IR, and use of a 12:1 table Bucky grid. A patient with a knee concept of selecting an optimal kVp that is required for the
measuring 15 cm (6 inches) then requires a change only in radiographic examination and adjusting the mAs for varia-
the kVp from 63 to 71 (2 kVp change for every 1-cm change tions in part thickness. Optimal kVp can be described as the
in part thickness). kVp that is high enough to ensure penetration of the part but
not too high to diminish radiographic contrast. For this type
CRITICAL CONCEPT of chart, the optimal kVp for each part is indicated, and mAs
Variable kVp–Fixed mAs Technique Chart is varied as a function of part thickness.
The variable kVp chart adjusts the kVp for changes in part CRITICAL CONCEPT
thickness while maintaining a fixed mAs.
Fixed kVp Peak–Variable mAs Technique Charts
Fixed kVp–variable mAs technique charts identify optimal kVp
The baseline kVp for each anatomic area has not been
values and alter the mAs for variations in part thickness.
standardized. Historically, a variety of methods have been
used to determine the baseline kVp. The goal is to determine
a kVp that adequately penetrates the anatomic part when us- Optimal kVp required for each anatomic area have not
ing a 2-kVp adjustment for every 1-cm change in tissue been standardized. Although charts identifying common kVp
thickness. The baseline kVp can be determined experimen- for different anatomic areas can be found, experienced ra-
tally with the use of radiographic phantoms (patient equiva- diographers tend to develop their own optimal kVp. The goal
lent devices). is to determine the kVp that will penetrate the part without
Developing a variable kVp technique chart that can be compromising radiographic contrast. Digital computer pro-
used effectively throughout the kVp range has proved prob- cessing provides the opportunity to vary the image contrast
lematic. In addition, technology advances in imaging recep- displayed; therefore, the optimal kVp determined for digital
tors may challenge the applicability of the variable kVp–fixed IRs could be higher than film-screen IRs. Specifying the opti-
mAs type technique chart. mal kVp used in a fixed kVp–variable mAs technique chart
In general, changing the kVp for variations in part thick- encourages all radiographers to adhere to the departmental
ness may be ineffective throughout the entire range of radio- standards.
graphic examinations. A variable kVp–fixed mAs chart may Once optimal kVp are established, fixed kVp–variable
be most effective with pediatric patients or when small ex- mAs technique charts alter the mAs for variations in thick-
tremities, such as hands, toes, and feet, are being imaged. At ness of the anatomic part. Because x-rays are attenuated
low kVp, small changes in kVp may be more effective than exponentially, a general guideline is that for every 4- to 5-cm
changing the mAs. change in part thickness, the mAs should be adjusted by a
This type of chart has the advantage of being easy to factor of 2. Using the previous example for a patient’s knee
formulate because making kVp changes to compensate for measuring 10 cm (4 inches) and an optimal kVp, the
 CHAPTER 13  Exposure Technique Selection 199

exposure technique is 73 kVp at 10 mAs, 400 speed film- phantoms for sample anatomic areas provide a means for
screen IR with a 12:1 table Bucky grid. A patient with a knee establishing standardized exposure factors. The concept of
measuring 15 cm (6 inches) requires a change only in the comparative anatomy helps the radiographer extrapolate
mAs, from 10 to 20 (a 5-cm [2 inch] increase in part thick- exposure techniques for similar anatomic areas. After the
ness requires a doubling of the mAs). initial development of an exposure technique chart, the chart
Accurate measurement of the anatomic part is important must be tested for accuracy and revised if necessary.
but is less critical compared with the precision needed with Poor radiographic quality may result when the exposure
variable kVp charts. An advantage of fixed kVp–variable mAs technique chart is not used properly. Radiographers need to
technique charts is that patient groups can be formed around problem-solve by evaluating the numerous exposure vari-
4- to 5-cm (1.6- to 2- inches) changes. Patient thickness ables that could have contributed to a poor-quality radio-
groups can be created instead of listing thickness changes in graph before assuming the chart is ineffective.
increments of 1 cm. A commitment by management and staff to use expo-
Alternatively, patients can be grouped by size (such as sure technique charts is critical to the consistent produc-
small, medium, large, extra large) or actual weight ranges in tion of quality radiographs. Well-developed technique
pounds (such as 100 – 130 pounds) and therefore measuring charts are of little use if radiographers choose not to
the thickness would not be required. In addition, using con- consult them.
sistently higher “optimal” kVp ranges with digital imaging
systems can reduce the variability among exposure tech-
niques for the same or similar anatomic region. The fixed
SPECIAL CONSIDERATIONS
kVp–variable mAs technique chart has the advantages of Appropriate exposure factor selection and its modification
easier use, more consistency in the production of quality ra- for variability in the patient are critical to the production of
diographs, greater assurance of adequate penetration of all a quality radiograph. Thus the radiographer must be able to
anatomic parts, uniform radiographic contrast, and increased recognize a multitude of patient and equipment variables
accuracy with extreme variation in size of the anatomic part. and have a thorough understanding of how these variables
affect the resulting radiograph to make adjustments to pro-
Exposure Technique Chart Development duce a quality image.
Radiographers can develop effective technique charts that
assist in exposure technique selection. The steps involved in Projections and Positions. ​Different radiographic projec-
technique chart development are similar, regardless of the tions and patient positions of the same anatomic part often
design of the technique chart. The primary tools needed are require modification of exposure factors. For example, an
radiographic phantoms, calipers for accurate measurement, oblique position of the lumbar spine requires more exposure
and a calculator. Once optimal radiographs are produced us- than an AP projection because of an increase in the amount
ing these phantoms, exposure techniques can be extrapolated of tissue that the primary beam must pass through. However,
(mathematically estimated) for imaging other similar ana- an oblique ankle requires slightly less exposure than the AP
tomic areas. for comparable exposure to the IR.
A critical component in technique chart development is to General guidelines, based on variations in radiographic
determine minimum kVp that adequately penetrates the ana- projection or patient position, can be followed to change ex-
tomic part to be radiographed. One method available is to use posure factors. When compared with an AP projection, an
the concept of comparative anatomy, which can assist the increase or decrease in the amount of tissue should deter-
radiographer in determining minimum kVp. This concept mine any changes in exposure factors for oblique and lateral
states that different parts of the same size can be radiographed patient positions.
by use of the same exposure factors, provided that the mini-
mum kVp needed to penetrate the part is used in each case. Casts and Splints. ​Casts and splints can be produced with
For example, a radiographer knows what exposure factors to materials that attenuate x-rays differently. Selecting appropri-
use with a particular radiographic unit for a knee that mea- ate exposure factors can be challenging because of the wide
sures 10 cm (4 inches) in the anteroposterior (AP) aspect, but variation of materials used for these devices. The radiogra-
he or she is now confronted with radiographing a shoulder. pher should pay close attention to both the type of material
The radiographer measures the shoulder in the AP aspect and and how the cast or splint is used.
determines that it measures 10 cm (4 inches). The radiogra- Casts.  Casts can be produced with either fiberglass or
pher does not have a technique for a shoulder for this radio- plaster. Fiberglass generally requires no change in exposure
graphic unit. The concept of comparative anatomy states that factors from the values used for the same anatomic part
the shoulder in this case can be radiographed successfully us- without a cast.
ing the same technique that the radiographer has used for the Plaster presents a problem in terms of exposure factors.
10-cm (4-inch) knee as long as the minimum kVp to pene- Plaster casts require an increase in exposure factors com-
trate the part has been used for the shoulder or knee. pared to imaging the same part without a cast. However, the
The stages for development of exposure technique charts method and amount of increase in exposure has not been
are similar regardless of the type of chart. Patient-equivalent standardized.
200 SECTION II  Image Production and Evaluation

Thus exposure factor adjustments made for cast materials TABLE 13-5  Some Common Additive
may be based on the part thickness using a technique chart. and Destructive Diseases and Conditions
For example, if an AP ankle measured through the CR is by Anatomic Area
4 inches (10 cm) without the cast and 8 inches (20 cm) with
Additive Conditions Destructive Conditions
the cast, the radiographer simply increases the exposure tech-
nique to that of an ankle measuring 8 inches (20 cm) to Abdomen
obtain an acceptable radiograph. Aortic aneurysm Bowel obstruction
Ascites Free air
Splints.  Splints present less of a problem in determining
Cirrhosis
appropriate exposure factors than casts. Inflatable (air) and
Hypertrophy of some organs
fiberglass splints do not require any increase in exposure. (e.g., splenomegaly)
Wood, aluminum, and solid plastic splints may require that
exposure factors be increased, but only if they are in the path Chest
of the primary beam. For example, if two pieces of wood are Atelectasis Emphysema
bound to the sides of a lower leg, no increase in exposure is Congestive heart failure Pneumothorax
necessary for an AP projection because the splint is not in the Malignancy
path of the primary beam and does not interfere with the Pleural effusion
radiographic image. Using the same example, if a lateral pro- Pneumonia
jection is produced, the splint is in the path of the primary Skeleton
beam and interferes with the radiographic imaging of the Hydrocephalus Gout
part. This necessitates an increase in exposure technique to Metastases (osteoblastic) Metastases (osteolytic)
produce a properly exposed radiograph. Osteochondroma (exostoses) Multiple myeloma
Paget disease (late stage) Paget disease (early stage)
Pathologic Conditions. ​Pathologic conditions that can
alter the absorption characteristics of the anatomic part Nonspecific Sites
being examined are divided into two categories. Additive Abscess Atrophy
Edema Emaciation
diseases are diseases or conditions that increase the absorp-
Sclerosis Malnutrition
tion characteristics of the part, making the part more diffi-
cult to penetrate. Destructive diseases are those diseases or
conditions that decrease the absorption characteristics of the
part, making the part less difficult to penetrate. Table 13-5 using the normal exposure factors for a particular anatomic
presents a list of additive and destructive diseases. Generally part. Several situations in which a soft tissue technique may be
speaking, it is necessary to increase the kVp when radio- needed are visualization of the larynx in a young child with
graphing parts that have been affected by additive diseases the croup, possible foreign body obstruction in the throat,
and to decrease the kVp when radiographing parts affected and foreign body location in the extremities (Figure 13-8).
by destructive diseases. Exposure factors must be altered to demonstrate these soft
However, it is not necessary to compensate for all additive tissues for film-screen imaging. When the area of interest
and destructive diseases. It is often desirable to image diseases requires less density to visualize the soft tissue, the mAs
with exposure factors that would normally be used for a spe- should be decreased accordingly. Digital imaging systems al-
cific anatomic part so that the effect of that disease on that low visualization of soft tissues without changing the expo-
part can be visualized clearly. sure technique.
When it is necessary or desirable to compensate for addi-
tive or destructive diseases or conditions, it is best to make Contrast Media. ​A contrast medium (also called contrast
changes in the kVp. Changing the kVp is fundamentally cor- agent) is used when imaging anatomic tissues that have low
rect because the kVp affects the penetrating ability of the subject contrast. A contrast medium is a substance that can
primary beam, and it is the penetrability of the anatomic part be instilled into the body by injection or ingestion. The type
that is affected by these particular diseases and conditions. It of contrast media used changes the absorption characteristics
is not possible to state an exact amount or percentage of kVp of the tissues by either increasing or decreasing the attenua-
that should be changed because the state or severity of the tion of the x-ray beam. Positive contrast agents, such as bar-
disease or condition is different with each patient. However, ium and iodine, have a high atomic number and absorb more
a minimum change of 15% in kVp is recommended. There x-rays (increase attenuation) than the surrounding tissue
are some instances in which a change in mAs may be more (Figure 13-9). Negative contrast agents, such as air, decrease
appropriate to the type of pathologic condition. For example, the attenuation of the x-ray beam and transmit more radia-
if the anatomic area has significant increases in gas, such as in tion than the surrounding tissue (Figure 13-10). Positive
bowel obstruction, a large decrease in mAs is best. contrast agents produce less radiographic density or more
brightness than the adjacent tissues. Negative contrast agents
Soft Tissue. ​Objects such as small pieces of wood, glass, or produce more radiographic density or less brightness than
swallowed bones are difficult to visualize radiographically the adjacent tissues.
 CHAPTER 13  Exposure Technique Selection 201

FIG 13-10  ​Negative Contrast Agents. Radiograph showing

increased density because of the decrease in x-ray beam at-
tenuation by use of a negative contrast agent. (From Fauber
TL: Radiographic imaging and exposure, ed 3, St Louis, 2009,
Mosby.)

FIG 13-8  ​Soft Tissue Imaging. Lateral soft tissue neck radio-
graph. (From Frank E: Merrill’s atlas of radiographic position-
ing and procedures, ed 12, St. Louis, 2012, Mosby.)
Even though negative contrast agents decrease the attenu-
ation characteristics of the part being examined, their use
does not require a change in exposure factors. Negative con-
trast agents can also be used in conjunction with positive
contrast agents. Positive contrast media studies require an
increase in exposure factors compared with imaging the same
part without a positive contrast medium.
The use of a contrast agent is an effective method of
increasing the radiographic contrast when imaging areas of
low subject contrast.
The quality of the radiographic image depends on a mul-
titude of variables. Knowledge of these variables and their
radiographic effect assists the radiographer in producing
quality radiographs.
Because differing types of IRs may respond differently to
radiation exposure, it is critical for the radiographer to be
knowledgeable about the characteristics of the IR in use.
Radiographic film acquires the latent image and then needs
to be chemically processed before the image can be dis-
played. Therefore, changes in the quantity and quality of
radiation exposure to a film-screen IR affect the amount of
density and contrast visible on the processed radiograph.
Because digital IRs separate acquisition from processing and
image display, their response to changes in radiation expo-
sure do not affect the amount of brightness displayed on the
FIG 13-9  ​Positive Contrast Agents. Radiograph showing image. However, the amount of exposure to the digital IR
decreased density because of the increase in x-ray beam at- needs to be carefully selected, as with film-screen IRs, to
tenuation by use of a positive contrast agent. (From Fauber produce a quality image with the least amount of exposure
TL: Radiographic imaging and exposure, ed 3, St Louis, 2009, to the patient. Film-screen and digital IRs are discussed in
Mosby.) more detail in Chapter 12, “Image Receptors.”
202 SECTION II  Image Production and Evaluation

SUMMARY
• AEC systems are designed to produce optimal radiation from exceeding a set amount; and the mAs readout, which
exposure to the image receptor to produce a quality image. displays exactly how much mAs was used to produce the
• AEC uses detectors (typically ionization type) that mea- image.
sure the amount of radiation exiting the patient and ter- • Limitations of AEC systems are that they typically allow
minate the exposure when it reaches a preset amount; this only one type of image receptor and that the minimum
amount corresponds to that needed to produce optimal response time may be longer than the exposure needed.
image quality. • APR is another exposure system that allows selection of a
• The kVp selected must penetrate the part and produce the specific body part and position, resulting in display of
desired scale of contrast. Increasing or decreasing the kVp preprogrammed exposure factors. These may include AEC
causes the exposure time to be decreased or increased information.
accordingly. • Quality control is important in monitoring the perfor-
• Changing the mA, when the option is available, causes the mance of the AEC system. Optical densities should be
exposure time to decrease or increase accordingly. within 60.2, and reproducibility of exposures for a given
• For AEC to work accurately, the x-ray beam must be cen- set of exposure factors and selected detector should result
tered precisely on the anatomic area of interest, the correct in mR readings within 5% and optical densities within
detectors must be selected, and the anatomic part must 60.10.
cover the dimension of the detectors. • Exposure technique charts standardize the selection of
• The mAs readout informs the radiographer of the total exposure factors for the typical patient so that the quality
radiation exposure used for the procedure. of radiographic images is consistent.
• Other AEC features that can be manipulated include den- • Exposure factors may need to be modified for varying
sity selectors that allow for increased or decreased expo- projections and positions, casts and splints, contrast
sure to the image receptor; backup time (or mAs), which media, and pathologic conditions.
provides a safety mechanism preventing the exposure

CRITICAL THINKING QUESTIONS

1. Given so many patient and exposure factor variables, how 2. What are the advantages and disadvantages of using AEC
can exposure time be automatically controlled to produce and APR?
sufficient radiation exposure to the image receptor?

REVIEW QUESTIONS
1. Automatic exposure control (AEC) devices work by 4. What factors are important when using automatic expo-
measuring _____. sure control (AEC) devices?
a. attenuation of primary radiation by the patient 1. detector selection
b. radiation that exits the patient 2. centering part to detector
c. radiation that is absorbed by the patient 3. back-up mAs, if set
d. radiation exiting the tube a. 1 and 2 only
2. Which of the following exposure system operates by b. 1 and 3 only
ionizing air that creates an electrical charge? c. 2 and 3 only
a. anatomically programmed radiography d. 1, 2, and 3
b. phototimer 5. Increasing patient thickness while using an AEC device
c. ionization chamber would result in:
d. none of the above a. increased exposure time.
3. During operation of the AEC device, the time of exposure: b. decreased film density.
a. is inversely related to the intensity of the exit radiation c. decreased mAs readout.
b. is directly related to the intensity of the exit radiation d. increased image contrast.
c. has an inverse squared relationship to the exit radiation 6. Which detector or combination is best for a Right Hip?
d. has no relationship to the intensity of the exit radiation a. center
b. left
c. right
d. right and left
 CHAPTER 13  Exposure Technique Selection 203

R E V I E W Q U E S T I O N S — cont’d
7 . What is the primary goal of exposure technique charts? 9. Of the following, which is most important when using a
a. extend life of x-ray tube technique chart?
b. improve radiographer’s accuracy a. same radiographer revises chart
c. consistency in image quality b. same chart used for all x-ray tubes
d. increase patient work flow c. accurately measure patient
8. What type of exposure technique system uses a fixed mAs d. include a patient history
regardless of patient thickness? 10. An advantage of the variable kVp technique chart is it:
a. fixed kVp a. produces lower contrast images.
b. variable kVp b. reduces patient exposure.
c. preprogrammed c. makes a 2 kVp change sufficient with any kVp.
d. AEC d. makes smaller technique changes possible.
SECTION III
Specialized Radiographic
Equipment

204
 14
Image-Intensified Fluoroscopy

OUTLINE
Introduction Recording Systems
Construction Digital Fluoroscopy
Intensification Principles Fluoroscopic Controls and Settings
Viewing and Recording Systems Quality Control
Viewing Systems Summary

OBJECTIVES
• Describe the principal parts of an image intensifier and • Discuss the fundamental principles of operation of the
their function. different approaches to digital fluoroscopy.
• Explain the operation of an automatic brightness control • Identify the major areas of quality control pertaining to
(ABC). fluoroscopy.
• Explain the operation of an image intensifier in magnifi- • Differentiate between those quality control processes that
cation mode. are the responsibility of the radiographer and those of
• Describe the options for viewing systems and the advan- the medical physicist.
tages and disadvantages of each.
• Describe the options for recording systems and the
advantages and disadvantages of each.

KEY TERMS
accelerating anode conversion factor minification gain
analog-to-digital converter (ADC) electrostatic focusing lenses output phosphor
automatic brightness control (ABC) flux gain photocathode
brightness gain image intensifier spatial resolution
camera tube input phosphor
charge-coupled device magnification mode

room for a period or by wearing adaptation goggles with red

INTRODUCTION lenses before performing the fluoroscopic examination. How-
Shortly after Dr. Roentgen’s discovery of x-rays and subsequent ever, fluoroscopy’s great advantage, which ensured its contin-
announcement, many other scientists began experimenting ued development, was that it allowed for dynamic radiographic
with this new phenomenon. Among them was the famed examination. That is, the inner workings of the human body
American inventor Thomas Edison. Among Mr. Edison’s more could be viewed in real time.
notable inventions in this area was the first commercially avail- In the 1950s the image intensifier was introduced into the
able fluoroscope in 1896, although it was not in a form we fluoroscopic system. The image intensifier improved the pro-
would recognize today (Figure 14-1). His fluoroscope was a cess in two ways. First, it brightened the image significantly,
calcium tungstate screen that interacted with the remnant eliminating the need to dark-adapt and improving the details
beam, producing a very faint image that one viewed while that could be seen. Second, it allowed for a means of indirectly
standing in the path of the x-ray beam as it exited the patient viewing the fluoroscopic image, first by mirror optics and
and screen. The practice of standing in the direct path of the later by television monitors, greatly reducing the radiation
x-ray beam meant that the dose to the fluoroscopist was ex- dose to the fluoroscopist. This chapter discusses the image
tremely high. Additionally, because the image was very dim, intensifier and its characteristics, viewing and recording sys-
the fluoroscopist had to “dark-adapt” by sitting in a darkened tems, and finally the digital fluoroscopy process in use today.
205
206 SECTION III  Specialized Radiographic Equipment

tube itself. Cesium iodide absorbs the remnant x-ray photon

energy and emits light in response. The photocathode is
made of cesium and antimony compounds. These metals
emit electrons in response to light stimulus in a process called
photoemission. The photocathode is bonded directly to the
input phosphor using a very thin adhesive layer. These layers
are curved so that all of the electrons emitted from the pho-
tocathode travel the same distance to the output phosphor
(see Figure 14-3). The electrostatic focusing lenses are not
really lenses at all but are negatively charged plates along the
length of the image intensifier tube. These negatively charged
plates repel the electron stream, focusing it on the small out-
put phosphor. To set the electron stream in motion at a con-
stant velocity, an accelerating anode is located at the neck of
the image intensifier near the output phosphor. This acceler-
ating anode maintains a constant potential of approximately
25 kV. The output phosphor is made of silver-activated zinc
FIG 14-1  ​Thomas Edison. Thomas Edison experimenting cadmium sulfide and is much smaller than the input phos-
with the fluoroscope he designed. The subject is his assis- phor. It is located at the opposite end of the image intensifier
tant, Clarence Dally. (From Eisenberg RL: Radiology: an illus- tube, just beyond the accelerating anode. This layer absorbs
trated history, St Louis, 1992, Mosby.) electrons and emits light in response.
The entire tube is approximately 50 cm (20 inches) in
length and 15 to 58 cm (6 to 23 inches) in diameter (diameter
CONSTRUCTION depends on manufacturer and intended use). The input
Conventionally the fluoroscopic chain consists of an x-ray phosphor faces the patient and receives the x-ray exposure
tube, an image intensifier (II), a recording system, and a that constitutes the remnant beam. The x-rays are absorbed
viewing system (Figure 14-2). The integration of digital and light is emitted in response, proportional to the percent-
technology is changing parts of this system, as is discussed at age of x-ray absorption. This light immediately exposes the
the end of this chapter. Here the focus is on the design and photocathode, which in turn emits electrons in proportion to
function of the image intensifier, recording, and viewing the light intensity. The ratio of light to electron emission is
systems. not one-to-one. It takes many light photons to result in the
Figure 14-3 illustrates the image intensifier within the emission of one electron. The resultant electrons are acceler-
fluoroscopic tower. The image intensifier is an electronic ated toward the output phosphor by the accelerating anode
vacuum tube that converts the remnant beam to light, then to and “focused” on the output phosphor by the electrostatic
electrons, then back to light, increasing the light intensity in focusing lenses. These high-energy electrons result in many
the process. It consists of five basic parts: the input phosphor, light photons being emitted from the output phosphor. Each
photocathode, electrostatic focusing lenses, accelerating electron results in substantially more light photons than was
anode, and output phosphor. The input phosphor is made necessary to cause its release. The end result of this process is
of cesium iodide and is bonded to the curved surface of the an increase in image brightness.

Camera tube/CCD

Photospot camera (if applicable)

Fluoroscopic Image intensifier

tower

Slot for cassette spot filming

(if applicable)
Monitor

Table X-ray tube (located under table)

FIG 14-2  ​Fluoroscopic Chain. The general components of the fluoroscopic chain. Note that the
x-ray tube for the system is typically located under the table.
 CHAPTER 14  Image-Intensified Fluoroscopy 207

Camera tube

Beam-splitting Lens
mirror Photospot
camera
Camera tube
If equipped with

Accelerating anode photospot system

Output phosphor

Electrostatic
Image focusing lenses
intensifier

Photocathode

Input phosphor

Slot for cassette

spot film

FIG 14-3  ​Image Intensifier. The image intensifier is situated within the fluoroscopic tower and
is attached to a camera tube. The method of attachment depends on the image-capture features
of the system.

CRITICAL CONCEPT converting that energy into many light photons. Flux gain is
Image Intensifier Operation expressed as the ratio of the number of light photons at the
output phosphor to the number of light photons emitted in
The image intensifier is an electronic vacuum tube that con-
the input phosphor and represents the tube’s conversion
verts the remnant beam to light, then electrons, then back to
efficiency. Minification gain is an expression of the degree to
light, increasing the light intensity in the process. The high-
energy electrons that interact with the output phosphor each
which the image is minified (made smaller) from input phos-
result in substantially more light photons than were neces- phor to output phosphor. This characteristic makes the im-
sary to cause their release at the photocathode, resulting in age appear brighter because the same number of electrons is
a brighter image. being concentrated on a smaller surface area. It is found by
dividing the square of the diameter of the input phosphor by
the square of the diameter of the output phosphor.
INTENSIFICATION PRINCIPLES input phosphor diameter 2
minification gain 
The radiographer must be familiar with several principles output phosphor diameter 2
and concepts associated with image intensification. Bright-
ness gain is one such principle. Brightness gain is an expres- Generally, the input phosphors are 15 to 30 cm (6 to
sion of the ability of an image intensifier tube to convert 12 inches) and the output phosphor is usually 2.5 cm (1 inch).
x-ray energy into light energy and increase the brightness of The International Commission on Radiation Units and
the image in the process. Traditionally, brightness gain was Measurements now recommends the use of the conversion
found by multiplying the flux gain by the minification gain. factor to quantify the increase in brightness created by an
image intensifier. Conversion factor is an expression of the
brightness gain  flux gain  minification gain luminance at the output phosphor divided by the input expo-
sure rate, and its unit of measure is the candela per square
Although the term brightness gain continues to be used, it meter per milliroentgen per second (cd/m2/mR/s). The nu-
is now common practice to express this increase in brightness meric conversion factor value is roughly equal to 1% of the
with the term conversion factor (discussed next). Flux gain has brightness gain value. The higher the conversion factor or
to do with the very concept of using an image intensifier to brightness gain value, the greater the efficiency of the image
create a brighter image by taking a few x-ray photons and intensifier.
208 SECTION III  Specialized Radiographic Equipment

CRITICAL CONCEPT Output phosphor

Brightness Gain and Conversion Factor
Normal mode
Brightness gain is an expression of the ability of an image
focal point
intensifier to convert x-ray energy into light energy and in-
crease brightness in the process. It is now more common to Magnification
express this as conversion factor, which is an expression of mode focal point
the luminance at the output phosphor divided by the input
exposure rate.

Regardless of whether the term brightness gain or the term

conversion factor is used to express the increase in brightness, Photocathode
the ability of the image intensifier to increase brightness de- Input phosphor
teriorates with the age of the tube. The radiographer should FIG 14-4  ​Magnification Mode. When the image intensifier
be aware that, as the image intensifier ages, more and more is operated in magnification mode, the voltage on the electro-
radiation is necessary to produce the same level of output static focusing lenses is increased, narrowing the diameter of
brightness, translating to an ever-increasing patient dose. the electron stream and shifting the focal point farther from
the output phosphor, resulting in a magnified image.

CRITICAL CONCEPT contribute to the image. The same is true of the 15-cm
Exposure Rate and Age of the Image Intensifier (6 inch) mode. Selecting magnification mode automatically
adjusts x-ray beam collimation to match the displayed tissue
As an image intensifier ages, the exposure rate to the patient
image and avoids irradiating tissue that does not appear in
increases to maintain brightness. The radiographer should be
alert for this trend.
the image. The degree of magnification (magnification factor
[MF]) may be found by dividing the full-size input diameter
by the selected input diameter. For example:
The radiographer must also be familiar with automatic
brightness control (ABC), a function of the fluoroscopic MF  30  15  2  magnification
unit that maintains the overall appearance of the fluoro-
scopic image (contrast and density) by automatically adjust- This magnification improves the fluoroscopist’s ability to
ing the kilovoltage peak (kVp), milliamperage (mA), or both. see small structures (spatial resolution, discussed shortly) but
The ABC generally operates either by monitoring the current at the expense of increasing patient dose. Recall that remnant
through the image intensifier or the output phosphor inten- x-ray photons are converted to light and then to electrons
sity and adjusting the exposure factor if the monitored value and are focused on the output phosphor. If fewer electrons
falls below preset levels. The fluoroscopic unit allows the are incident on the output phosphor, the output intensity
fluoroscopist to select a desired brightness level, and this level decreases. To compensate more x-ray photons are needed at
is subsequently maintained by the ABC. The ABC is a little the beginning of the process to produce more light, resulting
slow in its response to changes in patient tissue thickness and in more electrons at the input end of the image intensifier.
tissue density as the fluoroscopy tower is moved about over The ABC automatically increases x-ray exposure to achieve
the patient. This is visible to the radiographer as a lag in the this. Again, with an increase in x-rays used comes an increase
image brightness on the monitor as the tower is moved. in patient dose.
Another function of some image intensifiers is multifield
mode or magnification mode. Most image intensifiers in use
CRITICAL CONCEPT
today have this capability. When operated in magnification
mode, the voltage to the electrostatic focusing lenses is in- Magnification Mode and Patient Dose
creased. This increase tightens the diameter of the electron Operating the image intensifier in one of the magnification
stream, and the focal point is shifted farther from the output modes will increase the fluoroscopist’s ability to see small
phosphor (Figure 14-4). The effect is that only those elec- structures, but at the price of increasing radiation dose to the
trons from the center area of the input phosphor interact patient.
with the output phosphor and contribute to the image, giving
the appearance of magnification. For example, a 30/23/15–cm
(12/9/6 inch) trifocus image intensifier can be operated in Magnification modes improve spatial resolution, which
any of those three modes. When operated in the 23-cm refers to the smallest structure that may be detected in an im-
(9 inch) mode, only the electrons from the center 23 cm age. Spatial resolution is measured in line pairs per millime-
(9 inches) of the input phosphor interact with the output ter (Lp/mm), and typical fluoroscopic systems have spatial
phosphor; those about the periphery will miss and not resolution capabilities of 4 to 6 Lp/mm but depend greatly on
 CHAPTER 14  Image-Intensified Fluoroscopy 209

fluoroscopist should pulse the x-ray beam by stepping on and

off of the exposure pedal rapidly.

VIEWING AND RECORDING SYSTEMS

Viewing Systems
The original image intensifiers produced an image that was
viewed using a mirror optics system, something akin to a
sophisticated way of looking at the output phosphor with a
“rearview mirror.” Although it did eliminate the need for the
fluoroscopist to stand in the path of the x-ray beam, it was a
Image displaying terrible waste of the image intensifier technology. Conven-
“pincushion” distortion
tionally, the viewing system is now a television monitor. To
FIG 14-5  ​Pincushion Distortion. Appearance of the pin- view the image from the output phosphor on a television
cushion effect. The circle represents the television monitor monitor, it must first be converted to an electrical signal.
display and the grid represents the effect on the image.
There are two devices commonly used today to accomplish
this: the camera tube and the charge-coupled device (CCD).
the rest of the imaging chain (i.e., the viewing and recording
systems). Camera Tube. ​The camera tube most often used is the vidi-
Distortion is also an issue with image-intensified fluoros- con tube (Figure 14-6). Occasionally a variation of this tube
copy. In radiography, distortion is a misrepresentation of the called the plumbicon may be used. The vidicon tube is con-
true size or shape of an object. In the case of fluoroscopy, nected to the output phosphor of the image intensifier by
shape distortion can be a problem. In fluoroscopy distortion either a fiberoptic bundle or an optical lens system, discussed
is a result of inaccurate control or focusing of the electrons shortly. The vidicon tube is a diode tube contained in a glass
released at the periphery of the photocathode and the curved envelope to maintain a vacuum. The cathode consists of an
shape of the photocathode. The combined result is an un- electron gun that provides a continuous stream of electrons
equal magnification (distortion) of the image, creating what and a control grid that forms the electron stream into a
is called a “pincushion appearance” (Figure 14-5). This prob- “beam.” Around the tube are a series of alignment, focusing,
lem also causes a loss of brightness around the periphery of and deflection coils. These coils accelerate and precisely con-
the image, which is referred to as vignetting. trol the electron beam. Through the action of these coils, the
One last factor to consider with image intensifiers is noise. beam sweeps the anode back and forth from top to bottom in
Image noise results when insufficient information is present to a sequence known as a raster pattern. This sweeping motion
create the image. In the case of fluoroscopy, this lack of image- is very fast, approximately 1,000,000 sweeps per minute. The
forming information ultimately goes back to an insufficient anode of the tube consists of a face plate, a signal plate, and a
quantity of x-rays. If too few x-rays exit the patient and expose target. The face plate, a thinned segment of the glass envelope
the input phosphor, not enough light is produced, which de- positioned closest to the output phosphor of the image inten-
creases the number of electrons released by the photocathode sifier, allows transmission of light from the image intensifier
to interact with the output phosphor. This then results in a to the camera tube. The signal plate is bonded to the face
“grainy” or “noisy” image. Although other factors in the fluo- plate and is a thin layer of graphite material that conducts
roscopic chain may contribute to noise, the solution generally electricity. This metallic layer is thin enough to transmit light
comes back to increasing the mA (quantity of radiation). For traveling through the face plate from the image intensifier but
image-intensified fluoroscopy this is a small increase in mA thick enough to conduct electricity that will be generated in
because these systems operate at 2-5 mA. That said, to mini- the camera tube. The target layer is a photoconductive layer
mize radiation dose with image-intensified fluoroscopy, the made of antimony trisulfide in vidicon tubes and lead oxide

Scanning electron beam

Electron gun Target Wire mesh
Camera lens

Electron multiplier Returning electron beam Electrons Sensitive Object being

giving output signal with image signal photoelectric surface televised
FIG 14-6  ​Camera Tube. Basic parts of a vidicon tube. The output phosphor is connected to the
“photoelectric surface” end of the tube using a lens system or fiberoptics.
210 SECTION III  Specialized Radiographic Equipment

in plumbicon tubes. This photoconductive material will con- contained in each pixel “bucket.” To discharge the signal, each
duct the electricity if illuminated; otherwise, it acts as an in- conveyor belt moves its buckets down the line to a measuring
sulator. Between this layer and the electron beam is another meter. In each row, the buckets are moved to the end of the
control grid that decelerates and aligns the electron beam so row and each bucket’s charge is measured and “recorded.” In
that it is oriented correctly when it interacts with the anode. this way each pixel is “read” individually and sent to the tele-
The way this tube works is that the electron beam is acti- vision monitor (Figure 14-7).
vated and begins sweeping the anode target. Light travels Coupling of Devices to the Image Intensifier.  As men-
from the output phosphor of the image intensifier through tioned earlier, the camera tube or CCD may be coupled to the
the face plate and signal plate to the other side of the target output phosphor of the image intensifier by either a fiberop-
layer. If the electron beam and light from the output phos- tic bundle or optical lens system. The fiberoptic bundle is
phor are incident on the same place at the same time, elec- simply a bundle of very thin optical glass filaments. This sys-
trons are transmitted through the target to the signal plate. tem is very durable and simple in design but does not allow
The signal plate carries this current as an electronic signal to for spot filming.
the television monitor, where it is reconstructed as a visible The optical lens system is a series of optical lenses that
image. The process of image reconstruction is discussed focus the image from the output phosphor on the camera
shortly. If the electron beam is in a different place in its sweep tube. When spot filming is desired, a beam-splitting mirror
than a particular photon of light from the output phosphor, (a partially silvered mirror that allows some light to pass
the target acts as an insulator. This action of the target modu- through and reflects some in a new direction) is moved into
lates the electronic signal. That is, the greater the light inten- the path of the output image and diverts some of the light
sity, the greater the number of electrons transmitted and the to the desired spot-filming device (e.g., photospot or cine
greater the magnitude of the electronic signal to the monitor, camera). This system, although allowing for spot filming of
giving variations in brightness of different parts of the televi- this type, is more susceptible to rough handling, which may
sion image. cause maladjustment of the mirror and lenses and result in
a blurred image.
Charge-Coupled Device. ​The charge-coupled device
(CCD) is a light-sensitive semiconducting device that gener- Television Monitor. ​The purpose of the television monitor
ates an electrical charge when stimulated by light and stores is to convert the electronic signal from the camera tube or
this charge in a capacitor. The charge is proportional to the CCD back into a visible image. This monitor is a cathode ray
light intensity and is stored in rows of pixels. The CCD is a tube that consists of an electron gun with a control grid, fo-
series of metal oxide semiconductor capacitors, with each cusing and deflecting coils, an anode, and a fluorescent screen
capacitor representing a pixel. Each pixel is made up of three (Figure 14-8). The electron gun is modulated (controlled) by
polysilicon gates. To digitize the charge from this device, the the signal from the camera tube or CCD. That is, the televi-
gates of each pixel are charged in sequence, moving the signal sion monitor electron gun is moving in the same pattern as
down the row, where it is transferred into a capacitor. From the camera tube (or signal from the CCD), and electrons
the capacitors, the charge is sent as an electronic signal to the emitted from it are in proportion to the signal intensity. The
television monitor. control grid forms the electrons into a beam that is controlled
The common analogy for how this process works is to by the focusing and deflecting coils and directed to the fluo-
consider each row of pixels as a series of buckets on a con- rescent screen. The beam sweeps the screen in the same raster
veyor belt. Each row of pixels is represented by a series of pattern described in the discussion of the camera tube. In
buckets on parallel conveyor belts. The “electron charge” is essence, the television monitor is reconstructing the image

CCD column
CCD column
CCD column

Serial register

Output amplifier

FIG 14-7  ​Charge-Coupled Device Processing. The bucket analogy is commonly used to illus-
trate charge-coupled device processing. Each conveyor belt of buckets represents a row of pixels.
Each pixel (bucket) is carrying an electron charge. Each charge is moved down the row to a serial
register (measuring meter), where it is measured and recorded. In this way, each pixel is “read”
individually and sent to the television monitor.
 CHAPTER 14  Image-Intensified Fluoroscopy 211

Anode Liquid Crystal Display Monitors. ​Liquid crystal display

(LCD) monitors are one of the modern display monitor op-
tions. LCD monitors offer superior resolution and bright-
ness over television monitors. They work in a completely
Deflection coil Light different way than television monitors. LCD monitors are
Focusing
made up of several layers (Figure 14-9). The heart of the
coil LCD is the liquid crystal layer, which is sandwiched between
polarizing layers. The liquid crystal layer contains nematic
liquid crystals. These crystals are typically rod shaped and
Electron
are semiliquid. They exist in an unorganized “twisted” state.
beam
When an electric current is applied, they organize or
“untwist.” In the untwisted state they organize into configu-
Aluminum rations that will block or allow light to pass through depend-
Electron Control reflector
gun grid ing on the polarizing filters. The polarized layers on each
Phosphor
side are oriented at a 90-degree angle to each other so that
light that may be able to pass through one would be at the
Glass wrong orientation to pass through the other. When electric
envelope
current is applied to the liquid crystal layer, the “untwisting”
FIG 14-8  ​Television Monitor. The general parts of the televi- changes orientation of light passing through the back layer
sion monitor. Note that the electron gun of the monitor is modu- and allows it to pass through the front. A thin-film transistor
lated by the camera tube attached to the image intensifier. (TFT) panel is located behind the liquid crystal layer. The
number of TFTs is equal to the number of pixels displayed.
from the output phosphor as a visible image. The image is The TFTs control the current to each pixel and switch it on
created on the fluorescent screen one line at a time starting in or off by causing the liquid crystals to twist or untwist. A
the upper left-hand corner and moving to the right (active monochromatic LCD monitor will display the light as shades
trace). It then blanks (turns off) and returns to the left side of gray. A color LCD monitor has a color filter layer added to
(horizontal retrace). This process continues to the bottom of display shades of color. The intensity of light is controlled by
the screen. It then returns to the top (vertical retrace) and the current to the crystals, which is controlled by the TFTs.
begins again by placing a line between each of the previous This in turn determines the shade of gray if monochromatic
ones. This action creates a television frame. Typical television or shade of color if a color monitor.
monitors are called 525-line systems because the traces create
a 525-line frame. High-resolution monitors have 1024 lines Plasma Monitors. ​Plasma monitors may also be a modern
per frame. However, the monitor continues to be the weak option for display monitors. Plasma monitors are very simi-
link in terms of resolution of the fluoroscopic chain. The im- lar in construction to LCD monitors but instead of a liquid
age intensifier is capable of resolving approximately 5 Lp/mm, crystal layer they have a thin layer of pixels (Figure 14-10).
whereas the monitor can display only 1 to 2 Lp/mm. Each pixel contains three neon and xenon gas-filled cells

Mirror
Polarizing film
Glass filter
Negative electrode
Liquid crystal layer
Positive electrode
Glass filter
Polarizing film

Cover glass

LCD TV

FIG 14-9  ​LCD Monitor. The layers and components of a liquid crystal display monitor.
212 SECTION III  Specialized Radiographic Equipment

Plasma monitor
Address electrode

Magnesium oxide coating

Display electrodes
(inside dielectric layer)

Rear plate glass

Pixel

Dielectric layer

Phosphor coating
in plasma cells

Dielectric layer

Front plate glass

FIG 14-10  ​Plasma Monitor. The layers and components of a plasma monitor.

(subpixels). Each of these cells is coated with a different phos- fluoroscopic to radiographic mode and exposes the film.
phor layer formula that will produce red, green, or blue light In the shift to radiographic mode, the mA increases from
when stimulated. On each side of this layer of pixels are one of the 2 to 5 mA fluoroscopic modes to one of the 100 to
dielectric layers. When electricity is passed between these 1200 mA radiographic modes. Because this method of imag-
dielectric layers through the pixels, the gas within is ionized. ing uses radiographic mode, it uses a much higher radiation
The liberated electrons release ultraviolet radiation in order dose to the patient than the others. As an alternative to expos-
to return to the shell of an atom. The ultraviolet radiation in ing the entire film, the tower is generally equipped with a
turn stimulates the phosphor coating in the cell, producing series of masking shutters that can “divide” the cassette and
visible light of a color corresponding to the phosphor for- allow for a number of exposures on one cassette such as two
mula. The current through the pixels (and subpixels) is exposures on one cassette, four on one, and six on one. In each
modulated by the electrodes several thousand times per sec- setting the image is smaller and organized as one of multiple
ond, thereby controlling the intensity of light produced. This images on one film.
control and modulation process makes it possible for plasma
monitors to produce billions of different shades of color.
CRITICAL CONCEPT
Cassette Spot Filming
CRITICAL CONCEPT
Cassette spot-film devices are one means of recording static
Coupling Systems and the Television Monitor images during a fluoroscopic examination. The unit shifts to
The camera tube and CCD are devices that couple the image radiographic mode, and the radiation dose to the patient is
intensifier to the television monitor to convert the image much higher than in fluoroscopic mode.
from the output phosphor to an electronic signal that can be
reconstructed on the television monitor.
Film Cameras. ​Film cameras (sometimes called photospot
cameras) have also been a mainstay of conventional fluoros-
copy. Refer back to Figure 14-3. They most commonly use
Recording Systems 105-mm “chip” film or 70-mm roll film. The photospot cam-
Cassette Spot Film. ​Cassette spot filming has been a stan- era is also a static imaging system that is used with an optical
dard of image-intensified fluoroscopic imaging for many lens system incorporating a beam-splitting mirror. When the
years. Refer back to Figure 14-3. This is a static imaging pro- spot-film exposure switch is pressed, the beam-splitting mir-
cess in which a standard radiographic cassette is used to ob- ror is moved into place, diverting some of the beam toward
tain an image. With this system, the cassette is loaded into the the photospot camera and exposing the film. This device is
lower part of the fluoroscopic tower and “parked” in a protec- using the visible light image from the output phosphor of the
tive envelope in the back. When the spot-film exposure button image intensifier and is exposing the 105-mm (or 70-mm)
is pressed, the cassette is moved into position between the film photographically, much like a 35-mm film camera used
patient and image intensifier, and the machine shifts from in photography. This system allows for very fast imaging of
 CHAPTER 14  Image-Intensified Fluoroscopy 213

up to 12 frames per second, and, because it is “photograph- fluoroscopy. They are much lighter and more compact, they
ing” the image off of the output phosphor of the image inten- produce a digital signal directly (no need for a camera tube
sifier, it requires approximately half the radiation dose of the or ADC), and—because it is a digital system producing a
cassette spot-filming system. digital signal, absent of the electronic components of the old
As more departments transition to fully digital environ- II system—there is less electronic noise. Detector array sizes
ments and eliminate film and chemical processing, a greater are currently available in sizes of 25 3 25 cm to 40 3 40 cm
dependence is placed on digital imaging and storage means. (10 3 10 inches to 16 3 16 inches).
Without chemical processing and film, the cassette spot film- The cesium iodide amorphous silicon indirect-capture
ing and the photospot imaging go away. detector is essentially the same as that for DR. However, for
use as a dynamic digital detector in digital fluoroscopy ap-
plications, there are a few differences. In general, dynamic
DIGITAL FLUOROSCOPY versions of these detectors must respond in rapid sequences
Like conventional fluoroscopy, digital fluoroscopy has evolved to create a dynamic image. Current dynamic versions are
over time. The early versions of digital fluoroscopy used the capable of up to 60 frames per second. To accomplish this,
conventional fluoroscopic chain but added an analog-to-digital rapid readout speeds (how quickly the active matrix pro-
converter (ADC) and computer between the camera tube and cesses the image data) are necessary. The design is a two-
the monitor. An ADC is a device that takes the video (analog) dimensional rectilinear array of pixels that can be electroni-
signal and divides it into a number of bits (1s and 0s) that the cally processed line by line in a fraction of a second.
computer “understands.” The number of bits that the signal is Furthermore, for fluoroscopic applications, very low-noise
divided into determines the contrast resolution (number of gray flat-panel detector systems are needed. Fluoroscopy generally
shades) of the system. The ADC is necessary for the computer to operates at a low dose output, so any operational noise de-
process and display the image. Once in digital form, the image grades the fluoroscopic image, making noise a greater factor
can be postprocessed and stored in that format or printed onto in detectors used for this application. Application-specific
film using a dry laser printer, for example. integrated circuits (ASIC) are used to minimize noise and
The incorporation of a CCD into this set-up further im- amplify signal from the active matrix. These circuits are par-
proved digital fluoroscopy. The CCD eliminated some of the ticularly important in fluoroscopic applications because they
problems associated with the camera tube. The CCD is more minimize noise, maximize readout speed, and allow for
light-sensitive (higher detective quantum efficiency [DQE]) switching from low-dose to high-dose inputs (for spot imag-
and exhibits less noise and no spatial distortion. It also has a ing). Another consideration with the low-dose fluoroscopic
higher spatial resolution and requires less radiation in the applications is the need to maintain a large fill factor (the area
system, reducing patient dose. of each pixel that is sensitive to x-ray detection materials).
A more recent advance in digital fluoroscopy is the intro- With general radiography that uses a larger dose output, this
duction of a flat-panel detector in place of an image intensi- is generally not a problem, but it becomes a problem with
fier. Two forms of flat-panel detectors may be used for fluoro- fluoroscopic applications, particularly with indirect-capture
scopic applications: the cesium iodide amorphous silicon detectors. Other features such as a light-emitting diode array
indirect-capture detector and the amorphous selenium “backlighting system” have also been incorporated to erase
direct-capture detector. Both are described in Chapter 12. the detector between frames to prevent “ghosting” caused by
(Refer back to that chapter for additional information.) Cur- any residual exposure charge from the previous frame.
rently the most commonly used for fluoroscopic application The use of flat-panel detectors in place of an image inten-
is the cesium iodide amorphous silicon indirect-capture de- sifier offers several advantages. The first is a reduction in size,
tector. The scintillator of this system uses cesium iodide or bulk, and weight of the fluoroscopic tower. A flat-panel de-
gadolinium oxysulfide as the phosphor. The photodetector is tector greatly reduces all three, allowing easier manipulation
amorphous silicon, which is a liquid that can be painted onto of the tower, greater flexibility of movement, and greater
a substrate (foundation or underlying layer) and is the mate- access to the patient during the examination. A flat-panel
rial that makes flat-panel detectors possible. The other com- detector with a 30 3 40 cm (12 3 16 inch) active area occu-
ponent is the TFT array. TFTs are electronic components lay- pies less than 25% of the volume of a 30-cm (12-inch) image
ered onto a glass substrate that include the readout, charge intensifier tube and less than 15% of the volume of a 40-cm
collector, and light-sensitive elements. The panel is configured (16-inch) image intensifier tube. The flat-panel detectors also
into a network of pixels (or detector elements [DELs]) cov- replace the spot filming and other recording devices. They
ered by the scintillator plate, with each pixel containing a operate in radiographic mode (100 – 1200 mA) so that in
photodetector and a TFT. With this system, x-ray energy is many cases additional radiographic images are not needed.
absorbed by the scintillator and converted to light energy. This The images, both dynamic and static, are recorded by the
light is then absorbed by the photodetectors and converted to system and can be readily archived with the patient record in
electric charges. These electric charges are in turn captured a Picture Archiving and Communication System (PACS). It
and transmitted by the TFT array to the monitor for display. should be noted that the images produced are very large data
Flat-panel detectors are very popular in interventional files; spot images can be 8 MB or larger and dynamic images
and cardiology applications and gaining ground in general as large as 240 MB per second. Furthermore, flat-panel
214 SECTION III  Specialized Radiographic Equipment

detectors do not degrade with age; are more durable; present

a rectangular field providing more information; and have bet- Fluoroscopic Controls and Settings
ter contrast resolution, higher DQE, wider dynamic range, and There are a number of controls and setting, both on the con-
all of the postprocessing options common to digital images. trol console and tower, that allow adjustment of the radiation
The spatial resolution of flat-panel detectors is the same for all output and image quality. To begin, the consideration for
field-of-view options provided binning (process of grouping selecting kVp is the same as for general radiography. Recall
and averaging adjacent DELS) is not used, and it is higher than that the higher the kVp, the higher the maximum and average
that of II system (2.5 – 3.2 Lp/mm versus 1 – 2 Lp/mm). energies of the x-ray beam. Here too, most of the x-ray beam
Finally, flat-panel detectors do not exhibit most image arti- will be Bremsstrahlung, and the average energy of the beam
facts seen with image intensifiers. Flat-panel detectors have will then be one third of the kVp selected. Using higher kVp
an operational dynamic range 60 times larger than that of settings (appropriate for the examination) will result in a
image intensifier systems and because of this do not exhibit higher energy beam and lower patient dose.
veiling glare. Because the DELs of a flat-panel detector are Most fluoroscopic units today allow for the selection of
arranged in a grid pattern (uniform columns and rows), they dose rates. The dose-rate setting may be labeled as low, me-
do not exhibit the pincushion and S distortion artifacts. dium, or high (or icons may be used to imply the same).
Vignetting (unequal brightness) and defocusing artifacts are These settings change the dose generally by 50% (medium is
also eliminated with flat-panel detectors. They do all of this 50% of high and low is 50% of medium). These selections
with as much as a 50% lower radiation dose to the patient. control the radiation dose rate at the image receptor. As with
These systems, while operating at much higher mA settings radiography, the operator should select the dose rate depend-
than image-intensified fluoroscopy systems (100 – 1200 mA), ing on the exam to be performed. For example, differentia-
use a pulsed beam (radiation production is pulsed on and off tion of soft tissue structures needs a lower scale of contrast
rapidly) technology to reduce radiation output necessary for and would require a higher dose rate while barium studies
the fluoroscopic image and with it radiation dose require a comparatively higher scale of contrast and therefore
This lowered radiation dose is also a focus of all fluoros- a lower dose rate.
copy systems. The use of a “dead man” exposure switch (one Collimation of the fluoroscopic beam reduces the field
that turns the exposure off when the pedal or button is re- size exposing the patient. Fully open, the unit will expose the
leased) has long been a part of fluoroscopy systems. Today’s patient to a beam adequate to cover the full size of the image
systems move far beyond exposure switch design. Dose-area intensifier or detector. With the newest units, lines will ap-
product (DAP) meters (meters that measure exposure in air, pear on the last image hold (LIH) displayed on the monitor,
followed by a computation to estimate absorbed dose to the indicating the position of the collimator plates. This allows
patient) are required on all new fluoroscopes in the United the collimator to be further adjusted without exposing the
States. Pulsed fluoroscopy and automated dose rate control patient to additional radiation. The collimator should be
systems that modulate exposure factors to minimize dose are adjusted to eliminate all anatomic structures not necessary to
also incorporated on new systems. Further discussion of the exam being performed. By reducing the area of tissue
these systems and controls follows. It should be noted that being exposed, we reduce overall patient dose.
the use of intermittent fluoroscopy by the operator will also The option to include the grid is also a control setting. The
reduce dose. This has long been an encouraged practice and grid will reduce the amount of scatter reaching the image
simply refers to the operator using as little “beam on” time as intensifier or detector and improve image quality. But be-
possible to make the necessary observations and complete the cause it also removes some useful radiation from the remnant
exam. Recall that fluoroscopy is the primary contributor to beam, mA (quantity of radiation) must be increased to main-
occupational exposure and in recent years, with very complex tain overall exposure to the image intensifier or detector. In
interventional procedures, a potentially high source of general then, its use increases radiation dose to the patient.
patient exposure. The decision to use it should be based on the exam and the
anatomic area’s capacity to produce scatter radiation. The
abdomen, for example, will produce more scatter radiation,
CRITICAL CONCEPT and the grid should be selected while the extremities or pedi-
Digital Fluoroscopic Systems atric patients may not require its use.
The use of flat-panel detectors in place of an image intensi- Modern fluoroscopic units also allow for the selection and
fier offers several advantages such as a reduction in the size, interchangeability of added filtration thickness or material.
bulk, and weight of the fluoroscopic tower, allowing for easier The operation of this control may entail the substitution of
manipulation of the tower and greater access to the patient filters of different thicknesses or switching of filtration mate-
during the examination. The flat-panel detectors also replace rial. The typical material used for beam filtration is alumi-
the spot filming and other recording devices, and, because num, which has an atomic number ideally suited to removing
they are capable of operating in radiographic mode, in many low-energy x-ray photons. It is important to remove these
cases additional radiographic images are not needed. The im- unuseful photons from the beam before they can expose the
ages, both dynamic and static, can also be readily archived
patient and contribute only to patient dose. This filtration
with the patient record in a PACS.
acts to increase the average energy of the beam by removing
 CHAPTER 14  Image-Intensified Fluoroscopy 215

low-energy photons (along the same line as dropping a stu- larger. Electronic magnification is the selection of a smaller
dent’s lowest grades, making his/her average higher). Higher field of view (FOV). When a smaller FOV is selected, an area
atomic materials such as copper are used in some units and may smaller than the size of the image intensifier or detector is
be selected when additional filtration and beam hardening are exposed by the x-ray beam, but the area is enlarged to fill the
desired. display monitor area magnifying the anatomic structures.
Anatomic programs are also available on modern fluoro- This improves ability to see small structures, but it also in-
scopic units. These programs are preset fluoroscopic exam creases patient dose.
settings established and programmed into the unit at the
time of manufacture or at the time of installation as dictated
by the facility. Each preset will bring up a predetermined set
QUALITY CONTROL
of exposure factors, filter thickness and type, etc., just as they Quality control programs are vitally important for all ionizing
do on radiographic units. Along this same line are the default radiation–producing equipment to monitor equipment per-
settings on the unit. These defaults are intended to be “ideal” formance and minimize patient dose. Fluoroscopic equip-
or “standard” values for minimizing dose and maximizing ment is used extensively in health care and contributes sig-
image quality. They are not hard and fast rules of operation nificantly to the radiation dose received by the general
and should be changed depending on circumstances and the population. Federal guidelines regarding fluoroscopic equip-
exam to be performed. The operator should evaluate the de- ment may be found in Title 21 of the Code of Federal Regula-
fault settings when they appear on the control panel or tower tions Part 1020 (21 CFR 1020) subchapter J. Quality control is
to be sure they match the exam and patient (e.g., size, pediat- a team effort among the radiographer, radiologist, and medi-
ric versus adult, pathology, anatomy of interest). cal physicist. The role of the radiologist is generally one of
An operational feature of modern fluoroscopy units is supervision of the whole quality control program and process.
pulsed fluoroscopy. This is simply a design of the unit that The radiographer’s role is more that of a facilitator in the
rapidly turns the x-ray beam on and off during operation. process, and the medical physicist has primary responsibility
This operation introduces two concepts necessary to under- for performance testing and interpretation. Although some
standing its value, pulse rate and pulse width. Pulse rate refers data may be collected and some monitoring performed by a
to how many pulses occur per second of operation. Think of radiographer, performance tests and their interpretation are
this as how many exposures occur per second. Pulse width carried out by a medical physicist. That said, the radiographer
refers to the length of each pulse. Think of this as how long should be familiar with the monitoring and testing necessary
each exposure lasts. The operator can select pulse rates gener- to ensure that the fluoroscopic unit is operating correctly.
ally from 1 pulse per second to 30 pulses per second. Pulse The radiographer, in particular a quality control radiogra-
widths are generally less than 6 milliseconds for pediatrics pher, may be responsible for the operational inspection of the
and less than 10 milliseconds for adults. If the unit is oper- equipment. This inspection should be conducted using a
ated at 30 pulses per second, the radiation dose is no different checklist of the items found in Table 14-1 and conducted at
than that in the older form of operation (continuous fluoros- least every 6 months. This radiographer may also be respon-
copy). However, if operated at pulse rates below 30 a radia- sible for an inspection of the suite itself to examine the gen-
tion dose reduction is realized. eral physical condition of the room, unit, supporting electri-
Finally, there are two other operational functions of mod- cal cables, and control booth, noting any wear or deteriorating
ern fluoroscopic units that are important to understand. The condition. This inspection of the physical condition should
first is frame averaging. Frame averaging is an operation that be placed on the same schedule and conducted along with the
reduces overall patient dose and image noise by averaging operational inspection.
multiple image frames together. Because the combining The other important part of the quality program is the
of frames reduces noise, less radiation is needed to maintain performance inspection and testing of the equipment. Al-
image quality. The second is geometric magnification versus though a quality control radiographer may perform some of
electronic magnification. With geometric magnification the these tests, an appropriately trained and licensed medical
patient is placed closer to the x-ray tube (a situation possible physicist should conduct and interpret this portion of the
with C-arm designs such as those found in interventional ra- program as well as oversee the entire quality control monitor-
diology or mobile C-arms and not radiographic/fluoroscopic ing program. The American College of Radiology Technical
table designs), creating a larger-than-normal space between Standards recommends 18 characteristics that should be eval-
the anatomic area of interest and the image intensifier or de- uated and monitored by a medical physicist. These character-
tector. This will result in the anatomic structures appearing istics are listed in Table 14-2 with a brief explanation of each.
216 SECTION III  Specialized Radiographic Equipment

TABLE 14-1  Operational Inspection Checklist

Inspect: Ensure that:
Bucky slot cover When the Bucky is parked at the foot of the table, the metal cover should expand and
cover the entire opening.
Protective curtain The curtain should be in good condition and move freely into place when the tower is
moved to the operating position.
Tower: locks, power assist, control panel The electromagnetic locks are in good working order, the power assist moves the
tower about easily in all directions, and all control panel indicator lights are
operational.
Exposure switch (deadman switch) The switch is not sticking and operates the x-ray tube while in the depressed position
only. (Also test the switch with the tower in the park position. It should not activate
the x-ray tube while parked.)
Collimator shutters In the fully open position, the shutters should restrict the beam to the size of the input
phosphor and be accurate to within 63%.
Fluoroscopic timer Should create an audible alarm after 5 minutes of fluoroscopic “beam-on” time.
Monitor brightness While exposing a penetrometer through a fluoroscopic phantom, the monitor image is
adjusted to display as many of the penetrometer steps as possible.
Table tilt motion The table tilts smoothly to its limit in both directions and the angulation indicator is
operational.

TABLE 14-2  Performance Inspection Checklist Based on American College of Radiology

Standards
Characteristic Description
Integrity of unit assembly This is the checklist described in Table 14-1.
Collimation and radiation beam alignment Ensures that the collimated beam accurately correlates to the actual radiation field.
Fluoroscopic system resolution Tests the system’s ability to display details of small objects (high-contrast resolution)
and larger objects (low-contrast resolution).
AEC system performance Tests proper calibration of the AEC to ensure that appropriate exposure factors are
used to produce an image.
Image artifacts Looking for variations in image appearance (artifacts) that do not belong.
Fluoroscopic phantom image quality A standardized test phantom is used to quantify the quality of the displayed fluoro-
scopic image.
kVp accuracy and reproducibility Compares the selected kVp on the control panel versus the actual kVp as measured
by a test tool.
Linearity of exposure versus mA Tests the ability of the unit to provide a consistent mR/mAs output across the avail-
able mA stations.
Exposure reproducibility Measures the consistency of exposure output at preselected techniques.
Timer accuracy Measures the exposure timer’s accuracy in delivering precise selected exposure
times.
Beam quality assessment (HVL) Measures the beam’s “hardness” or penetrating ability.
Fluoroscopic exposure rates Measures the intensity of the x-ray beam. Fluoroscopic exposure rate should not
exceed 10 R/min for units with ABS systems and 5 R/min for those without ABS
systems.
Image receptor entrance exposure Measures the radiation intensity at the image receptor.
Fluoroscopic alignment test The radiation beam alignment ensures that the radiation beam aligns with the center
of the image intensifier within 2% of the SID.
Equipment radiation safety functions Assesses features of the unit that reduce unnecessary radiation exposure.
Patient dose–monitoring system Assesses for proper function of patient dose–monitoring systems such as DAP
calibration, if present meters.
Video and digital monitor performance Assesses the display characteristics of the monitor (described in Chapter 12)
Digital image receptor performance Assesses the image capture and output characteristics (described in Chapter 12)

ABS, Automatic brightness stabilization; AEC, automatic exposure control; DAP, dose-area product; HVL, half-value layer; kVp, kilovoltage peak;
mA, milliamperage; mAs, milliamperes/second; mR, milliroentgen; R, roentgen; SID, source-to-image receptor distance.
 CHAPTER 14  Image-Intensified Fluoroscopy 217

SUMMARY
• Thomas Edison is credited with inventing the first com- are charged in sequence, moving the signal down the row,
mercially available fluoroscope. Many improvements have where it is transferred into a capacitor. From the capaci-
been made to the concept, and it was the introduction of tors, the charge is sent as an electronic signal to the televi-
the image intensifier that greatly advanced the system. sion monitor.
• The image intensifier is an electronic vacuum tube that • The purpose of the television monitor is to convert the
consists of five basic parts: the input phosphor, photocath- electronic signal from the camera tube or CCD back into
ode, electrostatic focusing lenses, accelerating anode, and a visible image. In essence, the television monitor is recon-
output phosphor. It converts the remnant beam to light, structing the image from the output phosphor as a visible
then electrons, then back to light, which increases the light image on the fluorescent screen by way of the camera tube
intensity in the process. or CCD.
• Brightness gain is an expression of the ability of an image in- • LCD and plasma monitors are modern display monitor
tensifier tube to convert x-ray energy into light energy and options. They offer superior resolution and brightness
increase the brightness of the image in the process. It is deter- over television monitors and work in a completely differ-
mined by multiplying the flux gain by the minification gain. ent way than television monitors.
• Flux gain is expressed as the ratio of the number of light • Cassette spot-film devices are one means of recording
photons at the output phosphor to the number of light static images during a fluoroscopic examination. During
photons emitted at the input phosphor, and minification use, the unit shifts to radiographic mode (100 – 1200 mA)
gain is an expression of the degree to which the image is and the radiation dose to the patient is much higher than
minified (made smaller) from input phosphor to output fluoroscopic mode.
phosphor. • Photospot filming is another method of recording static
• ABC is a function of the fluoroscopic unit that maintains images during fluoroscopic examinations, but this method
the overall appearance of the fluoroscopic image (contrast is actually “photographing” the image off of the output
and density) by automatically adjusting the kVp, mA, or phosphor via a beam-splitting mirror.
both, either by monitoring the current through the image • The early versions of digital fluoroscopy used the conven-
intensifier or the output phosphor intensity and adjusting tional fluoroscopic chain but added an ADC and com-
the exposure factor if the monitored value falls below puter between the camera tube and the monitor. The ADC
preset levels. is necessary for the computer to process and display the
• When an image intensifier is operated in magnification image. Once in digital form, the image can be postpro-
mode, the voltage to the electrostatic focusing lenses is cessed and stored in that format or printed onto film using
increased, which tightens the diameter of the electron a dry laser printer, for example.
stream, shifting the focal point farther from the output • The use of flat-panel detectors in place of an image inten-
phosphor and giving the appearance of magnification and sifier offers several advantages such as a reduction in size,
improving spatial resolution. This also causes an increase bulk, and weight of the fluoroscopic tower, allowing for
in radiation dose to the patient. easier manipulation of the tower and greater access to the
• Distortion—particularly the pincushion effect, unequal patient during the examination. The flat-panel detectors
brightness (vignetting), and image noise—are common also replace the spot filming and other recording devices,
problems with image intensified fluoroscopy. and because they are capable of operating in radiographic
• The camera tube is one method of coupling the image mode, in many cases additional radiographic images are
intensifier to the television monitor. The vidicon tube is not needed. The images, both dynamic and static, can also
connected to the output phosphor of the image intensifier be readily archived with the patient record in a PACS.
by either a fiberoptic bundle or an optical lens system. The • Modern fluoroscopic units have features such as the abil-
electron beam is activated and begins sweeping the anode ity to select dose rates, adjust the collimator during last
target. If the electron beam and light from the output image hold, change filtration, select a predetermined set of
phosphor are incident on the same place at the same time, exposure factors, in addition to pulsed fluoroscopy, frame
electrons are transmitted through the target to the signal averaging, geometric and electronic magnification.
plate, which carries this current as an electronic signal • Quality control is a team effort between the radiographer,
to the television monitor, where it is reconstructed as a radiologist, and medical physicist. Although some data
visible image. may be collected and some monitoring performed by a
• The CCD is another method of coupling the image inten- radiographer, performance tests and their interpretation
sifier to the television monitor. It is a light-sensitive semi- are carried out by a medical physicist. That said, the ra-
conducting device that generates an electrical charge when diographer should be familiar with the monitoring and
stimulated by light and stores this charge in a capacitor. To testing necessary to ensure that the fluoroscopic unit is
digitize the charge from this device, the gates of each pixel operating correctly.
218 SECTION III  Specialized Radiographic Equipment

CRITICAL THINKING QUESTIONS

1. Describe the function of a flat-panel detector as it relates 2. Your patient wants to know how a fluoroscope works and
to patient dose reduction. whether they should be concerned about the radiation.
How would you answer the patient?

REVIEW QUESTIONS
1 . Which of the following is composed of cesium iodide? 7. A signal is received by the monitor from which part of
a. conventional fluoroscopic screen the TV camera tube?
b. II input phosphor a. electron gun
c. II output phosphor b. target
d. II photocathode c. signal plate
2. Which of the following are negatively charged electrodes d. face plate
plated on the inner surface of the glass envelope of the 8. Which display monitor design used nematic liquid
image intensifier? crystals?
a. photocathode a. LCD
b. electrostatic focusing lenses b. plasma
c. input phosphor c. television (CRT)
d. output phosphor d. these gases are not used in monitors
3. Which of the following emits electrons in response to light 9. Which of the following is within the spatial resolution
stimulus? range of a flat-panel detector?
a. conventional fluoroscopic screen a. 1.0 Lp/mm
b. II input phosphor b. 2.0 Lp/mm
c. II output phosphor c. 3.0 Lp/mm
d. II photocathode d. 4.0 Lp/mm
4. Which part of the image intensifier will attract the 10. Flat-panel detectors use which of the following to create
electrons and increase their kinetic energy? a digital signal?
a. input phosphor a. ADC
b. output phosphor b. CCD
c. electrostatic focusing lenses c. CRT
d. accelerating anode d. signal is already digital
5. Which of the following will occur if voltage to the electro- 11. The ratio of the number of light photons at the output
static focusing lenses is increased? phosphor to the number at the input phosphor equals:
a. inversion of the image a. brightness gain.
b. reversal of the image b. flux gain.
c. minification of the image c. minification gain.
d. magnification of the image d. magnification gain.
6. Which portion of the TV camera tube will conduct only 12. What fluoroscopic operation is defined as the number of
when illuminated? exposures per second?
a. electron gun a. frame averaging
b. target b. pulse width
c. signal plate c. pulse rate
d. face plate d. dose rates
 15
Additional Equipment

OUTLINE
Introduction Mammography
Mobile Equipment Linear Tomography
Radiographic Units Tomographic Angle
Fluoroscopic Units Fulcrum
Dedicated Units Focal Plane
Chest Exposure Technique
Panoramic X-ray Summary
Bone Densitometry

OBJECTIVES
• Differentiate between radiographic and fluoroscopic • Explain the principles of linear tomography.
mobile equipment. • Recognize the variations required in exposure technique
• State the purpose of dedicated units and identify their factors for mobile and dedicated units, and linear
unique features. tomography.

KEY TERMS
bone densitometry linear tomography panoramic x-ray (panorex)
C-arm mammography pivot point
dedicated units mobile equipment tomographic angle
focal plane object plane
fulcrum osteoporosis

Radiographic Units
INTRODUCTION Mobile x-ray units can be smaller light-duty units or full-
A variety of specialized equipment is used in imaging that power units that are transported on wheels (Figure 15-1).
either improves visualization or provides important informa- These mobile units may be transported with or without the
tion about anatomic tissue. Radiographers need to be famil- use of motors. Mobile units can be categorized in several
iar with the unique features of the additional equipment used ways depending on the design of the generator: direct power,
in the radiology department. Additional education and train- battery power, capacitor discharge, or high frequency. Mobile
ing may be required to operate the specialized equipment in units operated by plugging into a wall outlet for direct power
a safe and competent manner. may experience fluctuations in voltage, which affects the ra-
diation output. Battery-operated units provide more consis-
tent radiation output, similar to a three-phase generator, but
MOBILE EQUIPMENT need to be recharged. Capacitor discharge units must be
Mobile equipment can be radiographic or fluoroscopic units plugged into a wall outlet during operation but produce con-
that are transportable to the patient’s bedside or the operat- sistent radiation output, similar to that of a single-phase
ing room. Patients imaged with a mobile unit are not capable generator. High-frequency units produce a consistent radia-
of being imaged in the radiology department because of a tion output and are lightweight but must be plugged into a
condition or a circumstance such as undergoing surgery. To wall outlet during operation.
operate a mobile unit safely, the radiographer must be aware Exposure techniques can therefore vary greatly depending
of its specialized features. on the type of mobile unit and its radiation output for a
219
220 SECTION III  Specialized Radiographic Equipment

CRITICAL CONCEPT
Mobile Radiographic Imaging
Mobile x-ray units can vary in the radiation output for a given
exposure technique. In addition, care must be exercised in
transporting and manipulating the mobile unit at the patient’s
bedside. It takes additional training and experience to align
the x-ray tube, patient, and image receptor to achieve a diag-
nostic-quality radiographic image at a patient’s bedside.

Fluoroscopic Units
C-arm mobile units have fluoroscopic capabilities that are
typically used in the operating room when imaging is neces-
sary during surgical procedures. Display monitors are also
included, which offer both static and dynamic imaging dur-
ing the procedure. Because it is a fluoroscopic system, many
of the features of a fixed fluoroscopic unit are also made
available with a C-arm. A C-arm unit is designed with an
x-ray tube and image intensifier attached in a C configura-
FIG 15-1  ​Radiographic Mobile Unit. A mobile x-ray unit.
tion (Figure 15-2). As a result, the unit can be positioned in a
(Courtesy Philips Healthcare, Andover, Mass.) variety of planes, enabling viewing from different perspec-
tives. Generally, three sets of locks are provided to move and
hold the C-arm in place. One set moves the entire “c” toward
or away from the base (the equivalent of moving a table side
selected exposure technique. Additionally, care must be taken to side). Another set allows the pivot of the “c” about its axis
in manipulating the unit at the patient’s bedside to avoid any (the equivalent of angling a general radiographic tube head
damage to the mobile unit or bedside patient care equip- assembly). The last set allows the “c” to slide along its arc (the
ment. A radiography suite is a “controlled” and shielded en- equivalent of moving the patient from anteroposterior or
vironment specially designed for radiographic imaging. In a posteroanterior to oblique to lateral without having to move
mobile environment, however, radiographers must take re- the patient).
sponsibility for radiation protection for themselves, the As a general rule, the x-ray tube should be positioned un-
patient, and other individuals within close proximity. der the patient and the image intensifier above the patient.
Radiographers should wear a lead apron during the radiation Positioning the C-arm in this manner during the imaging
exposure and stand as far from the patient and x-ray tube procedure reduces the radiation exposure to the operator.
as possible (at least 6 feet). Shielding of the patient and other Because the C-arm uses fluoroscopy, standard radiation ex-
individuals who must remain in the room should be posure techniques and safety practices used during fluoros-
performed as in the radiology department. copy in the radiology department must also be adhered to
Imaging patients using a mobile x-ray unit presents many
challenges. Radiographers need to carefully assess the pa-
tient’s condition to determine the appropriate alignment of TV monitors and Image intensifier tower
the x-ray tube, patient, and image receptor. The tube-head control cart
assembly is freely adjustable, and the radiographer must take
care to create the correct tube-part-receptor orientation,
which is more readily established in a radiographic suite. The
ability to obtain a standard source-to-image receptor dis-
tance (SID), use a grid, and operate an automatic exposure
control (AEC) device (if available) may be jeopardized dur-
ing mobile imaging. Obstacles (patient care equipment), pa-
tient condition, and the physical room environment may
greatly limit or alter the radiographer’s options for obtaining Adjustable
what are otherwise routine images. It is imperative that the C-arm
radiographer be able to adjust the equipment to maintain Head end of
proper alignment of the tube and image receptor to achieve a Surgical bed
X-ray tube
diagnostic-quality image at the patient’s bedside. Therefore,
additional training and experience is warranted before FIG 15-2  ​C-Arm Mobile Unit. A mobile C-arm unit. (Courtesy
attempting mobile imaging. Philips Healthcare, Andover, Mass.)
 CHAPTER 15  Additional Equipment 221

during operation of a C-arm unit. The radiographer should Panoramic X-ray

also pay particular attention to the distance between the pa- A panoramic x-ray (panorex) unit is designed to image
tient and x-ray tube as well as to total fluoroscopy time. Here, curved surfaces, typically the mandible and teeth. The unit
too, fluoroscopy is being used in an “uncontrolled” environ- moves the x-ray tube and image receptor around the sta-
ment, and it is the radiographer’s responsibility to monitor tionary patient (Figure 15-4). The x-ray beam is well col-
and apply radiation safety measures. limated to the most central portion of the beam. Long ex-
posure times are required to achieve the desired effect. The
control panel has limited milliamperage (mA) and kilo-
DEDICATED UNITS voltage peak (kVp) values available for selection. The pan-
Radiographic units designed for specific imaging procedures orex provides a high-quality image of a large surface area
are classified as dedicated units. Although dedicated units and is generally used for imaging of the mandible. The
may have limited applicability, radiographers must be familiar curved nature of this bone makes imaging difficult, and
with these specialized radiographic systems. using a panorex “straightens” this bone, laying it out to ap-
pear flat on the image receptor. Although such units may
Chest have specialized application in general radiography for
A dedicated chest unit is designed to image the thorax in the imaging the mandible, they are most often found in dental
upright position. The Bucky mechanism is attached to an offices.
x-ray tube that can be moved vertically to adjust to the height
of the patient (Figure 15-3). The image receptor is fixed and Bone Densitometry
changes the film or prepares the digital image receptor for the Bone densitometry is a specialized procedure using ioniz-
next exposure. Film-type chest units are attached to a film ing radiation to provide information on the condition of
processor, whereas digital chest units send image data to a the skeletal bones. Bone densitometry can determine if a
computer for processing and then display the images on a patient’s bone mineral density or mass is normal or low,
monitor. The control panel is more compact than the panel of typically for evaluation of osteoporosis. Osteoporosis is a
a standard radiographic x-ray unit and displays fewer auto- bone disease in which the bones become thinner and more
matic preprogrammed radiographic exposure factor selec- porous and therefore are susceptible to fractures. Because
tions. A dedicated chest unit has limited capabilities but can x-rays are attenuated by anatomic tissues and their attenu-
image patients more quickly and efficiently. In addition, a ation can be measured, structural changes in the bones
dedicated chest unit eliminates the need for the radiographer can be evaluated to assess mineral content and the density
to leave the room to process the exposed image receptor. of bones.
These units are typically found where a very large volume of The most common bone densitometry procedure is dual-
chest radiography is performed. The application of such units energy x-ray absorptiometry (DXA) (Figure 15-5). The ana-
is to improve workflow and patient care by standardizing and tomic regions, typically the lower spine and hips, are scanned
simplifying a routine process (e.g., two-view chest x-rays). with two different x-ray energies to isolate bone from soft
tissue attenuation. The amount of x-ray photons that pass
through the patient depends on the amount of bone mineral
density; the denser the bone, the fewer photons are transmit-
ted. Because bone attenuates the x-ray beam more than soft
tissue, information about the condition of bone tissue can be
extracted and computed.
The DXA scintillation detectors absorb the x-ray photons
and convert the energy proportionally to visible light, which
is measured and then sent to a computer for data analysis.
The x-ray photons measured at both high and low energies
are compared with the standards for young, healthy adults. If
the data indicate there is bone mineral or density loss, the
patient may be diagnosed with osteoporosis.
Data analysis includes a T-score, which indicates the num-
ber of standard deviations the individual measurement is
from the data mean for a population sample of young,
healthy adults. Additionally, a Z-score compares the individ-
ual measurement to a data mean for a population of similarly
aged individuals. The T-score primarily indicates fracture
risk, whereas the Z-score may signify the need to evaluate the
patient for secondary causes of osteoporosis.
FIG 15-3  ​Dedicated Chest Unit. A dedicated chest unit. DXA equipment and data analysis vary by manufacturer
(Courtesy Siemens Healthcare.) and as a result cannot be compared.
222 SECTION III  Specialized Radiographic Equipment

Direction of
x-ray tube travel

Lead-shielded
cover

Image receptor

Direction of image
receptor travel

Direction of lead-
shielded cover travel

FIG 15-4  ​Panoramic X-ray Unit. A panoramic x-ray unit. The unit moves the x-ray tube and image
receptor around the stationary patient. (Photo courtesy of Instrumentarium Dental.)

FIG 15-5  ​Bone Densitometry. A dual-energy x-ray absorpti- FIG 15-6  ​Mammographic Unit. A mammographic unit.
ometry bone densitometry unit.

Mammography
CRITICAL CONCEPT Mammography is a specialized radiographic imaging proce-
Dual-Energy X-ray Absorptiometry dure of the breast (Figure 15-6). Because the breast is com-
posed of soft tissues that attenuate the x-ray beam similarly,
The most common bone densitometry procedure is DXA.
specialized equipment and techniques must be used to best
The anatomic regions, typically the lower spine and hips, are
scanned with two different x-ray energies to isolate bone
visualize its structures. There are several important features
from soft tissue attenuation. Because bone attenuates the of a dedicated mammographic x-ray unit that make it
x-ray beam more than soft tissue, information about the uniquely qualified to image the breast tissue. In addition,
structural changes in the bones can be evaluated to calculate exposure technique factors and imaging principles play an
the bone mineral density used for diagnosis of osteoporosis. important role in producing quality mammograms.

Unique Features. ​The fundamental principles of using ion-

Patients must be imaged using the same equipment and izing radiation to image the breast are the same for mam-
positioning is critical to achieving accurate information. mography as in conventional imaging. However, special fea-
Radiographers and physicians must be highly skilled in tures of the dedicated equipment are important to achieve
achieving consistent information during bone densitometry. high-quality breast imaging. A low-kilovoltage exposure
 CHAPTER 15  Additional Equipment 223

technique is necessary to image tissue having low subject to store images in a picture archiving and communication
contrast. A low kVp (24 to 34 kVp) increases the subject con- system (PACS), and in particular the ability to display breast
trast to better visualize the similarly composed tissues of the images with increased contrast resolution.
breast. Because the kVp range for mammography is low, in- Dedicated mammography units have special features that
creased milliamperage/second (mAs) is required. Therefore, allow compression and magnification of the breast. Com-
radiation exposure to the breast is increased. pression of the breast makes the tissue thickness and optical
Mammography uses a much lower kVp range, and there- density more uniform and reduces scatter production to im-
fore the mammographic x-ray tube is constructed of a differ- prove contrast. In addition, compression places the tissue
ent target material to produce more x-ray photons in the structures closer to the image receptor, which improves spa-
desired kVp range. Common mammographic target materi- tial resolution. Magnification techniques may be required to
als are molybdenum and rhodium, as opposed to tungsten, visualize small structures such as lesions or microcalcifica-
which is used in radiographic x-ray tubes. At low kVp, the tions. It is important to note that the radiation dose to the
x-ray emission spectra from molybdenum or rhodium con- breast tissue is increased during magnification techniques.
tain more low-energy x-rays that are better suited for breast
imaging.
Operating a mammographic x-ray tube at a low kVp with
LINEAR TOMOGRAPHY
the anode composed of molybdenum and rhodium provides A major limitation of general radiography is that three-
x-ray photons with the energy levels (emission spectrum) dimensional objects are imaged in only two dimensions.
that best visualize the breast. In addition, the tube filter is Anatomic areas of interest may be superimposed on top of
composed of molybdenum or rhodium to absorb the lowest one another and therefore not well visualized. Linear tomo­
and highest wavelengths so the remaining x-ray energies will graphy is an imaging procedure using movement of the x-ray
best visualize breast tissue. The window or exit port for the tube and image receptor in opposing directions to create im-
radiation is composed of beryllium, which will allow the de- ages of structures in a focal plane by blurring the anatomy
sired longer x-ray wavelengths to exit the tube. The focal spot located above and below the plane of interest. The greater the
size needed to provide excellent spatial resolution is much amount of blurring of the objects above and below, the more
smaller than conventional radiography, typically in the visible is the area of interest.
0.1- to 0.3-mm range. Computed tomography has replaced most of the proce-
dures that used tomography. However, linear tomography is
still used in imaging; for example, imaging of the kidneys
CRITICAL CONCEPTS during intravenous urography. Inexpensive equipment can
Dedicated Mammography Units be added to the conventional x-ray unit to perform linear
tomography (Figure 15-7). It requires a rod attached to the
Unique features of a dedicated mammography unit include
x-ray tube and Bucky, a motor to move the x-ray tube, and
the ability to produce low kVp photons by using a tube anode
constructed of molybdenum and rhodium, a molybdenum- or
the ability to adjust the height of the area of interest either by
rhodium-composed tube filter, a beryllium port window, moving the patient up or down or by changing the fulcrum
smaller focal spot sizes for improved resolution, compression (pivot point).
for imaging a more uniform breast, and the ability to magnify The basic principle of operation is that when the x-ray
areas of the breast. tube travels in an arc trajectory in one direction and the im-
age receptor travels in the opposite direction, blurring of

Dedicated mammography units include the use of grids,

AEC devices, and image receptors. However, these are designed
differently for imaging the breast tissue. A lower-ratio linear
grid with a lower frequency is best for breast imaging. The AEC
device operates similarly as in conventional radiography but
must be more accurate for breast imaging in terms of repro-
ducibility to provide consistent exposure to the IR.
The film-screen and digital image receptors used in mam-
mography are specially designed for imaging the breast.
Single-emulsion mammographic film is used with a single
intensifying screen to improve resolution, and the film is
manufactured to display higher contrast. Different types of
digital image receptors are used in breast imaging. Both com-
puted radiography and direct radiography image receptors in
mammography provide the same advantages as in routine FIG 15-7  ​Linear tomographic unit. (From Bontrager K:
radiography. Important advantages of digital detection in Bontrager’s textbook of radiographic positioning and tech-
mammography include postprocessing capabilities, the ability niques, ed 8, St Louis, 2013, Mosby.)
224 SECTION III  Specialized Radiographic Equipment

Fulcrum
During movement of the x-ray tube and image receptor,
there is a fixed point known as the pivot point or fulcrum.
The fulcrum lies within the plane of the anatomic area to be
Tomographic imaged. Depending on the type of tomographic system, the
angle fulcrum can be fixed or adjustable.

Object CRITICAL CONCEPT

plane Pivot Point or Fulcrum
Fulcrum During movement of the x-ray tube and image receptor, there
is a fixed or pivot point that lies in the plane of interest. De-
pending on the type of system, the height of the fulcrum can
be changed by moving the patient up and down or the pivot
point is moved up or down.

FIG 15-8  ​Principles of Linear Tomography. When the x-ray In a system with a fixed fulcrum, the patient is moved up
tube travels in an arc trajectory in one direction and the image
or down to place the area of interest at the level of the ful-
receptor travels in the opposite direction, blurring of objects
occurs above and below the fulcrum.
crum. In a system using an adjustable fulcrum, the patient
remains fixed and the fulcrum or pivot point is moved up or
down.
objects occurs above and below a fixed pivot point, or ful-
crum (Figure 15-8). Anatomic areas above and below this Focal Plane
fixed point are less visible because of motion unsharpness or The plane in which the area of interest lies is known as the
blur. Several features are important to create a quality tomo- focal plane or object plane. This plane lies at the level of the
graphic image. fulcrum. The structures in this plane are sharper because ob-
jects above and below are blurred as a result of the motion of
Tomographic Angle the x-ray tube and image receptor. The thickness or width of
The tomographic angle is the arc created during total move- the focal plane, referred to as sections, is determined by the to-
ment of the x-ray tube. The amount of blur created in the mographic angle, and they are inversely related (Figure 15-9).
image is directly related to the tomographic angle. However, The smaller the tomographic angle, the greater is the thickness
the thickness of the section is inversely related to the tomo- of the focal plane. For a larger tomographic angle, the thickness
graphic angle. or width of the section is decreased.

Large Small
tomographic tomographic
angle angle
Small Large
thickness thickness
of cut of cut

A B
FIG 15-9  ​Focal Plane. The thickness of a section is determined by the tomographic angle and
they are inversely related. For a larger tomographic angle, the thickness of the section is de-
creased (A). The smaller the tomographic angle, the greater is the thickness of the focal plane (B).
 CHAPTER 15  Additional Equipment 225

CRITICAL CONCEPT patient. A low mA should be selected to allow for the neces-
sary increase in exposure time. The kVp is still selected based
Amplitude, Blur, and Focal Plane
on the region of interest. Overall, patients receive increased
The tomographic angle determines the amount of blur cre- radiation exposure during tomographic procedures. Proper
ated in the image. Increasing the tomographic angle in- shielding, restricting the field size, and minimizing repeats
creases the amount of blur, and decreasing the tomographic are important considerations in minimizing patient dose
angle decreases the amount of blur. The tomographic angle during tomography.
determines the thickness of the focal plane visualized. In-
Because the x-ray tube and image receptor move in only
creasing the tomographic angle decreases the thickness of
one direction during linear tomography, it has limitations. The
the focal plane, and decreasing the tomographic angle in-
creases the thickness of the focal plane.
tomographic angle has a limited range of movement, and this
affects the ability to obtain a thin focal plane. To achieve maxi-
mum blurring, the area of interest should be perpendicular to
the direction of the movement. Linear tomography results in
Exposure Technique structures imaged that are parallel to the motion and therefore
To achieve the required blurring during tomography, the ex- are distorted by elongation, which can appear as streaks. Prior
posure time must be increased. An exposure time that is too to the use of computed tomography, different types of mo-
short does not allow for complete blurring, and an exposure tions, such as hypocycloidal, circular, and elliptical, were used
time that is too long causes unnecessary exposure to the to overcome the limitations of linear tomography.

SUMMARY
• Mobile radiographic and fluoroscopic units may be used composed structures. Mammographic x-ray tubes are
to image patients when they are unable to travel to the constructed to produce x-ray photons with low energy to
radiology department. Radiation output may be more increase contrast resolution. The focal spot sizes are 0.1 to
variable for mobile units. 0.3 mm to increase recorded detail.
• Dedicated units, such as chest, panorex, bone densitome- • Compression of the breast is necessary during mammog-
try, and mammography, are types of imaging equipment raphy to make the thickness and exposure to the IR
designed for specific purposes and anatomic regions. more uniform, decrease scatter production, and increase
• During bone densitometry, the lower spine and hips are recorded detail.
scanned with two different x-ray energy levels to isolate bone • Linear tomography is an imaging technique used to blur
from soft tissue attenuation. Because bone attenuates the x-ray anatomy located above and below the area of interest.
beam more than soft tissue, information about the structural • The tomographic angle is directly related to the amount of
changes in the bones can be evaluated to calculate bone min- blurring and is inversely related to the thickness of the
eral density, which aids the diagnosis of osteoporosis. focal plane.
• Because the breast is a low–subject-contrast tissue, a low • The height of the pivot point or fulcrum is adjusted to be
kVp (22 to 28 kVp) is needed to visualize the similarly located within the plane of interest.

CRITICAL THINKING QUESTIONS

1. Why is a variety of specialized imaging equipment neces- 2. How is exposure technique selection affected when using
sary in diagnostic radiology? specialized imaging equipment?

REVIEW QUESTIONS
1. Which of the following creates images of an anatomic area 3. What is an advantage of C-arm fluoroscopy when com-
within a plane while blurring structures above and below? pared to traditional image-intensified fluoroscopy in a
a. panorex standard x-ray room?
b. DXA a. the x-ray tube can be positioned under the patient
c. C-arm fluoroscopy b. provides dynamic imaging
d. linear tomography c. monitors total fluoroscopy time
2. What type of mobile x-ray generator produces the most d. allows imaging in a variety of planes
consistent radiation output? 4. What disease process can be evaluated using bone densi-
a. high frequency tometry?
b. direct power a. atelectasis
c. battery power b. osteoporosis
d. capacitor discharge c. myeloma
d. ascites
Continued
226 SECTION III  Specialized Radiographic Equipment

R E V I E W Q U E S T I O N S — cont’d
5. In mammography, because the breast has _____ subject 8. What feature of a dedicated mammographic unit will
contrast, it is necessary to use a _____ kilovoltage expo- even out the breast tissue thickness?
sure technique. a. molybdenum anode
a. high, high b. compression
b. low, high c. AEC
c. high, low d. lower ratio grid
d. low, low 9. During linear tomography, the amount of blur created in
6. During DXA scanning, the T-score indicates the number the image is directly related to the:
of standard deviations the individual measurement is a. pivot point.
from the data mean for a population sample of _____. b. object plane.
a. similarly aged individuals c. tomographic angle.
b. a wide range of age groups d. length of exposure time.
c. young, healthy adults 10. During linear tomography, a smaller tomographic angle
d. older, healthy adults will create:
7. What anatomic area is typically imaged with a panoramic a. increased amount of blur.
x-ray unit? b. decreased focal plane thickness.
a. mandible c. increased focal plane thickness.
b. chest d. no change in amount of blur.
c. breast
d. kidneys
 16
Computed Tomography

OUTLINE
Introduction Image Quality
Development Noise
Generations Spatial Resolution
Additional Advancements Contrast Resolution
Image Data Production Artifacts
Image Reconstruction Quality Control
Computed Tomography Image Characteristics Radiation Protection
Reconstruction Process Dose Notification and Alerts
Imaging Controls and Data Storage Summary
Equipment
Protocols
Postprocessing
Multiple Options
Windowing

OBJECTIVES
• Identify the major developments in computed tomogra- • Describe common postprocessing methods.
phy (CT) technology, including the five generations of • Explain how window width (WW) and window level
CT equipment, spiral CT, and multislice CT, and explain (WL) settings determine which pixels in the CT image
their effect on CT imaging. will be white, black, or a shade of gray.
• Describe the components of the CT imaging system and • Explain how WW and WL settings affect the image con-
explain their functions. trast and brightness.
• Differentiate between raw and image data. • Describe CT image quality characteristics; identify how
• Identify the characteristics of the CT image, including image settings affect the quality and their associated
matrix, pixel, and voxel. tradeoffs.
• Describe the reconstruction process, following the con- • Identify artifacts associated with CT imaging and explain
version of raw data to image data. how they can be reduced or eliminated.
• Differentiate between linear attenuation coefficients and • Identify CT quality control tests and their purpose.
CT numbers. • Discuss how radiation protection can be practiced for CT
• Based on the Hounsfield scale, identify the CT numbers imaging, including methods for protecting the patient as
associated with water, air, and bone. well as others remaining in the room.
• Identify equipment associated with CT studies. • Describe Dose Notifications and Alerts and when they
• Describe factors that are set within an examination may be used in clinical practice.
protocol.

KEY TERMS
adaptive statistical iterative recon- computed tomography (CT) number dose alert value
struction computed tomography (CT) table dose descriptor
algorithm cone beam dose length product
annotation contrast resolution (DLP)
array processor CT Dose Index (CTDIvol) dose optimization
automatic tube current modulation data acquisition system (DAS) dose notification value
beam-hardening artifact detector array dose report
bowtie filter display field of view (DFOV) edge enhancement filter

227
228 SECTION III  Specialized Radiographic Equipment

K E Y T E R M S — cont’d
electron-beam computed tomogra- partial-volume artifact slip-ring technology
phy (EBCT) pitch smoothing filter
fan-beam geometry pixel spatial resolution
filtered back projection postpatient collimator spiral (helical) computed
gantry prepatient collimator tomography
generations (first through fourth) profile streak artifact
Hounsfield unit quantum noise view
image data raw data voxel
linear attenuation coefficient ray voxel volume
matrix region of interest (ROI) window level (WL)
multiplanar reformation (MPR) ring artifact window width
multislice computed tomography scan field of view (SFOV) windowing
(MSCT) scintillation-type detector Z axis

Not only does the resulting image demonstrate minimal su-

INTRODUCTION perimposition of anatomic structures, the image data are
Introduced in the early 1970s, computed tomography (CT) based on the attenuation characteristics of the anatomy being
quickly revolutionized the field of medical imaging. Taking imaged, and the image display can be adjusted to distinguish
advantage of the development of faster and more powerful tissues that have x-ray attenuations that differ only slightly
computers, CT combines a tightly collimated x-ray beam and (Figure 16-2).
detectors that rotate around the patient. X-ray transmission A little over 40 years later, today’s CT imaging process is
values are measured multiple times as the tube circles the extremely fast and produces images with remarkable detail,
patient and signal data are digitized and sent to the computer not only in transverse (head-to-foot) slices but also refor-
(Figure 16-1). Following a large number of calculations, a matted in coronal (front-to-back), sagittal (side-to-side),
cross-sectional axial image is reconstructed and displayed. and three-dimensional images. CT studies of the head, chest,
abdomen, and pelvis are now routine in every aspect of
health care, including the emergency department, outpa-
tient, and inpatient imaging. CT is used to enhance positron
emission tomography (PET) and single-photon emission
computed tomography (SPECT) nuclear medicine studies.
CT is also the mainstay of radiation therapy treatment plan-
ning. Although CT continues to expand its role in medicine,
it is not without drawbacks. Patient radiation dose, espe-
cially to children, is an important issue that must continually
be addressed. For these reasons, radiographers must have a
basic understanding of how CT works, as well as its advan-
tages and issues.

DEVELOPMENT
Detectors In the early 1970s Godfrey Hounsfield, using mathematic
formulas developed by Alan Cormack in the 1960s, demon-
strated the first CT scanner. Hounsfield’s and Cormack’s
work in developing CT was recognized in 1979 with the No-
bel Prize in Physiology or Medicine. Today’s CT scanner
Attenuation readings looks significantly different from the original. The major de-
velopments in x-ray beam and detector geometry are called
generations. Beyond these generations, additional develop-
ments have had a great influence on CT imaging. All CT
To computer systems involve an x-ray tube and detector or detectors lo-
FIG 16-1  ​Computed Tomography Process. As the x-ray cated inside a structure called the gantry, which surrounds
tube and detectors rotate around the patient, the detectors the patient. Especially for the first three generations of CT
measure the exit radiation multiple times, and the digitized scanners, developments resulted in significant reductions in
attenuation readings data are sent to the computer. scan time.
 CHAPTER 16  Computed Tomography 229

Gallbladder Pancreas Small bowel

Generations
The first two generations of CT scanners are considered
“translate-rotate” types because the x-ray beam was not wide
CT slice
enough to cover the entire anatomy being imaged. As seen in
Liver Figure 16-3, A, first-generation scanners had a pencil-thick
x-ray beam and a single detector. The only anatomy that
could be imaged was the head because it took approximately
5 minutes to collect the transmission data for one slice. While
energized, the x-ray beam and detector had to travel across
(translate) the head before it could rotate 1 degree and repeat
R kidney L2 Aorta L kidney the process. In that the x-ray beam was pulsed on and off as
it moved across the head, the transmission data were col-
FIG 16-2  ​Cross-Sectional Slice. Compared with the radio-
lected with parallel-beam geometry. All subsequent CT gen-
graphic image (left), the computed tomography image is able
to visualize abdominal organs and structures that are more erations use fan-beam geometry. Second-generation CT
similar in tissue density. (From Bontrager KL, Lampignano JP: scanners (Figure 16-3, B) had a small fan beam and detector
Textbook of radiographic positioning and related anatomy, array. The unit had only approximately 30 detectors, and
ed 7, St Louis, 2010, Mosby.) the fan beam was still not wide enough to cover the anatomy,
so translation was still required. However, because more
anatomy was imaged at one time, the process had to be re-
peated only approximately 18 times. Scan time was signifi-
cantly reduced to approximately 30 seconds.

Pencil beam Multiple pencil beams

A Single detector B Multiple detectors

Fan beam

C Multiple detector array

D Stationary ring of detectors

FIG 16-3  ​Generations I-IV. The first four generations of computed tomography scanning meth-
ods (first generation [A], second generation [B], third generation [C], and fourth generation [D])
demonstrate how changes in the tube movement and detector configuration have evolved.
230 SECTION III  Specialized Radiographic Equipment

Third- and fourth-generation CT scanners eliminate the resulted in significant scan time reduction and minimized the
need to translate because the fan beam is widened to cover use of EBCTs.
any anatomic area. Both systems collect the data for one slice
very quickly, in approximately 1 second or less. The major dif-
ference between the third- and fourth-generation scanners is in CRITICAL CONCEPT
the detector array. Third-generation scanners (Figure 16-3, C) Computed Tomography Generations
have a curved array of hundreds of detectors, which are located
CT generations represent advances in the operation of the
opposite the x-ray tube and rotate as the tube rotates and pulses.
x-ray tube and detectors, primarily to reduce scan time.
Fourth-generation scanners (Figure 16-3, D) have thousands
of fixed detectors in a ring inside the gantry. The tube rotates
while continuously emitting radiation, but the detectors do
not rotate. The primary advantage of the fourth-generation Additional Advancements
scanner is that it overcomes a specific third-generation arti- Spiral (helical) and multislice (multidetector) CT develop-
fact. However, most scanners in use today are based on third- ments have had such a dramatic effect on reducing scan time
generation technology. and improving image quality that they are standard on modern
Many consider the electron-beam computed tomogra- CT units. Prior to the late 1980s, conventional CT studies were
phy (EBCT) scanner to be the fifth generation (Figure 16-4). done in slice-by-slice mode. The patient was placed on the table
Developed for cardiac imaging, the EBCT reduces scan time and moved a certain amount into the bore of the gantry. The
to as little as 50 ms, fast enough to image the beating heart. pulsing x-ray tube and detectors rotated 360 degrees, collecting
EBCT does not use an x-ray tube; instead, it uses a beam of data. Once complete, the patient and table were moved incre-
electrons generated outside the gantry. Inside the gantry mentally into the scanner and the tube was rewound into its
there are 180-degree rows of fixed detectors on one side and original position. The process was repeated for each slice of
180 degrees of tungsten arcs opposite. The electron beam is the procedure. In the late 1980s CT scanners with slip-ring
rapidly moved to bombard the tungsten arcs, producing an technology were introduced. Located inside the gantry,
x-ray beam. The x-rays then pass through the patient, and the slip-ring technology allowed the tube to continue to
transmission information is collected by the detectors. These rotate without the need to rewind. Continuous rotation of
units are very fast because they have no moving parts. For a the tube (and detectors) coupled with continuous movement
number of years they were the only scanners fast enough for of the table and patient through the gantry are the basic
cardiac imaging. However, two additional developments components of spiral (helical) CT (Figure 16-5). Instead of

Data acquisition system

Dectector ring

Electron beam

Electron gun

Target ring

FIG 16-4  ​Electron-Beam Computed Tomography. Considered by many to be the fifth genera-
tion of computed tomography scanners, electron-beam computed tomography uses an electron
gun and tungsten arcs to allow very quick imaging times.
 CHAPTER 16  Computed Tomography 231

Path of continuously rotating

Start of spiral scan x-ray tube and detector

Direction of continuous
patient transport
FIG 16-5  ​Spiral Computed Tomography. As the patient moves smoothly through the gantry
aperture (along the Z axis), the tube and detectors continuously travel around the patient, creating
a spiral path.

collecting data one slice at a time, spiral CT collects the data MSCT; as the number of detector rows increases, the dose
for an entire volume of tissue (such as the head or chest) at decreases.
one time. Scan time is reduced because the start and stop
time of the slice-by-slice scanner is eliminated.
Another major development in CT technology is mul- CRITICAL CONCEPT
tislice computed tomography (MSCT), which is used in Modern Scanners
conjunction with spiral imaging (Figure 16-6). Instead of
Today’s CT system is typically a third-generation, multislice
collecting the transmission data for one slice each time the
spiral scanner.
tube rotates around the patient, MSCT collects data for 4 to
3201 slices per revolution. This is accomplished by opening
up the x-ray beam along the Z axis (direction from head to Dual-source CT units are advanced third-generation sys-
foot) and having a detector array with 4 to 3201 rows. The tems complete with two sets of tube-detector pairs. The dual
number of detector rows equals the number of slices per acquisition systems are mounted 90 degrees apart along the
revolution. As the number of slices being imaged per revolu- rotating gantry, with one tube for high kVp and one tube for
tion increases and the x-ray beam is opened, it goes from low kVp images. The DSCT system is known for quicker scan
being a fan beam to a cone beam. As the cone beam increases time and less patient dose due to its design. DSCT also has a
in size, the divergence of the x-rays results in increased dis- better ability to differentiate between tissues than standard
tortion toward the top and bottom edges. However, spiral CT and is therefore receiving more clinical attention.
MSCT allows overall improved image quality with faster scan As new technologies continue to be developed, improve-
time and the ability to perform additional procedures such as ments in image quality with reductions in scan time are the
CT angiography and cardiac imaging. Radiation dose is in- goal, as is reduced patient dose.
versely proportional to the number of detector rows in
IMAGE DATA PRODUCTION
A CT scanning system includes the scanning unit, the operator’s
console, and the computer. The major components of the scan-
ning unit are the gantry and CT table, or couch (Figure 16-7).
The gantry contains the equipment that produces the data for
image formation. It can be tilted and includes laser beams to
determine whether the patient is accurately located in the aper-
ture (opening) of the gantry. The CT tabletop may be flat or
curved and can be raised and lowered to help the patient get on
and off. It has a wide range of horizontal movement, allowing
the patient to easily move through the gantry during the scan.
Table movement during scanning is controlled by the protocol
FIG 16-6  ​Multislice Spiral Computed Tomography. In ad- set at the operator’s console.
dition to the spiral method for collecting computed tomogra- The actual process of producing a CT image of a cross-
phy data, having multiple rows of detectors results in four sectional slice of anatomy begins with the x-ray tube and ends
(shown here) or more slices being imaged during each revolu- with a matrix of CT numbers that represent the attenuation
tion of the tube. (Courtesy Philips Medical Systems.) characteristics of the anatomy being imaged. Between the two
232 SECTION III  Specialized Radiographic Equipment

lower-energy x-ray photons, resulting in an x-ray beam with

a higher percentage of high-energy photons. The filter fre-
quently used in CT is a bowtie filter (Figure 16-9), which has
Gantry
a shape and composition that makes the energy level of the
photons that reach the detectors more consistent.
Two sets of collimators serve different purposes in CT im-
age production. The first, similar to radiography, is to limit
Patient table patient exposure and reduce the amount of scatter radiation
produced in the patient. This is accomplished by the
prepatient collimator, located between the tube and patient,
which limits the beam to a fan or cone shape. After the x-ray
beam passes through the patient, it passes through the
Gantry postpatient collimator, located just before the detector array.
aperture
This collimator controls how much of the detector is exposed
(Figure 16-10). For single-slice CT, it controls slice thickness,
FIG 16-7  ​Computed Tomography Scanner. The gantry,
gantry aperture, and patient or computed tomography table
or couch are seen here. (Courtesy Philips Medical Systems.)

Detectors
are found a generator, a filter, collimators, detectors, the data
acquisition system (DAS), and the computer. Other than the
computer, all are found in the CT gantry (Figure 16-8). To-
gether they produce image data that can then be manipulated “Bowtie” filter More uniform
to demonstrate a wide spectrum of tissues. x-ray beam
The x-ray tube used in CT imaging is a modification of the FIG 16-9  ​Bowtie Filter. The bowtie filter removes longer-
standard tube. Because the tube is continuously pulsing and wavelength x-ray photons, resulting in more consistent energy
exposures are fairly lengthy, the anode must be able to with- photons reaching the detectors.
stand large amounts of heat. This is accomplished by using a
larger-diameter anode that rotates very rapidly. Today’s scan-
ners use a high-frequency generator to supply electricity to
the tube. With its electric current having minimal voltage
ripple, the high-frequency generator allows the production of
an x-ray beam with fairly consistent energy levels. This results
in more accurate, improved-quality CT data.
In addition to using a high-frequency generator, to have a Prepatient
high-energy x-ray beam that is as consistent as possible, the collimator
beam must be filtered. Similar to the filtration in a standard
x-ray tube, placing a filter in the path of the beam attenuates

High-
voltage
generator

X-ray
tube
Predetector
collimator
Detectors Detector array
FIG 16-10  ​Collimators. The prepatient collimator reduces
patient exposure and scatter production, whereas the prede-
FIG 16-8  ​Inside Gantry. Removing the computed tomogra- tector collimator determines how much of the detector is
phy gantry cover reveals the generator, tube, and detector exposed, reducing the amount of scatter contributing to the
array. (Courtesy Philips Medical Systems.) image.
 CHAPTER 16  Computed Tomography 233

whereas for MSCT it controls how many rows of detectors The last component found in the gantry is the data acqui-
are being used. This collimator severely limits the amount sition system (DAS). The electrical signal produced by the
of scatter radiation reaching the detectors, resulting in detector-photodiode goes immediately to the DAS, which
improved image contrast. amplifies this weak signal, converts it to logarithmic data,
converts it from analog to digital data, and sends it to the
computer (Figure 16-12). The logarithmic conversion of the
CRITICAL CONCEPT measured electrical signal is critical to CT imaging. By know-
Collimators ing the original x-ray beam intensity, the intensity of the
transmitted radiation (as measured by the detector), and the
CT uses two collimators: prepatient and postpatient. These
thickness of the part, logarithmic conversion produces at-
collimators significantly reduce the amount of scatter radia-
tion produced and that reaches the detectors, improving
tenuation information. More accurately known as the linear
contrast resolution. attenuation coefficient and symbolized by the Greek letter
m (mu), this information is the basic building block of the CT
image. The linear attenuation coefficient is a measure of the
The detector array is the physical component, consisting of probability that the x-ray beam will interact with the material
multiple detectors that efficiently absorbs the transmitted radia- it is in while traveling in a straight path. This value is based
tion and accurately converts it to an electrical signal. Each pulse on both the characteristics of the material and the energy of
of the tube as it rotates around the patient produces a view, a the x-ray photons. These logarithmic data are then converted
snapshot of all the transmission measurements from that loca- from analog (continuous) to digital (discrete) information by
tion. The view is composed of rays, which are the parts of the the analog-to-digital converter (ADC); leaving the gantry,
x-ray beam that fall on one detector. The transmission measure- these raw data are sent to the computer for image recon-
ment for an individual detector and the composite electrical struction.
signal may be referred to as a profile. Today’s CT scanners use a
scintillation-type detector coupled with a photodiode. Typi-
cally made of cadmium tungstate or a ceramic material, the
scintillation detector absorbs the transmitted radiation and pro-
duces a proportional flash of light. The photodiode is a solid- X-ray
state device that converts the light to a proportional electrical tube
signal. Use of this type of detector and photodiode results in the
ability to have many small detectors packed tightly together,
improving the quality of the CT image. A 64-slice CT scanner
has a detector array of 64 rows of 10001 detectors (Figure 16-11).

X-ray tube
X-ray
system

Detector

CT detector
electronics

CT detection system

Binary-coded
information

Computer

Multislice/multirow
detector FIG 16-12  ​Raw Data. The data acquisition system (DAS), lo-
FIG 16-11  ​Multislice Detector Array. The multislice com- cated immediately after the detectors (in the middle section
puted tomography detector array has multiple rows of detec- of the diagram), amplifies the electronic signal, converts it to
tors, collecting data for multiple slices every tube rotation. logarithmic data, and sends it to the computer.
234 SECTION III  Specialized Radiographic Equipment

CRITICAL CONCEPT task; for CT the reconstruction algorithm is key. The most
common reconstruction algorithm used in modern CT is fil-
Raw Data
tered back projection (FBP) (using a computer or electronic
Raw data, the very large number of calculated linear attenua- filter). The computer must analyze all of the data for one slice
tion coefficients of the tissue being scanned, are the basis of the area being imaged to determine the attenuation coeffi-
for the CT image. cient (m) for each voxel. Each voxel’s m is then mathematically
converted to a CT number. Building on the FBP algorithm is
the adaptive statistical iterative reconstruction (ASIR) tech-
IMAGE RECONSTRUCTION nique. Adaptive statistical iterative reconstruction starts
reconstruction after a first-pass FBP reconstruction and short-
Computed Tomography Image Characteristics ens reconstruction time while maintaining much lower image
Similar to a digital radiographic image, the CT image can be noise than if the same raw data were reconstructed with
described by a matrix, the number of rows and columns that FBP alone. ASIR reduces quantum noise substantially with no
make up the image. A CT image may be 512 rows by 512 impact on spatial or contrast resolution.
columns or 1024 by 1024. Interestingly, the CT image matrix
is typically smaller than the matrix for digital radiography
because of the difference in the type of data used. The small- CRITICAL CONCEPT
est component of the matrix and digital image is the pixel Image Reconstruction
(picture element). In CT each pixel is assigned a CT number,
Image reconstruction uses the raw data from all the detected
representing the attenuation characteristics of the anatomy
x-ray transmissions for one slice and, using the filtered back
found in the voxel (volume element). The voxel, determined projection algorithm, calculates the linear attenuation coeffi-
by the size of the pixel and the thickness of the slice, is the cient for each voxel in the slice.
actual small amount of tissue that will be represented by one
pixel (Figure 16-13). The dimensions of this small piece of
tissue, the voxel volume, have a significant effect on image Often referred to as Hounsfield units, the CT number is
quality. related to the attenuation characteristic of the tissue in the
voxel but it is not an attenuation coefficient. By using a
Reconstruction Process formula that relates the attenuation coefficient of the tissue
The primary role of the CT computer is to analyze the enor- to the attenuation coefficient of water, the CT number of
mous amount of raw data sent from the DAS and reconstruct water is set at zero (0). Any material that attenuates more
it into a digital array of CT numbers (image data) based on x-ray photons than water has a positive CT number, and
the image matrix. The computer must be very fast and pow- any material that attenuates fewer x-ray photons than
erful to perform a multitude of simultaneous calculations. water has a negative CT number. The Hounsfield scale pro-
Many CT computers include an array processor, a compo- vides for 2000 different CT numbers, with water being 0,
nent dedicated to performing these calculations needed for bone being approximately 11000 (appearing white) and air
image reconstruction. being 21000 (appearing black) (Figure 16-14). The end re-
The computer takes the raw data from the DAS and, using sult of reconstruction is a matrix of CT numbers, the image
algorithms, changes it into image data. An algorithm is a se- data (Figure 16-15).
quence of computer operations for accomplishing a specific

CRITICAL CONCEPT
Computed Tomography Numbers
Based on the linear attenuation coefficient, the CT number of
water is mathematically calculated to be 0. All tissues with
greater attenuation than water have CT numbers greater than
0, and all tissues with less attenuation than water have CT
numbers less than 0.

0.5 mm

0.5 mm CRITICAL CONCEPT

0.5 mm
10 mm Pixel Image Data
0.5 mm
Voxel Image data is the matrix of CT numbers, each representing
the attenuation characteristics of the tissue contained in the
FIG 16-13  ​Pixel and Voxel. The pixel is the smallest element voxel. Although CT numbers can be assigned any shade of
of the matrix that makes up the computed tomography im- gray (including black or white) in the displayed image, the
age. It is the two-dimensional representation of the smallest image data never changes.
volume of tissue (voxel) of the slice being scanned.
 CHAPTER 16  Computed Tomography 235

Hounsfield EMI
Computer 19 23 22 17 21 19 22 14 16 17 19
scale scale processing 17 23 16 18 17 17 15 18 17 19 17
18 18 17 20 21 18 16 20 18 20 18
24 20 18 19 22 24 18 17 24 14 24
( + 1000) ( + 500) 20 23 23 17 16 23 23 18 18 26 23
27 22 24 28 18 27 24 24 21 19 27
26 26 21 25 26 21 20 23 22 20 26
+ 1000 Hu + 500 51 22 24 20 21 51 24 27 16 21 21
12 52 26 27 12 12 52 26 18 15 19
Bone/calcification 96 115 55 25 26 96 14 51 25 17 14
10 79 65 51 24 10 89 12 26 28 15
27 15 84 12 53 27 11 96 21 23 24
40 19 119 24 96 13 19 25 10 12 24 52
39 63 263 144 24 89 63 15 27 26 21 14
38 00 294 528 263 36 00 64 19 24 24 89
37 -8 55 258 294 294 -8 31 63 53 26 11
36 -2 -2 457 263 528 302 43 00 13 55 25
35 13 3 2 301 264 503 144 -8 89 65 15
34 21 21 13 4 301 251 526 302 36 84 64
33 Congealed blood -2 -2 21 0 2 302 258 503 294 24 31
32 -2 -2 -2 0 -1 -2 457 251 528 144 43
31 1 1 0 -8 1 1 2 302 264 524 144
60 30 -1 -1 1 -2 -6 -1 2 -2 301 258 526
29 -2 -2 -2 13 -4 -2 1 1 2 457 254
28 -2 -2 -4 21 12 -2 -2 -1 -1 2 455
27 12 3 -3 -2 20 2 -3 -2 1 13 2
26 0 5 12 -2 -2 21 1 -2 -6 21 2
25 0 0 0 0 0 1 20 2 -4 -2 1
24 0 0 0 0 0 0 1 21 12 0 -2
23 0 0 0 0 0 0 0 1 20 1 -3
22 0 0 0 0 0 0 0 0 0 22 1
21 Gray matter 0 0 0 0 0 0 0 0 0 0 21
40 20
19
18 Numeric printout
17
16 FIG 16-15  ​Image Data. Image data consist of the computed
15
14 White matter tomography numbers (Hounsfield units) that have been calcu-
13
12 lated and assigned to the pixels of the image matrix. (From
11 Seeram E: Computed tomography, ed 3, Philadelphia, 2009,
20 10
9 Saunders.)
8
7
6 Blood
5
4
3
2
1
0 Hu 0 Water

-100 -50 Fat

-1000 Hu -500

FIG 16-14  ​Hounsfield Scale. The computed tomography

(CT) numbers for a variety of tissues are identified. Based on
the Hounsfield scale (61000), note the similarity of the CT
numbers of many of these tissues, slightly greater than water
(0 Hounsfield units).

IMAGING CONTROLS AND DATA STORAGE FIG 16-16  ​Operator’s Console. The operator’s console in-
cludes keyboard, mouse, and multiple monitors.  (Courtesy
Equipment Philips Medical Systems.)
The CT technologist is responsible for setting the parameters
of the examination and ensuring that the study is properly
saved and archived. Controls are found primarily at the study and at a specific rate. Once the reconstructed images
operator’s console but may also be found in the examination are displayed with shades of gray assigned to the CT numbers
room on the gantry. Using a keyboard, mouse, and multiple (based on the window settings), the technologist evaluates
monitors, the technologist selects the appropriate protocol image quality and manipulates the image to enhance visibil-
for the requested examination and completes the scanning ity of key information. Data from completed CT studies can
process (Figure 16-16). Often the procedure involves the in- be temporarily stored on the local computer’s hard drive and
travenous injection of iodinated contrast; setup then includes on large-capacity external devices for long-term storage. The
the operation of a power injector. The power injector allows technologist is responsible for accurately sending the com-
for the injection of contrast at a specified time during the pleted studies to the Picture Archiving and Communication
236 SECTION III  Specialized Radiographic Equipment

System (PACS) for interpretation by the radiologist and 100% helix

archival. Pitch factor = 1.00 Slice thickness = a

Z- axis
Protocols (couch) 3 revolutions
Imaging protocols are available for many studies and include
predetermined imaging settings. There may also be situations
when the radiologist will need the technologist to change a Pitch = a
protocol in response to a change in patient condition, result
of a biopsy, or other recommended reason. Therefore, the
technologist should be aware of what elements are involved Image extent = 3a
in creating the protocol for the exam. Some of the parameters
included in a protocol include milliamperage (mA), kilovolt Slice thickness = a
peak (kVp), and focal spot size, similar to radiographic imag- 125% helix
Pitch factor = 1.25
ing. In addition, the CT protocol addresses slice thickness,
image matrix size, scan field of view (SFOV), and display
field of view (DFOV). The SFOV determines the actual ana- Pitch = 1.25a
tomic area of interest as set by the technologist and imaged
during the exam, whereas the DFOV setting controls the area
of anatomy seen on the monitor. Image extent = 3.75a
Additional settings include scan time and image display.
Scan time is affected by how fast the tube completes a 360- Slice thickness = a
degree rotation, how much the tube is energized, and pitch. 150% helix
Systems with faster tube rotation produce an image in less Pitch factor = 1.50
time, as will systems that can be set to have the tube energized
and collect data during only a portion of the tube revolution
(for example, a half scan during which the tube is on and data Pitch = 1.5a
collected over 180 degrees of the rotational arc). With spiral
CT, when imaging one slice per rotation, pitch identifies the
Image extent = 4.5a
relationship between slice thickness and the distance the table
FIG 16-17  ​Pitch. The slice thickness remains unchanged,
travels every time the tube rotates (Figure 16-17). MSCT pitch
and increasing the pitch increases the amount of tissue
relates the beam collimation (which includes a number of
imaged or decreases the scan time.
slices) to the distance the table travels per rotation. Pitch
ranges from 0.5 to 2. A pitch of 1 means that during each tube
rotation, the table is moving the same distance as the slice
thickness and collimation. A pitch greater than 1 indicates the Multiplanar reformation (MPR) can be done by the
table is moving farther than the slice thickness and collima- computer to display the image data in coronal, sagittal, or
tion, resulting in a faster scan. Pitch of less than 1 results in the oblique planes (Figure 16-18). Reformatting differs from
table moving less distance than the slice thickness and colli- reconstruction in that the computer uses the image data that
mation, so the scan takes longer and has overlapping slices. was previously reconstructed (using the filtered back-projec-
Examination protocols may also include (electronic) recon- tion reconstruction algorithm) to produce these additional
struction filters such as edge enhancement or smoothing, as images. Image smoothing or edge enhancement filters
well as display windows such as bone or lung. Generally change the appearance of the anatomy, based on the type of
speaking, protocols are standardized settings, but may need to tissue being imaged.
be assessed and adjusted based on the individual patient.
Windowing
POSTPROCESSING The postprocessing technique of windowing allows for the
display of either a wide variety of tissue types or perhaps tis-
Multiple Options sues that are very similar to each other. Windowing includes
Once the image data (the matrix of CT numbers) have been adjusting how many CT numbers are visible in the image
produced through reconstruction, postprocessing techniques (window width [WW]), as well as which CT numbers are
allow adjustments to the image to provide additional infor- included (window level [WL]). The WL determines the mid-
mation or allow different anatomy to be made visible. Addi- point of the range of CT numbers to be displayed. Combined,
tional information may include adding a printed comment WW and WL determine which CT numbers (and the associ-
or label to the image (annotation), image magnification, or ated pixels) are visible in the image display (Figure 16-19).
selection of a region of interest (ROI) for statistical analysis. For example, an image with a WW of 400 and WL of 250
Using a DFOV smaller than the SFOV results in a magnified produces an image that displays pixels with CT numbers
image. ranging from 50 to 450 (400 different numbers, 200 above
 CHAPTER 16  Computed Tomography 237

and 200 below 250). All pixels with CT numbers of 50 or

lower are black, whereas all pixels with CT numbers of 450 or
higher are white. The pixels between these values will be a
shade of gray. The images in Figure 16-20 demonstrate the
same slice of anatomy with different preset windows, chang-
ing the anatomy being displayed.
The WL is set near the CT number of the type of anatomy
to be visualized. For example, because soft tissue structures
have CT numbers just higher than water, the WL for soft tis-
sue anatomy such as brain or liver is set around 30 to 60. The
WW depends on how similar or dissimilar the anatomy of
interest is. To visualize tissues that are very similar to each
other, such as blood (CT number of approximately 20) and
brain (CT number of approximately 40), the WW must be
small. A large WW would result in an image in which brain
and blood either share the same shade of gray or shades so
much alike that the human eye could not tell them apart. A
wide WW is used when many different tissue types need to
be seen.
It is the combination of WW and WL that determines the
visibility of different tissues in the CT image. In addition,
adjustment of the WW and WL affects the brightness and
FIG 16-18  ​Multiplanar Reformation. Multiplanar reformation contrast of the image. As the WL decreases (e.g., changing
(MPR) is the result of the computer using the original axial im-
from 200 to 230), the image appears brighter (more white)
age data to produce images in other planes, such as the sagit-
tal image seen here.  (From Bontrager KL, Lampignano JP:
(Figure 16-21). As the WW decreases (e.g., going from 800 to
Textbook of radiographic positioning and related anatomy, ed 7, 80), the image demonstrates increased contrast (more black
St Louis, 2010, Mosby.) and white) (Figure 16-22). It is interesting to note that CT
WL changes affect image brightness in the opposite direction
as digital radiography. As with all postprocessing techniques,
the CT image data remain constant and, although visibility
may change, no new information is present.

Gray levels
+1000 Gray scale

27 22 24 28 18 27 24 24 21 19 27
26 26 21 25 26 21 20 23 22 20 26
51 22 24 20 21 51 24 27 16 21 21
12 52 26 27 12 12 52 26 18 15 19
96 115 55 25 26 96 14 51 25 17 14
10 79 65 51 24 10 89 12 26 28 15

Computer
27
19
15
119
84 12
24 96
53
13
27 11 96
19 25 10
21 23
12 24
24
52
0
63 263 144 24 89 63 15 27 26 21 14
Processing 00 294 528 263 36 00 64 19 24 24 89
of Attenuation –8 55 258 294 294 –8 31 63 53 26 11
–2 –2 457 263 528 302 43 00 13 55 25
Data 13 3 2 301 264 203 144 –8 89 65 15
21 21 13 4 301 251 526 302 36 84 64
–2 –2 21 0 2 302 258 503
–2 –2 –2 0 –1 –2 457 251
294 24
528 144
31
43
CT gray-scale image

CT computer Numerical CT image

performs image (CT Numbers)
reconstruction

–1000
FIG 16-19  ​Image Data to Gray-Scale Image. Windowing is the postprocessing technique that
determines how gray levels are assigned to the image data (computed tomography number for
each pixel in the matrix).  (From Seeram E: Computed tomography, ed 3, Philadelphia, 2009,
Saunders.)
238 SECTION III  Specialized Radiographic Equipment

A B
FIG 16-20  ​Different Windows. Two images of the same computed tomography slice (without
any alteration in image data) demonstrate the effect of windowing, allowing the visualization of
lung tissue (A) using lung windows and the heart and great vessels (B) using mediastinal win-
dows.  (From Bontrager KL, Lampignano JP: Textbook of radiographic positioning and related
anatomy, ed 7, St Louis, 2010, Mosby.)

A B

C D
FIG 16-21  ​Effect of Changing Window Level. Having the window width remain at 399 while
reducing the window level (WL) from 1248 (A) to 2106 (D) demonstrates the effect of WL on
image brightness. (From Seeram E: Computed tomography, ed 3, Philadelphia, 2009, Saunders.)

IMAGE QUALITY
CRITICAL CONCEPT
It is the technologist’s responsibility to evaluate image quality
Windowing
and make adjustments as appropriate. Similar to radio-
Windowing, a common postprocessing technique, allows graphic imaging, CT studies often have tradeoffs between
adjustment of the window width (WW) and window level image quality and patient radiation dose that must be consid-
(WL) to determine the shade of gray (or black or white) as- ered. The primary image quality characteristics to be consid-
signed to every CT number in the image data. Changing the
ered with CT include noise, spatial resolution, contrast reso-
WW and WL allows different tissues to be made visible.
lution, and image artifacts.
 CHAPTER 16  Computed Tomography 239

A B

C D
FIG 16-22  ​Effect of Changing Window Width. Maintaining a window level of 40, narrowing the
window width from 603 (A) to 95 (D) demonstrates the increase in image contrast.  (From
Seeram E: Computed tomography, ed 3, Philadelphia, 2009, Saunders.)

Noise
In a perfect CT image of a container of water, all of the pix-
els would have CT numbers of 0 and be the same shade of
gray. In reality, the CT numbers vary randomly and the im-
age is mottled or grainy. This is noise, an undesirable char-
acteristic; the amount of noise depends on a number of
factors. The equipment itself, including the detectors and A
electronics, contributes to noise seen in the image, but this
is inherent and cannot be altered. Beyond the CT system,
the technologist can influence the amount of noise and its
visibility.
The major cause of noise is determined by the number of
x-ray photons used to produce the image (quantum noise). As
with radiography, the fewer the number of photons used to
create the image, the greater the quantum noise (Figure 16-23). B
Because the CT image is based on the photons measured by the FIG 16-23  ​Noise. An increase in quantum noise is clearly
detectors, any factor that increases this measurement reduces seen when the mA is reduced from 100 mA (A) to 50 mA (B).
quantum noise. This includes using a higher mA, longer rota- (From Seeram E: Computed tomography, ed 3, Philadelphia,
tion time, higher kVp, and a larger slice thickness. A large pixel 2009, Saunders.)
results in decreased noise. Increasing the pitch (having the
patient move through the gantry faster) reduces the number of
photons used to create the image, resulting in increased noise. because the visibility of noise more adversely affects the im-
The visibility of noise is strongly affected by the recon- age, whereas a slight loss of resolution is often acceptable.
struction filter (Figure 16-24). Using a sharp, high-resolution
or edge enhancement filter makes all the information in the CRITICAL CONCEPT
image appear sharper, including the noise. A smoothing Quantum Noise
filter, also known as a noise reduction filter, makes the noise
less visible. When imaging structures with small details, such The amount of quantum noise in the CT image affects spatial
resolution, contrast resolution, and patient dose. Appropriate
as bone, the visibility of noise is a necessary tradeoff. Smooth-
image quality must be based on balancing these factors.
ing filters can be used when imaging soft tissue structures
240 SECTION III  Specialized Radiographic Equipment

A B
FIG 16-24  ​Filters. The same computed tomography slice has the edge enhancement electronic
filter applied (A) and the smoothing filter (B). Notice the effect on the appearance of noise and
soft tissue anatomy. (Courtesy Siemens Healthcare.)

Spatial Resolution As with noise, the reconstruction filter has a major effect
CT spatial resolution (high contrast resolution) is the ability on the visibility of the image sharpness. A smoothing filter
of the image to differentiate between structures with very dif- smoothes out edges and decreases the spatial resolution,
ferent attenuation characteristics (CT numbers) when they are whereas sharp- or high-resolution filters sharpen the edges
very close together. Similar to radiography, the line-pair test and improve spatial resolution. Because these filters also
phantom can be used for evaluation (Figure 16-25), and the affect the visibility of noise, a compromise must be made
resolution is described as line pairs per centimeter (Lp/cm) or depending on the type of anatomy being imaged.
millimeter (Lp/mm). Line pair resolution for CT is typically
0.5 to 1 Lp/mm. A high level of spatial resolution can be Contrast Resolution
achieved by having small pixels and thin slices (Figure 16-26). CT contrast resolution (low contrast resolution) is the abil-
The pixel size is determined by the matrix size and the field of ity to discriminate between structures with very similar at-
view (FOV). As the matrix increases (more rows and columns) tenuation characteristics (CT numbers) (Figure 16-27). Ex-
or the FOV decreases, the pixel size decreases. Equipment also cellent contrast resolution is one of the major attributes of
affects spatial resolution; using a small focal spot size or having CT imaging. Compared with radiography, both film-screen
smaller detectors produces an image with increased spatial and digital, CT can differentiate between tissues that are 10
resolution. times more similar, such as ventricles as compared with brain
tissue. This is accomplished by having minimal scatter reach
the detectors (because of very tight collimation, both pre-
patient and postpatient) and by using the windowing process
to visualize these small differences. Using a small WW at the
appropriate WL allows structures with similar CT numbers
to have visibly different shades of gray.
The limiting factor for contrast resolution is noise. Any
factor that reduces the amount or visibility of noise improves
contrast resolution. Therefore, choice of mA, kVp, slice thick-
ness, matrix size, FOV, and reconstruction filter affects con-
trast resolution.

CRITICAL CONCEPT
Contrast Resolution
The ability of CT images to differentiate between tissues with
very similar attenuation characteristics (low contrast resolu-
tion) makes it an invaluable tool in diagnostic imaging.

FIG 16-25  ​Spatial Resolution. Image of a line-pair test

phantom used for assessment of spatial resolution.  (From Artifacts
Seeram E: Computed tomography, ed 3, Philadelphia, 2009, The fourth component of CT image quality is artifacts. CT ar-
Saunders.) tifacts can be identified when the CT number in the image data
 CHAPTER 16  Computed Tomography 241

A B
FIG 16-26  ​Effect of Changing Slice Thickness. The effect of slice thickness is clearly shown by
comparing the spatial resolution of an image of a thick 10-mm slice (A) and that of a thin 1.5-mm
slice (B).  (From Mayo JR: High-resolution computed tomography, Radiol Clin North Am 29:
1043-1048, 1991.)

FIG 16-28  ​Streak Artifact. Streak artifacts caused by metal

prostheses are seen.  (From Seeram E: Computed tomogra-
phy, ed 3, Philadelphia, 2009, Saunders.)

FIG 16-27  ​Low Contrast Resolution. Image of a low contrast in inaccurate CT numbers. This is particularly evident in
quality control test phantom.  (From Seeram E: Computed head examinations. Computer algorithms can reduce beam-
tomography, ed 3, Philadelphia, 2009, Saunders.) hardening artifacts.
Partial-volume artifacts arise when the voxel is so large
that it contains more than one type of tissue (for example,
does not accurately represent the attenuation characteristics of a voxel might contain both bone and muscle). When the
the associated anatomy. Streak, ring, shading, and partial vol- attenuation coefficient is calculated for this voxel (followed
ume are common CT artifacts. Streak artifacts (Figure 16-28) by determination of the CT number for the pixel), it is not an
are linear-shaped artifacts that are often the result of patient accurate representation of either the bone or muscle. This
motion or the presence of metal in the anatomy being imaged. artifact can be reduced by decreasing pixel size or slice thick-
Immobilization, removal of metal when possible, and computer ness, resulting in a smaller voxel.
algorithms can reduce streak artifacts. Ring artifacts are circular- CT image quality always involves tradeoffs that must be
shaped artifacts that are associated with a faulty detector in weighed in relation to the examination and the patient. Im-
third-generation scanners (this problem was eliminated in ages with high spatial resolution can be produced, but may
fourth-generation scanners). be at the expense of increased noise or patient dose. High
Shading artifacts are common and typically are the result contrast resolution requires low noise, which means de-
of the beam-hardening artifact (Figure 16-29). As the x-ray creased spatial resolution or increased dose. Reducing the
beam passes through the patient, especially through bone, partial-volume artifact requires smaller voxels, necessitat-
the lower-energy photons are filtered out, resulting in beam ing increased dose or more noise. Decisions about exami-
hardening. Because the attenuation coefficient (m) of a ma- nation protocols and their adjustments must be carefully
terial depends on the beam energy, beam hardening results considered.
242 SECTION III  Specialized Radiographic Equipment

A B
FIG 16-29  ​Beam-Hardening Artifact. The beam-hardening artifact is seen between the petrous
pyramids as a band of decreased brightness (A). Algorithms have been applied to reduce the
artifact (B). (From Seeram E: Computed tomography, ed 3, Philadelphia, 2009, Saunders.)

examinations, especially by children. Incidences concerning

QUALITY CONTROL radiation overexposures have been prominent in news and
As with radiographic x-ray equipment, CT systems require media, and many health care facilities, professional organiza-
regular tube warm-up procedures, preventive maintenance, tions, and governmental agencies have responded with in-
and quality control testing to ensure the accuracy and quality creased initiatives to promote radiation safety in CT imaging.
of the CT image. Tube warm-up and regular maintenance It is the technologist’s duty to be knowledgeable about meth-
should be done according to the manufacturer’s directions. ods available to limit dose to both the patient and others who
Specific test objects have been designed for CT quality con- may be in the room (Box 16-1).
trol, evaluating a number of factors such as spatial resolution, ALARA is the key radiation protection principle that en-
contrast resolution, and noise. Accuracy, linearity, and uni- sures that patient doses are kept as low as is reasonably
formity are other characteristics to be assessed. When a achievable. Every exposure should have a benefit and a justi-
water-filled container is imaged, a system that is accurate has fication. In CT, however, the focus is on dose optimization as
the CT number in a particular spot very close to 0, whereas a well. The CT technologist must reduce the radiation dose
system that is uniform has a variety of areas within the image while maintaining the required image quality needed for
all with CT numbers very close to 0. Linearity is demon- making a diagnosis.
strated when an image of a variety of materials demonstrates The CT technologist should ensure that patients receive
CT numbers consistent with the linear attenuation coeffi- the appropriate exam for their symptoms and signs. The
cients of those materials. There are a number of additional technologist should take a thorough patient history prior to
quality control tests for CT systems, some of which include the ordered study to discover if there is a strict clinical indi-
assessment of the accuracy of table movement, pitch, and cation to help eliminate unnecessary and duplicate examina-
localization devices. As with all quality control programs, test tions. The technologist will access the medical record to see
frequency (e.g., daily, monthly, semiannually) and acceptable if the patient has had any recent CT exams and alert the or-
standards must be set. dering practitioner if necessary. Also, the technologist may

RADIATION PROTECTION BOX 16-1  Radiation Protection Practices

Since being introduced in the 1970s, the number and type of
in CT
CT procedures being performed has increased significantly ALARA
each decade. Today, because of technological advances and Dose optimization
overutilization, CT examinations account for approximately Appropriate exam
one half of the U.S. population’s radiation exposure resulting Appropriate protocol selection and SFOV
Correct patient centering
from medical procedures. Questions and concerns are wide-
Out-of-plane lead shielding
spread about the radiation dose being received from these
 CHAPTER 16  Computed Tomography 243

need to intercede on the patient’s behalf and alert the order- CT DOSE DESCRIPTORS
ing practitioner if there may be a more appropriate exam or
test for the indication, such as MRI or ultrasound. Although
the impact of these action may seem minimal, they could
potentially prevent a duplicate examination or unnecessary
radiation exposure.
Once the CT examination has been deemed appropriate,
the technologist must choose the appropriate and correct
protocol and technical factors to create the best image quality
while limiting radiation dose to the patient. Certain technical
factors, such as the mA, kVp, and pitch, directly affect patient
CTDI: CT Dose Index (mGv)
dose. To decrease dose, the mA and kVp could be reduced Energy absorbed per unit of mass described
and the pitch increased. However, because these factors also
affect noise and contrast resolution, it is important to balance
reductions in dose with appropriate image quality. Auto-
matic tube current modulation (ATCM) provides ongoing
adjustment of the mA based on patient size and tissue char-
acteristics, maintaining image quality while reducing dose,
especially for small patients (Figure 16-30). ATCM can be DLP: Dose Length Product (mGv cm)
used in three different techniques. In angular modulation Energy absorbed per unit of mass over a scanned length
(in-plane), the automatic control of the tube current is along FIG 16-31  ​CT Dose Descriptors. CT Dose Index or CTDI is
the X-Y axis. In longitudinal modulation (through-plane), measured in mGy and is defined as the energy absorbed per
the automatic control of the tube current is along the Z-axis. unit of mass. The Dose Length Product is measured in (mGy
Finally, in angular-longitudinal modulation, the automatic times centimeters) and is defined as the energy absorbed per
control of the tube current is along all three axes. unit of mass over a scanned length.
Patient dose during CT imaging is complex and is ex-
pressed using different descriptors based on manufacturer Current CT scanners display the CTDIvol and DLP indices
and calibration phantoms. The most commonly used dose before and after the CT study is performed. This is called the
descriptors include the CTDIvol and DLP (Figure 16-31). dose report (Figure 16-32). Required since 2002, the dose
The CT dose index measures mean absorbed dose in the report is sent to PACS with the rest of the patient’s CT study.
scanned object volume and in MSCT units is specifically Another way to limit radiation dose to the patient is proper
called CTDIvol because it adjusted for weighted index and centering. The patient must be centered in the CT gantry iso-
pitch. CTDIvol is measured in Gray (mGy, cGy). The dose center for accurate imaging of the anatomy. This ensures
length product (DLP) is a measurement of energy absorbed proper dose distribution, while inaccurate patient centering
per unit of mass over a scanned length (z axis) and can be will degrade the image quality and increase the dose to the
expressed with the following formula: patient (especially with ATCM). Improper centering of the
patient in the gantry can lead to an increase in surface dose as
DLP 5 CTDIvol 3 Scan length of exposure
well as the peripheral dose to the patient. Current research
indicates that when using a 32-cm CTDI body phantom, a
miscentering of 3 cm results in increase in doses by 18% and
miscentering of 6 cm results in increase in doses by 41%.
200 If the patient is centered too high in the gantry, the ATCM
assumes the patient is larger and increases the technical
150 factors used, which results in a higher dose and images with
Effective mAs

decreased quality. If the patient is centered too low in the gan-

100 try, the ATCM assumes the patient is smaller, calculates an in-
sufficient dose, and produces images with poor image quality.
50 It is also necessary to position the patient correctly so that
radiation is not delivered to sensitive areas. An example of this
0 would be during pediatric head or neuro perfusion CT stud-
0 50 100 150 200 ies. In this situation, the technologist should position the head
Relative distance (mm) so that the eyes are out of the primary beam to limit dose.
FIG 16-30  ​Automatic Tube Current Modulation (ATCM). Conventional radiographic shielding (lead) of radiosensi-
The mA is automatically adjusted as the patient is scanned tive tissues such as gonads or thyroid can be done when they
while maintaining a uniform noise level for different thick- are located outside of the SFOV (out-of-plane). Although the
nesses of body parts examined. This is an example of Longi- shielding may have limited value because of very tight colli-
tudinal Modulation, or Through Plane Modulation mation (and minimal scatter), it is recommended even if only
244 SECTION III  Specialized Radiographic Equipment

Patient Name: Exam no: 1744

Accession Number: 10 Aug 2014
Patient ID: Discovery CT750 HD
Exam Description: CT HALS/THORAX/ABDOMEN
Dose Report
Scan Range CTDlvol DLP Phantom
Series Type
(mm) (mGy) (mGy - cm) cm

1 Scout
2 Helical S15.750 - I650.250 5.10 373.00 Body 32
5 Helical S188.000 - I105.000 5.10 182.72 Body 32

Total Exam DLP: 555.72

1/1

FIG 16-32  ​CT Dose Report. This dose report is created by current CT units and display the
CTDIvol and DLP indices before and after a CT study is performed. The dose report is sent to PACS
with the rest of the patient’s CT study.

for psychological purposes. This shielding must completely Dose Notification and Alerts
surround the patient because the tube travels in a circular mo- Beginning in 2014, the National Electrical Manufacturers As-
tion. It is also very important that shielding not be within the sociation (NEMA) requires that the XR 25 CT Dose-Check
SFOV so that all of the anatomy of interest is imaged and Standard software be included in all new CT scanners sold in
artifacts are avoided. the United States. Existing manufacturers can also make ef-
Thin, in-plane bismuth shields are available specifically forts to ensure that installed units also meet this radiation
for CT studies. They can be used to reduce exposure to the safety standard.
breast, thyroid, and eyes when they are within the SFOV. A Dose notification value is used to trigger a message when
These shields are placed directly over the tissue and filter the a single planned and confirmed scan is likely to exceed a pre-
beam, reducing the low-energy photons and superficial dose. programmed value (CTDIvol and/or DLP) (Figure 16-33). This
The American Association of Physicists in Medicine (AAPM) programmed value is set for each scan sequence in an exam.
recommends against using in-plane bismuth shields in lieu of These values were set by the AAPM so that notifications would
other methods of radiation protection, such as proper scan be infrequent, but they can be changed based on individual
length, collimation, and other methods of dose optimization. facility department preferences (Table 16-1).
Children require special consideration regarding radiation A Dose alert value is used to trigger a message when cu-
dose because they are more sensitive to the effects of radia- mulative dose at a location, plus the dose for the next planned
tion and have more years for problems to manifest. Referring and confirmed scan(s), is likely to exceed a preprogrammed
physicians should be educated regarding the dose associated value (Figure 16-34). The value is set once and applies to all
with CT examinations as well as alternative procedures, and exams in that study. This is a scanner parameter and is not
CT examinations should use routine pediatric protocols protocol or sequence specific. The FDA-recommended default
based either on age or weight. The Image Gently campaign value is CTDIvol51000 mGy.
was created by the Alliance for Radiation Safety in Medical The dose notification and alert system is put into operation
Imaging to promote and improve the safety and effectiveness before patient scanning and can help protect patients from
of medical imaging of children. Image Gently provides news inadvertent use of excessively high CTDIvol and/or DLP. It is
and education for practitioners, technologists, and parents not designed to optimize dose, and these alerts do not termi-
concerning ways to help reduce radiation dose for children. nate the x-ray exposure. Rather, it was designed to prevent
Radiation protection of anyone who remains in the room egregious errors by the technologist or CT unit. Notifications
during scanning must be considered based on time, distance, draw attention to potentially high exposure so users can con-
and shielding. It is important that technologists, parents, or firm that settings are appropriate. Operator education is es-
any others who must remain in the room wear protective ap- sential, and event logs documenting exposure should be mon-
parel, stand away from the gantry, and limit time in the room. itored by the department to ensure proper usage of the system.
Women of child-bearing age should be questioned regarding
their pregnancy clearance.
Radiation exposure from CT studies is a major concern, CRITICAL CONCEPT
particularly with respect to pediatrics. Although there is gen- Patient Exposure
eral agreement that the benefits of appropriate CT procedures
far outweigh the risks, it is the responsibility of those who Patient (especially pediatric) radiation exposure resulting
from CT examinations is a significant concern and should be
develop and use CT protocols to minimize the risks based on
considered at each step of the procedure.
the “as low as reasonably achievable” (ALARA) principle.
 CHAPTER 16  Computed Tomography 245

DOSE NOTIFICATION

One or more group result in a projected dose exceeding the Notification

Value Set. Select Cancel to go to Viewedit and adjust scan parameters
if clinically appropriate to set below the Notification Value. Selecting
Confirm will proceed to scan and log user confirmation of scan
paramenters exceeding Notification Value.

Series # 1 Series Description A/P Onocology

Images NV Projected
CTDIvol (mGy) 1-9 30 31.09

Diagnostic Reason

Confirm Cancel

FIG 16-33  ​CT Dose Notification Value. This is used to trigger a message when a single planned
and confirmed scan is likely to exceed a preprogrammed value (CTDIvol and/or DLP). These values
were set by the AAPM so that notifications would be infrequent but can be changed by individual
facility department preferences.

TABLE 16-1  Notification Values Recommended by the AAPM

Working Group on Standardization of CT Nomenclature and
Protocols
Ct Scan Region (of Each Individual Scan CTDIvol Notification
in an Examination) Value (mGy)
Adult Head 80
Adult Torso 50
Pediatric Head
• ,2 years old 50
2-5 years old 60
Pediatric Torso
• ,10 years old (16-cm phantom)* 25
• ,10 years old (32-cm phantom)† 10
Brain Perfusion (examination 600
that repeatedly scans the same anatomic level to measure the
flow of contrast media through the anatomy)
Cardiac
Retrospectively gated (spiral) 150
Prospectively gated (sequential) 50
*
As of January 2011, GE, Hitachi, and Toshiba scanners use the 16-cm–diameter CDTI phantom as
the basis for evaluating dose indices (CDTIvol and DLP) displayed and reported for pediatric body
examinations.
†As of January 2011, Siemens and Philips scanners use the 32-cm–diameter CDTI phantom as the
basis for evaluating dose indices (CDTIvol and DLP) displayed and reported for pediatric body exami-
nations.
(From American Association of Physicists in Medicine: AAPM dose check guidelines version 1.0,
College Park, 2011, AAPM. Available at: http://www.aapm.org/pubs/CTProtocols/documents/
NotificationLevelsStatement.pdf)
246 SECTION III  Specialized Radiographic Equipment

DOSE ALERT

A dose value will be exceeded!

The accumulated CTDIvol (1177.41 mGy) will locally exceed the alert value
(1000 mGy for adult). Please reconsider the current examination procedure.

Hint: The currently used scan protocol cannot be saved!

User name (mandatory)

Diagnostic reason

Password

Load Cancel

FIG 16-34  ​CT Dose Alert Value. This is used to trigger a message when cumulative dose at a
location, plus the dose for the next planned and confirmed scan(s), is likely to exceed a prepro-
grammed value.

SUMMARY
• CT was introduced in the 1970s and has revolutionized • The image data can be postprocessed, adjusting the visibil-
medical imaging by creating cross-sectional slices that are ity of the anatomy being studied. The most powerful
able to make similar tissues appear different. postprocessing technique is windowing, which allows ad-
• CT has developed through five generations of equipment, justment of which CT numbers will be made visible.
along with spiral and multislice technology, dramatically • WW controls how many CT numbers will be assigned
reducing scan time and improving image quality. shades of gray (or black or white) and affects the image
• Using a modified x-ray tube, high-frequency generator, contrast.
two sets of collimators (producing a tightly collimated fan • WL sets the midpoint of the window, determining which
beam), an array of detectors, and a data acquisition system, specific CT numbers will be included, and affects the im-
the x-ray transmission values are measured and linear age brightness.
attenuation coefficients calculated and digitized (raw data). • CT image quality is evaluated in terms of noise, spatial
• Using the filtered back projection algorithm, the raw data are resolution, contrast resolution, and artifacts. Excellent im-
used to determine the linear attenuation coefficient for each age quality often has the tradeoff of increased patient
voxel that will be represented by a pixel in the CT image. dose.
• The voxel’s linear attenuation coefficient is then converted • Quality control testing must be done to ensure that the CT
to a CT number (Hounsfield unit), which describes the image has accurate information.
attenuation characteristics of the voxel’s tissue relative to • Radiation dose caused by CT examinations is an impor-
water. The matrix of CT numbers is the image data. tant issue, especially as it relates to children. Technologists
• Imaging protocols include settings for mA, kVp, slice need to adjust technical factors, shield, and use pediatric
thickness, matrix size, SFOV, DFOV, pitch, and image dis- protocols to protect the patient from unnecessary expo-
play. These settings can be adjusted based on individual sure. Radiation safety practices must also be in place to
patients. protect others who remain in the scan room.

CRITICAL THINKING QUESTIONS

1. How does the process of creating a CT image differ from 4. Why is it important to personalize the CT protocol to the
that of a radiographic image? patient size (e.g ,pediatric versus adult)?
2. Why is the CT number a critical aspect of the CT imaging 5. How would a change in the CT parameters affect the
process? radiation exposure to the patient?
3. How does the windowing process allow different tissues to
be made visible in the CT image?
 CHAPTER 16  Computed Tomography 247

REVIEW QUESTIONS
1. The circular structure that the patient and table travel 8. Using a DFOV smaller than the SFOV results in a:
through during the CT scanning process that encompass a. magnified image.
the x-ray unit, data-acquisition system, and the detector/ b. minified image.
detectors is the: c. normal sized image.
a. donut. d. computer system crash.
b. couch. 9. The amount of CT numbers that are visible in the image
c. magnet. is known as the:
d. gantry. a. window level (WL).
2. In a major improvement from single-slice CT acquisition, b. window width (WW).
spiral (helical) CT allowed: c. raw data.
a. continuous of the table and the patient through the d. histogram.
gantry. 10. The ability of the image to differentiate between struc-
b. the entire volume of tissue to be scanned in one tures with very different attenuation characteristics
acquisition. (CT numbers) when they are very close together is
c. scan time to be reduced. known as the:
d. all of the above. a. patient dose.
3. The number of _____ in MSCT equals the number of b. contrast resolution.
slices per revolution. c. edge enhancement filter.
a. detector rows d. spatial resolution.
b. computers 11. The ability to discriminate between structures with very
c. rows in the matrix similar attenuation characteristics (CT numbers) is
d. protocol sequences known as the:
4. The ____ controls how much of the detector is exposed a. patient dose.
during CT imaging, and severely limits the amount of b. contrast resolution.
scatter reaching the detectors. c. edge enhancement filter.
a. prepatient collimator d. spatial resolution.
b. postpatient collimator 12. In CT imaging, ALARA encompasses which of the
c. bowtie filter following?
d. detector array 1. Patient dose is kept as low as reasonably achievable.
5. Logarithmic data from linear attenuation coefficients that 2. Every exposure should have a benefit and justification.
is converted from analog to digital information by the 3. CT technologist must maintain required image quality
analog-to-digital converter and sent to the computer for needed for making a diagnosis (dose optimization).
image reconstruction is the: a. 1 only
a. raw data b. 1 and 2
b. filtered back projection c. 1 and 3
c. pixels d. 1, 2, and 3
d. voxels 13. Ongoing adjustment of the mA based on patient size and
6. What is the CT number of water? tissue characteristics during the CT exam, used to main-
a. 22000 tain image quality while reducing dose, is known as:
b. 100 a. automatic exposure control (AEC).
c. 0 b. automatic tube current modulation (ATCM).
d. 1500 c. filtered back projection (FBP).
7. Which of the following determines the actual anatomy d. adaptive statistical iterative reconstruction (ASIR).
that is imaged during the CT examination?
a. SFOV
b. DFOV
c. FOV
d. all of the above
Continued
248 SECTION III  Specialized Radiographic Equipment

R E V I E W Q U E S T I O N S — cont’d
14. Inaccurate patient centering during a CT exam will de- 16. The dose notification and alert system occurs before pa-
grade the image quality and increase the dose to the pa- tient scanning and can help protect patients from inad-
tient (especially with ATCM). vertent use of excessively high CTDIvol and/or DLP.
True False True False
15. Which of the following statements is true regarding the
use of lead shielding during CT?
1. The AAPM recommends against using lead shielding
in lieu of other methods of radiation protection.
2. Lead shielding of radiosensitive tissues can be effective
in limiting radiation dose when the shields are placed
appropriately outside the SFOV (out-of-plane).
3. The lead shielding must completely surround the pa-
tient because the tube(s) travel in a circular motion.
4. The lead shielding must lie on the couch because the
radiation comes from the area around the table.
a. 1 only
b. 2 and 3 only
c. 2 and 4 only
d. All of the above
 APPENDIX A
Answers to Review Questions

Chapter 1 1 0. D Chapter 8 3. B 8. A
1. D 11. A 1. B 4. C 9. C
2. B 12. C 2. D 5. A 10. D
3. D 13. C 3. C 6. C 11. B
4. A 14. B 4. C 7. D 12. C
5. A 5. C 8. B
6. C Chapter 5 6. A 9. D Chapter 15
7. D 1. D 7. D 10. C 1. D
8. C 2. C 8. B 2. A
9. A 3. B 9. B Chapter 12 3. D
10. B 4. C 10. A 1. A 4. B
5. D 2. C 5. D
Chapter 2 6. D Chapter 9 3. D 6. C
1. A 7. A 1. D 4. C 7. A
2. B 8. A 2. D 5. D 8. B
3. B 9. B 3. B 6. A 9. C
4. A 10. D 4. A 7. A 10. C
5. D 11. B 5. C 8. B
6. A 12. unsafe 6. D 9. D Chapter 16
7. B 13. safe 7. C 10. C 1. D
8. C 14. about 5 minutes 8. D 11. D 2. D
9. C 15. about 50 minutes 9. B 12. A 3. A
10. A 10. C 13. D 4. B
Chapter 6 11. D 14. C 5. A
Chapter 3 1. A 12. D 15. D 6. C
1. A 2. B 13. C 7. A
2. B 3. B 14. B Chapter 13 8. A
3. A 4. C 15. B 1. B 9. B
4. C 5. D 2. C 10. D
5. C 6. C Chapter 10 3. A 11. B
6. D 7. A 1. C 4. D 12. D
7. C 8. D 2. D 5. A 13. B
8. D 9. B 3. D 6. A 14. True
9. A 10. A 4. D 7. C 15. B
10. C 5. B 8. B 16. True
Chapter 7 6. D 9. C
Chapter 4 1. D 7. B 10. D
1. B 2. D 8. B
2. D 3. A 9. A Chapter 14
3. B 4. B 10. B 1. B
4. B 5. D 11. B 2. B
5. A 6. D 12. C 3. D
6. B 7. A 4. D
7. C 8. D Chapter 11 5. D
8. B 9. D 1. B 6. B
9. B 10. A 2. D 7. C

249
G LO S S A RY
15% rule  Changing the kVP by 15% has the same effect as doubling the automatic exposure control (AEC)  A device that uses an ionization
mAs or reducing the mAs by 50%. chamber to detect the quantity of radiation exposing the patient and
ABC  See automatic brightness control. image receptor.
absorption  Those x-ray photons removed from the x-ray beam as a result automatic film processor  A device that encompasses chemical tanks, a
of the uptake of their energy by body tissues. roller transport system, and a dryer system for the processing of radio-
AC  See alternating current. graphic film.
accelerating anode  A positively charged electrode in the neck of the automatic tube current modulation (ATCM)  Technique used in CT
image intensifier that accelerates the electron stream to the output phos- that provides an ongoing adjustment of the mA based on patient size
phor by maintaining a constant potential of approximately 25 kilovolts in and tissue characteristics, maintaining image quality while reducing
the tube. dose.
actual focal spot  Area of x-ray tube target actually bombarded with fila- average gradient  The slop of the straight-line region on the sensitomet-
ment electrons ric curve.
acute radiodermatitis  A skin reddening and inflammation caused by backup time  The maximum length of time the x-ray exposure will
prolonged exposure to ionizing radiation. continue when using an automatic exposure control system.
adaptive statistical iterative reconstruction  In CT, a type of recon- base plus fog (B 1 F)  The minimum amount of density on the radio-
struction technique that begins to calculate data after a first-pass filtered graphic film.
back projection reconstruction, which shortens reconstruction time while beam quality  The penetrating power of the x-ray beam.
maintaining much lower image noise. This technique reduces quantum beam quantity  The total number of x-ray photons in a beam.
noise substantially with no impact on spatial or contrast resolution. beam restriction  Used interchangeably with collimation; both terms refer
ADC  See analog-to-digital converter. to a decrease in the size of the projected radiation field.
AEC  See automatic exposure control. beam-hardening artifact  As the x-ray beam passes through the patient,
air gap technique  Method for limiting the scatter reaching the image especially through bone, the lower-energy photons are filtered out, result-
receptor. Scatter will miss the image receptor if there is increased distance ing in beam hardening; results in inaccurate computed tomography
between the patient and the image receptor (increased object-to-image numbers.
receptor distance). beam-restricting device  Changes the shape and size of the primary
algorithm  A sequence of computer operations for accomplishing a beam; located just below the x-ray tube housing.
specific task. beta particles  An electron that is emitted from an unstable nucleus with
alpha particles  A particle consisting of two protons bound to two the ability to ionize matter.
neutrons with a net positive charge and the ability to ionize matter. binding energy  A force of attraction that holds the nucleus of an atom
alternating current (AC)  Electrical current that changes direction in together and holds electrons in orbit around the nucleus. Also a measure
cycles as the electric potential of the source changes. of the amount of energy necessary to split an atom.
analog-to-digital converter (ADC)  A device that takes the analog signal bit depth  Number of bits that determines the precision with which the
and divides it into a number of bits (1s and 0s) that the computer “under- exit radiation is recorded and thus controls the exact pixel brightness
stands.” (gray level) that can be specified.
anatomically programmed radiography (APR)  A radiographic system body habitus  The general form or build of the body, including size. There
that allows the radiographer to select a particular button on the control are four types  sthenic, hyposthenic, hypersthenic, and asthenic.
panel that represents an anatomic area; a preprogrammed set of exposure bone densitometry  A specialized procedure using ionizing radiation to
factors is displayed and selected for use. provide information on the condition of the skeletal bones.
annotation  Printed comment or label added to the digital image. bowtie filter  The filter frequently used in computed tomography with a
anode  The positive end of the tube that provides the target for electron shape and composition that serve to make the energy level of the photons
interaction to produce x-rays; also an electrical and thermal conductor reaching the detectors more consistent.
anode heel effect  Phenomenon resulting from the angling of the target bremsstrahlung (brems) interactions  An interaction in which a
face that causes the intensity of the x-ray beam to be less on the anode side filament electron is attracted to the nucleus, causing it to slow down
because the “heel” of the target is in the path of the beam. and change direction. The energy loss is emitted as a bremsstrahlung
aperture diaphragm  The simplest type of beam-restricting device, photon.
constructed of a flat piece of lead that has a hole in it. brightness  The amount of luminance (light emission) of a display
APR  See anatomically programmed radiography. monitor.
array processor  A component of the computed tomography computer brightness gain  An expression of the ability of an image intensifier tube
that is dedicated to performing the calculations needed for image recon- to convert x-ray energy into light energy and increase the brightness of
struction. the image in the process.
artifact  Any unwanted image on a radiograph. Bucky  The Potter-Bucky diaphragm located directly below the radio-
atom  From the Greek word atomos, meaning “indivisible.” The basic graphic tabletop, which contains the grid and holds the image receptor.
building block of matter composed of electrons, protons, and neutrons. Bucky factor  Can be used to determine the adjustment in milliampere/
atomic mass number  The number of protons and neutrons an atom has second needed when changing from using a grid to nongrid (or vice-
in its nucleus. versa) or for changing to grids with different grid ratios; also called the
atomic number  The number of protons an atom contains in its nucleus. grid-conversion factor.
attenuation  Reduction in the energy or number of photons in the pri- calipers  Devices that measure part thickness.
mary x-ray beam after it interacts with anatomic tissue. camera tube  One of two commonly used devices used in a fluoroscopic
automatic brightness control (ABC)  A function of the fluoroscopic system to convert the light image from the output phosphor to an elec-
unit that maintains the overall appearance of the fluoroscopic image by tronic signal for display on a television monitor.
automatically adjusting the kilovoltage peak, milliamperage, or both. C-arm  Mobile unit that has fluoroscopic capabilities typically used in the
automatic collimator  Automatically limits the size and shape of the operating room when imaging is necessary during surgical procedures. A
primary beam to the size and shape of the image receptor. Also called a video unit is also attached, offering both static and dynamic recording
positive beam-limiting device. during the procedure.

250
 GLOSSARY 251

cassette  A sturdy, light-proof container for film. Also a sturdy protec- convergent line  An imaginary line if points were connected along the
tive container for the photostimulable phosphor plate in computed length of a linear focused grid.
radiography. convergent point  An imaginary point, if imaginary lines were drawn
cathode  The negative end of the x-ray tube and source of electrons. from each of the lead lines in a linear focused grid.
cathode ray tube  A partial vacuum tube that produced an electron stream conversion factor  An expression of the luminance at the output phos-
and was used to study cathode rays and led to the discovery of x-rays. phor divided by the input exposure rate; its unit of measure is the candela
CCD  See charge-coupled device. per square meter per milliroentgen per second (cd/m2/mR/s).
characteristic cascade  This process of outer-shell electrons filling inner- covalent bond  An atomic bond in which an outermost electron from one
shell vacancies, creating a cascading effect during a characteristic cascade. atom begins to orbit the nucleus of another adjacent atom in addition to
characteristic interactions  An interaction in which a filament electron its original nucleus.
removes an orbital electron from an atom; to regain stability, an outer-shell crossed grid  Has lead lines that run at a right angle to one another.
electron fills the vacancy, giving up its excess energy as a characteristic cross-hatched grid  Has lead lines that run at a right angle to one
x-ray photon. another.
charge-coupled device (CCD)  A light-sensitive semiconducting device CTDI  See computed tomography dose index.
that generates an electrical charge when stimulated by light and stores this CTDIvol  See computed tomography dose index in a volume.
charge in a capacitor. CT number  See computed tomography number.
classical interaction  Also commonly known as coherent scattering or CT table  See computed tomography table.
Thomson scattering. See coherent scattering. current  An expression of the flow of electrons in a conductor.
coherent scattering  an interaction that occurs with low-energy x-rays, cylinder  Essentially an aperture diaphragm that has an extended flange
typically below the diagnostic range. The incoming photon interacts with attached to it.
the atom, causing it to become excited. The x-ray does not lose energy, but DAP  See dose-area product.
changes direction. DAS  See data acquisition system.
collimation  Used interchangeably with beam restriction; both terms refer data acquisition system (DAS)  Amplifies the weak signal produced by
to a decrease in the size of the projected radiation field. the detector-photodiode, converts it to logarithmic data, converts it from
collimator  Located immediately below the tube window where the analog to digital data, and sends it to the computer.
entrance shutters limit the x-ray beam field size. DC  See direct current.
comparative anatomy  Similar anatomic parts can use similar exposure dedicated units  Radiographic units designed for specific imaging pro-
techniques to achieve diagnostic radiographs. cedures.
complimentary metal oxide semiconductor  A scintillator device made densitometer  A device used to measure optical densities.
up of a crystalline silicon matrix. density  The amount of overall blackness on the processed image.
compound  The combination of elements in definite proportions. density controls  Part of the automatic exposure control device that allows
Compton effect  Scattering that results from the loss of some energy of the radiographer to adjust the amount of preset radiation detection values.
the incoming photon when it ejects an outer-shell electron from a tissue derived quantities  The combinations of fundamentals quantities to form
atom. velocity, acceleration, force, momentum, work, and power.
Compton electron  The electron ejected from an atom during a Compton detective quantum efficiency (DQE)  An expression of the potential
scattering event. “speed class” or radiation exposure level that is required to produce an
Compton scattering  An interaction in which an incident x-ray photon optimal image.
enters a tissue atom, interacts with an orbital electron, and removes it detector array  The physical component consisting of multiple detectors
from its shell. In doing so, the incident photon loses up to one third of its that efficiently absorb the transmitted radiation and accurately convert it
energy and is usually deflected in a new direction. to an electrical signal for display on a computer workstation.
computed radiography systems  A digital imaging system that uses a detectors  Radiation-measuring devices
cassette, a photostimulable phosphor plate, a plate reader, and a computer developing agents  See reducing agents.
workstation to acquire and display a digital image. DFOV  See display field of view.
computed tomography dose index (CTDI)  Mean absorbed dose in the diagnostic densities  Appropriate range of optical densities.
scanned object volume. DICOM  See Digital Imaging and Communications in Medicine.
computed tomography dose index in a volume (CTDIvol)  In mul- differential absorption  The difference between the x-ray photons that
tislice CT units, the CTDI is adjusted for weighted index and pitch. are absorbed photoelectrically versus those that penetrate the body.
computed tomography (CT) number  Value related to the attenuation diffusion  The process by which washing works; exposes the film to water
characteristic of the tissue in the voxel, but not an attenuation coefficient; that contains less thiosulfate than the film.
also referred to as the Hounsfield unit. Digital Imaging and Communications in Medicine (DICOM)  A common
computed tomography (CT) table  Also known as the couch; platform computer language that allows different systems of a picture archiving and
that may be flat or curved and is used to move the recumbent patient communication system to communicate with each other.
through the gantry aperture. It can be raised or lowered to assist the direct current (DC)  A type of electrical current that flows in only one
patient in getting on and off. direction.
conductor  Material with an abundance of free electrons allowing free flow direct radiography systems  A digital imaging system that uses a detec-
of electricity. tor array in place of the Bucky assembly; the imaging-forming radiation
cone  Essentially an aperture diaphragm that has an extended flange is captured and transferred to a computer from the detector array for
attached. almost instant viewing at the control panel.
cone beam  The shape of the beam in computed tomography imaging as discrete emission spectrum  A graphic representation of characteristic
the number of slices being imaged per revolution increases and the x-ray x-ray production.
beam is opened. display field of view (DFOV)  Controls the area of anatomy seen on the
continuous emission spectrum  A graphic representation of brems- monitor in computed tomography imaging.
strahlung x-ray production. distortion  Results from the radiographic misrepresentation of either the
contrast medium  A substance that can be instilled into the body by injec- size (magnification) or shape of the anatomic part.
tion or ingestion. Dmax  The point on the sensitometric curve where maximum density has
contrast resolution  Used to describe the ability of the imaging system to been produced.
distinguish between small objects that attenuate the x-ray beam similarly Dmin  The point on the sensitometric curve where the minimum amount of
in digital imaging. radiation exposure produced a minimum amount of optical density.
252 GLOSSARY

dose alert value  In CT, a value used to trigger a message to the technolo- exposure intensity  A measurement of the amount and energy of the
gist when the cumulative dose at a location, plus the dose for the next x-rays reaching an area of the film.
planned and confirmed scan(s), is likely to exceed a preprogrammed exposure latitude  The range of exposure values to the image that will
value. produce an acceptable range of densities for diagnostic purposes.
dose descriptor  A computed value of radiation dose received by the exposure technique chart  Preestablished guidelines used by the radiog-
patient based on manufacturer and calibration phantoms. rapher to select standardized manual or automatic exposure control fac-
dose length product (DLP)  The measurement of energy absorbed per tors for each type of radiographic examination.
unit of mass over a scanned length (z axis). extrapolate  A process that mathematically estimates exposure techniques.
dose notification value  In CT, a value used to trigger a message to the fan-beam geometry  In CT, the size, shape, and motion of the x-ray beam
technologist when a single planned and confirmed scan is likely to exceed and its path, based on the divergent rays of the x-ray tube.
a preprogrammed value. feed tray  A flat metal surface with an edge on either side that permits the
dose optimization  The reduction of the radiation dose while maintain- film to enter the processor easily and align correctly.
ing the required image quality needed for making a diagnosis. filament  A coil of wire, usually 7 to 15 mm long, 1 to 2 mm wide, and
dose report In CT,  the display of the CTDIvol and DLP indices before and usually made of tungsten with 1% to 2% thorium added.
after the CT study is performed. filament circuit  Section of the x-ray circuit that consists of a rheostat, a
dose-area product (DAP)  An actual measure of patient dose measured step-down transformer, and the filaments.
by a DAP meter embedded in the collimator. The value depends on the film contrast  Ability to display a range of density differences which is
exposure factors and film size. manufactured into the film and also affected by film processing; also
double-emulsion film  Has an emulsion coating on both sides of the called image receptor contrast.
polyester base. film-screen contact  Exists when the screen or screens are in direct con-
DQE  See detective quantum efficiency. tact with the film.
dynamic range  The range of exposure intensities that an image receptor filtered back projection (FBP)  The most common reconstruction algo-
can respond to and acquire image data. rithm used in modern computed tomography that uses a computer or
EBCT  See electron-beam computed tomography. electronic filter to convert raw data from the DAS into image data.
edge enhancement filter  Makes all the information in the image appear filtration  The use of a material, usually aluminum (Al) or aluminum
sharper, including the noise. equivalent, to absorb the lower-energy photons from the x-ray beam.
effective focal spot  The x-ray beam area as seen from the perspective of fixed kVp–variable mAs technique chart  A type of technique exposure
the patient. chart in which the optimal kilovoltage peak value for each part is indi-
electric potential  The ability to do work because of a separation of cated and the milliampere per second value is varied as a function of part
charges. thickness.
electrodynamics  The study of electric charges in motion. fixing agent  Clears undeveloped silver halide from the film during pro-
electromagnetic induction  The phenomenon of inducing an electric cessing.
current in that conductor by moving a conductor through a magnetic fluorescence  Refers to the ability of phosphors to emit visible light only
field. while exposed to x-rays.
electromagnetic radiation  An electric and magnetic disturbance travel- fluoroscope  A device that allows dynamic x-ray examination using x-rays
ling through space at the speed of light. and a fluorescent screen.
electromagnetic spectrum  A way of ordering or grouping the different fluoroscopy  The use of a continuous beam of x-rays to create dynamic
electromagnetic radiations. All of the members of the electromagnetic images of internal structures that can be viewed on a display monitor.
spectrum have the same velocity (the speed of light or 3 3 108 m/s) and flux gain  An expression of the ratio of the number of light photons at the
vary only in their energy, wavelength, and frequency. output phosphor to the number of light photons emitted in the input
electromagnetism  The phenomenon of electricity and magnetism exist- phosphor; represents the tube’s conversion efficiency.
ing as two parts of the same basic force, electromotive force. A magnetic focal distance  The distance between the grid and the convergent line or
field is created by a flow of electricity, and a moving magnetic field can point. Also known as the grid radius.
create an electric current. focal plane  Same as the object plane; the plane where the area of interest
electron  Subatomic particle with one unit of negative electrical charge lies, at the level of the fulcrum.
and a mass of 9.109 3 10231 kg. focal range  The recommended range of source-to-image receptor dis-
electron shell  A defined energy level at a distance from the nucleus within tance measurements that can be used with a focused grid.
which electrons orbit. focused grid  Has lead lines that are angled, or canted, to approximately
electron-beam computed tomography (EBCT)  A CT scanner devel- match the angle of divergence of the primary beam
oped for cardiac imaging, the EBCT reduces scan time to as little as 50 ms, focusing cup  A metal shroud that is made of nickel and surrounds the
fast enough to image the beating heart. EBCT is considered by many to be x-ray tube filaments on their back and sides, leaving the front open and
the fifth generation. facing the anode target.
electrostatic focusing lenses  Negatively charged plates along the length fog  Unwanted exposure on the radiographic image that does not provide
of the image-intensifier tube that repel the electron stream, focusing it on any diagnostic information.
the small output phosphor. foreshortening  Refers to images that appear shorter than the true objects.
electrostatics  The study of stationary electric charges frequency  The number of waves passing a given point each second.
element  A substance that cannot be broken down into simpler parts by fulcrum  Also known as the pivot point; the fixed point during the move-
ordinary chemical means. ment of the x-ray tube, which lies within the plane of the anatomic area
elongation  Refers to images of objects that appear longer than the true to be imaged.
objects. fundamental quantities  The foundation units of measure of mass,
emulsion  The radiation-sensitive and light-sensitive layer of the film. length, and time.
exit radiation  The attenuated x-ray beam leaves the patient and is com- gamma rays  A very high-energy electromagnetic radiation originating
posed of both transmitted and scattered radiation; also called remnant from a radioactive nucleus with the ability to ionize matter.
radiation. gantry  Part of the computed tomography scanner that surrounds the
exposure amplitude  The arc or angle created during the radiation- patient and houses the x-ray tube and detectors.
exposure phase of the x-ray tube movement during tomography. GCF  See grid conversion factor.
exposure indicator  Provides a numeric value indicating the level of generations (first through fourth)  The major developments in x-ray
radiation exposure to the digital image receptor. beam and detector geometry in computed tomography.
 GLOSSARY 253

generators  Device that converts some form of mechanical energy into intensifying screen  A device found in radiographic cassettes that con-
electrical energy. tains phosphors that convert x-ray energy into light, which then exposes
geometric properties  Refers to the sharpness of structural lines recorded the radiographic film.
in the radiographic film image. intensity of radiation exposure  A measurement of the amount and
grayscale  The number of different shades of gray that can be stored and energy of x-rays.
displayed by a computer system in digital imaging. interspace material  Radiolucent strips between the lead lines of a grid,
grid  A device that has very thin lead strips with radiolucent interspaces; generally made of aluminum.
intended to absorb scatter radiation emitted from the patient before it inverse square law  The intensity of a source of radiation is inversely
strikes the image receptor. proportional to the square of the distance.
grid cap  Contains a permanently mounted grid and allows the image ionic bond  An atomic bond in which one atom give up an electron and
receptor to slide in behind it. another atom takes the extra electron and the difference in their electrical
grid cassette  An image receptor that has a grid permanently mounted to charge attracts and bonds the two together.
its front surface. ionization  The removal of an electron from an atom.
grid conversion factor (GCF)  Can be used to determine the adjustment ionization/ion chamber  A hollow cell that contains air and is connected
in milliampere/second needed when changing from using a grid to non- to the timer circuit via an electrical wire.
grid (or vice-versa) or for changing to grids with different grid ratios; also ionizing radiation  Radiation with sufficient energy to ionize atoms.
called the Bucky factor. kilovoltage peak (kVp)  The potential difference applied to the x-ray tube
grid cutoff  A decrease in the number of transmitted photons that reach that determines the energy (quality) of the x-ray photons produced.
the image receptor because of some misalignment of the grid. kVp  See kilovoltage peak.
grid focus  The orientation of a grid’s lead lines to one another. latent image  The invisible image that exists on the image receptor before
grid frequency  Expresses the number of lead lines per unit length in it has been processed.
inches, centimeters, or both. latent image centers  Several sensitivity specks with many silver ions
grid pattern  Refers to the linear pattern of the lead lines of a grid. attracted to them. These latent image centers appear as radiographic den-
grid ratio  The ratio of the height of the lead strips to the distance between sity on the manifest image after processing.
them. lead mask  Changes the shape and size of the projected x-ray field; similar
grounding  A protective measure to neutralize an electric charge; also a to an aperture diaphragm.
process of connecting the electrical device to the earth via a conductor leakage radiation  Photons produced in the x-ray tube that are traveling
half-value layer (HVL)  The thickness of absorbing material (aluminum in directions other than toward the patient.
or aluminum equivalent filtration) necessary to reduce the energy of the linear attenuation coefficient  A measure of the probability that the
x-ray beam to one-half its original intensity. x-ray beam will interact with the material while traveling in a straight
heat units (HUs)  A measure of the amount of heat stored in a particular path. The value is based on both the characteristics of the material and the
device. energy of the x-ray photons. The linear attenuation coefficient is symbol-
hertz (Hz)  A unit of measure for frequency equal to one cycle per second. ized by the Greek letter μ.
high contrast  A radiograph with few densities but great differences linear grid  Has lead lines that run in one direction only.
among them; described as short-scale contrast. linear tomography  An imaging procedure using movement of the x-ray
histogram analysis  A process in which a computer analyzes the histo- tube and image receptor in opposing directions to create images of struc-
gram using processing algorithms and compares it to a preestablished tures in a focal plane by blurring the anatomy located above and below the
histogram specific to the anatomic part being imaged. plane of interest.
Hounsfield unit  Value related to the attenuation characteristic of the tis- line-focus principle  A principle that states by angling the face of the
sue in the voxel but not an attenuation coefficient. Also referred to as the anode target a large actual focal spot size can be maintained and a small
computed tomography number. effective focal spot size can be created.
HUs  See heat units. log relative exposure  A measurement of the intensity of radiation expo-
HVL  See half-value layer. sure in increments by a factor of 2.
hydroquinone  A reducing agent found in the film developer chemistry long-scale contrast  A radiograph with a large number of densities but
that produces the black (higher) densities. little differences among them; described as low contrast.
Hz  See hertz. low contrast  A radiograph with a large number of densities but little dif-
image data  The digital array of CT numbers, based on the image matrix ferences among them; described as long-scale contrast.
that results from raw data being reconstructed. luminescence  The emission of light from the screen when stimulated by
image intensification  During fluoroscopy, the process of creating a radiation.
brighter visible image. mA  See milliamperage.
image intensifier  An electronic vacuum tube used in fluoroscopy that magnetism  The ability of a material to attract iron, cobalt, or nickel.
converts the remnant beam to light, then electrons, then back to light, magnification  an increase in the image size of an object compared with
increasing the light intensity in the process. its true, or actual, size.
image receptor  A device that receives the radiation leaving the patient. magnification factor (MF)  Indicates how much size distortion or magni-
image receptor contrast  Ability to display a range of density differences fication is demonstrated on a radiograph. MF 5 source-to-image receptor
which is manufactured into the film and also affected by film processing,; distance divided by source-to-object distance.
also described as film contrast. magnification mode  A function of the fluoroscopic unit that increases
immersion heater  A heating coil that is immersed in the bottom of the the voltage to the electrostatic focusing lenses, resulting in only those
developer and fixer tank of a processor. electrons from the center area of the input phosphor interacting with the
induction motor  An electric motor in which the shaft is rotated through output phosphor and contributing to the image, giving the appearance of
mutual induction. magnification.
infrared light  A low-energy, nonionizing electromagnetic radiation just mammography  A specialized radiographic imaging procedure of the
above microwaves. breast.
input phosphor  A layer of the image intensifier made of cesium iodide manifest image  The visible radiographic image on the exposed film after
and bonded to the curved surface of the tube itself. It absorbs the remnant processing.
x-ray photon energy and emits light in response. mAs readout  The actual amount of mAs used for an image is displayed
insulator  Material with very few free electrons prohibiting the flow of immediately on an automatic exposure control panel immediately after
electricity. exposure.
254 GLOSSARY

mAs/distance compensation formula  A mathematical calculation for particulate radiation  High energy particles with the ability to ionize matter.
adjusting the mAs when changing the source-to-image receptor distance. PBL device.  See positive beam-limiting device.
matrix  Combination of rows and columns (array) of pixels that make up penetration  Those x-ray photons that are transmitted through the body
a digital image. and reach the image receptor.
maximum contrast  The greatest difference in optical densities achieved penetrometer  A device constructed of uniform absorbers of increasing
within the straight-line region of the sensitometric curve. thickness that when radiographed, produces a series of graduated densities.
MF  See magnification factor. permanently installed equipment  Medical imaging equipment that is
microwaves  A low-energy, nonionizing electromagnetic radiation just fixed in place in a specially designed and shielded room.
above radio waves. phenidone  A reducing agent found in the film developer chemistry that
milliamperage (mA)  The current applied to the x-ray tube that ultimately produces the gray (lower) densities.
controls the number (quantity) of photons produced. phosphor layer  The active layer which is the most important screen com-
minification gain  An expression of the degree to which the image is ponent because it contains the phosphor material that absorbs the trans-
minified (made smaller) from input phosphor to output phosphor. mitted x-rays and converts them to visible light.
minimum response time  The shortest exposure time that the automatic photocathode  A layer of the image intensifier made of cesium and anti-
exposure control system can produce. mony compounds. These metals emit electrons in response to light stimulus.
mobile equipment  Medical imaging equipment that is designed to be photoconductor  A device that absorbs x-rays and creates electrical
easily transportable and can be taken to the patient’s bedside, the emer- charges in proportion to the x-ray exposure received.
gency department, surgery, or wherever it may be needed. photodetector  A device used to sense the light released from the photo-
modulation transfer function (MTF)  A measure of the ability of the system stimulable phosphor plate during scanning.
to preserve signal contrast as a function of spatial resolution and describes photodisintegration  An interaction in which extremely high energy
the fraction of each component that will preserve the captured image. photons interact with the nucleus of an atom, making it unstable, and to
Moiré effect  A zebra pattern artifact that can occur during computed regain stability the nucleus ejects a nuclear particle.
radiography imaging if the grid frequency is similar to the laser scanning photoelectric effect  In the diagnostic range, the total absorption of the
frequency or if a grid cassette is placed in a Bucky. incident photon by ejecting an inner shell electron of a tissue atom.
molecule  Fixed ratios of each type of constituent atom resulting in a pre- photoelectric interaction  An interaction in which the incident x-ray
dictable mass. photon interacts with the inner-shell electron of a tissue atom and
motors  Device that converts electrical energy to mechanical energy removes it from orbit. In the process, the incident x-ray photon expends
through electromagnetic induction. all of its energy and is totally absorbed.
MPR  See multiplanar reformation. photoelectron  The electron ejected from an atom during a photoelectric
MSCT  See multislice computed tomography. interaction.
MTF  See modulation transfer function. photomultiplier (PM) tube  An electronic device that converts visible
multiplanar reformation (MPR)  Operation by the computer to display light energy into electrical energy.
the image data in coronal, sagittal, or oblique planes. photon  A discrete bundle of electromagnetic energy.
multislice computed tomography (MSCT)  Instead of collecting the photostimulable luminescence  The release of energy from trapped elec-
transmission data for one slice each time, the tube rotates around the trons by a laser during the scanning of a photostimulable phosphor plate.
patient and collects data for 4 to 641 slices per revolution. photostimulable phosphor (PSP) plate  A plate made up of several layers
neutron  Subatomic particle with no electrical charge and a mass of 1.675 3 that stores x-ray energy as a latent image for cassette-based digital systems.
10227 kg. phototimer  Automatic exposure control detectors that use a fluorescent
nonfocused grid  Has lead lines that run parallel to one another; also (light-producing) screen and a device that converts the light to electricity.
called a parallel grid. Picture Archiving and Communication System (PACS)  An electronic
nucleus  The central core of an atom made up fundamentally of protons network for communication between the image acquisition modalities,
and neutrons. display stations, and storage.
object plane  Also known as the focal plane; the plane where the area of pitch  Identifies the relationship between slice thickness (single slice spiral)
interest lies, at the level of the fulcrum. or beam collimation (MSCT) and the distance the table travels every time
object-to-image receptor distance (OID)  Distance between the object the tube rotates.
radiographed and the image receptor. pivot point  Also known as the fulcrum; a fixed point during the move-
occupational exposure  Radiation exposure received by radiation workers. ment of the x-ray tube and image receptor that lies within the plane of the
optical density  Numeric calculation that compares the intensity of light anatomic area to be imaged.
transmitted through an area on the film (It) with the amount of light pixel  Picture element; the smallest component of the matrix.
originally striking (incident) the area (I0). pixel density  Number of pixels per unit area.
optimal kVp  The kVP value that is high enough to ensure penetration of pixel pitch  The pixel spacing or distance measured from the center of a
the part but not too high to diminish radiographic contrast. pixel to an adjacent pixel.
osteoporosis  A bone disease in which the bones become thinner and Planck’s constant  A mathematical value used to calculate photon ener-
more porous and therefore are susceptible to fractures. gies based on frequency and equal to 4.135 3 10215eV sec.
output phosphor  A layer in the image intensifier that absorbs the elec- plate reader  A device equipped with a drive system and optical system
tron stream and emits light in response. that converts the stored image on a photostimulable phosphor plate to an
PACS  See Picture Archiving and Communication System. electronic signal for display on a computer workstation.
pair production  An interaction occurs when the incident x-ray photon PM tube  See photomultiplier tube.
has enough energy to escape interaction with the orbital electrons and positive beam-limiting (PBL) device  Automatically limits the size and
interact with the nucleus of the tissue atom, resulting in the creation of shape of the primary beam to the size and shape of the image receptor.
the positron and an electron. Also called an automatic collimator.
panoramic x-ray (panorex)  Unit is designed to image curved surfaces, postpatient collimator  Located just after the patient and before the
typically the mandible and teeth. detector array in computed tomography imaging; controls how much of
parallel grid  Has lead lines that run parallel to one another; also called a the detector is exposed.
nonfocused grid. prepatient collimator  Located just before the patient in computed
partial-volume artifact  During computed tomography (CT), inaccurate tomography; a device that limits the beam size and therefore limits patient
information that occurs when the voxel is so large it contains more than exposure and reduces the amount of scatter radiation produced in the
one type of tissue. patient.
 GLOSSARY 255

primary beam  The x-ray beam upon exiting the collimator and exposing scale of contrast  The range of densities visible on a radiographic film.
the patient. scan field of view (SFOV)  In CT, SFOV determines the actual anatomic
primary circuit  Section of the x-ray circuit that consists of the main area of interest as set by the technologist and imaged during the exam.
power switch (connected to the incoming power supply), circuit breakers, scattering  Incoming photons are not absorbed, but instead lose energy
the autotransformer, the timer circuit, and the primary side of the step-up during interactions with the atoms composing the tissue.
transformer. scintillation-type detector  Typically made of cadmium tungstate or a
profile  In computed tomography the transmission measurement for an ceramic material; absorbs the transmitted radiation and produces a pro-
individual detector and the composite electrical signal. portional flash of light.
protective housing  A lead-lined metal structure that provides solid, sta- screen film  The most widely used radiographic film and is intended to be
ble mechanical support and serves as an electrical insulator and thermal used with one or two intensifying screens.
cushion for the x-ray tube. screen speed  The capability of a screen to produce visible light, with a
proton  Subatomic particle with one unit of positive electrical charge and faster screen producing more light than a slower screen (given the same
mass of 1.673 3 10227 kg. exposure).
quantum noise  Caused by too few photons reaching the image receptor secondary circuit  Section of the x-ray circuit that consists of the second-
to form the image; resulting in mottled or grainy appearance. ary side of the step-up transformer, the milliampere meter, a rectifier
radioactivity  The process by which an atom with excess energy in its bank, and the x-ray tube (except for the filaments).
nucleus emits particles and energy to regain stability. secondary electron  The ejected electron resulting from the Compton
radiographic contrast  The degree of difference or ratio between adjacent effect interaction; also called Compton electron.
densities. secondary photons  Characteristic photons produced in ionized tissue
radiographic density  The amount of overall blackness produced on the atoms as outer-shell electrons fill inner-shell vacancies.
processed image. sensitometer  Device used to produce consistent step-wedge densities by
radiologic quantities  The special radiologic science category of measure eliminating the variability of the x-ray unit.
for dose, dose equivalent, exposure, and radioactivity. sensitometric curve  A graphic display of the relationship between the inten-
radiolucent  Descriptive of less dense structures that have a much lower sity of radiation exposure (x axis) and the resultant optical densities (y axis).
probability of x-ray absorption. sensitometric strip  A step-wedge density image produced after exposing
radiopaque  Descriptive of dense structures that readily absorb x-rays. the film in a sensitometer and then processing the film.
radiowaves  The lowest-energy, non-ionizing electromagnetic radiation. sensitometry  The study of the relationship between the intensity of
rare earth elements  Those that range in atomic number from 57 to 71 radiation exposure to the film and the amount of blackness produced
on the periodic table of the elements; they are referred to as rare earth after processing.
elements because they are relatively difficult and expensive to extract from SFOV  See scan field of view.
the earth. sharpness factors  The accuracy of the structural lines is achieved by
raw data  The logarithmic data from the linear attenuation coefficient that maximizing the amount of spatial resolution or recorded detail and mini-
is converted from analog to digital information by the analog-to-digital mizing the amount of distortion.
converter and sent to the computer for image reconstruction. short-scale contrast  A radiograph with few densities but great differ-
ray (computed tomography)  A part of the x-ray beam that falls on one ences among them; described as high contrast.
detector. shoulder region  The point on the sensitometric curve where changes in
recirculation system  Acts to circulate the solutions in each of the tanks exposure intensity no longer affect the optical density.
of a film processor by pumping solution out of one portion of the tank SID  See source-to-image receptor distance.
and returning it to a different location within the same tank from which silver halide  The material in film that is sensitive to radiation and light.
it was removed. silver recovery  Refers to the removal of silver from used fixer solution.
recorded detail  Refers to the distinctness or sharpness of the structural single-emulsion screen film  One emulsion layer and is used with a sin-
lines that make up the recorded image. gle intensifying screen.
reducing agents  Agents that reduce exposed silver halide to metallic sil- size distortion  Refers to an increase in the object’s image size compared
ver and add electrons to exposed silver halide during film processing. with its true, or actual, size.
region of interest (ROI)  Selection of a region of the digital image data set slip-ring technology  Located inside the CT gantry; allows the tube to
for statistical analysis. continue to rotate without the need to rewind.
relative speed  The ability of the screen to produce visible light. Relative slope  Mathematically indicates the ratio of the change in y (optical den-
speed results from comparing screen-film systems based on the amount sity) for a unit change in x (log relative exposure).
of light produced for a given exposure. smoothing filter  A reconstruction filter that can change the appearance
remnant beam  The x-ray beam that remains after interaction with the of the anatomy by smoothing out the image noise to make it less visible.
patient and is exiting the patient to expose the image receptor. SOD  See source-to-object distance.
remnant radiation  The attenuated x-ray beam leaving the patient that is source-to-image receptor distance (SID)  The distance between the
composed of both transmitted and scattered radiation; also called exit source of the radiation and the image receptor.
radiation source-to-object distance (SOD)  The distance from the source of radia-
replenishment  Refers to the replacement of fresh chemicals after the loss of tion to the object being radiographed.
chemicals during processing, specifically developer solution and fixer solution. space charge  A cloud of electrons formed by the focusing cup as elec-
resistance  That property of an element in a circuit that resists or impedes trons are boiled off of the filament.
the flow of electricity. space-charge effect  The self-limiting factor caused by the space charge
resolution  The ability of the imaging system to resolve or distinguish reaching a size commensurate with the current used and making it diffi-
between two adjacent structures and can be expressed in the unit of line cult for additional electrons to be emitted.
pairs per millimeter (Lp/mm). spatial resolution  The smallest structure that may be detected in an
ring artifact  A circular-shaped artifact associated with a faulty detector in image measured in line pairs per millimeter (Lp/mm).
third generation CT scanners. It was eliminated in fourth-generation spectral emission  Refers to the color of light produced by a particular
scanners. intensifying screen.
ROI  See region of interest. spectral matching  Refers to correctly matching the color sensitivity of
rotor  A part of an induction motor made of an iron core (iron bars the film to the color emission of the intensifying screen.
embedded in the copper shaft) surrounded by coils and located in the spectral sensitivity  Refers to the color of light to which a particular film
center of the stators. is most sensitive.
256 GLOSSARY

speed  The degree to which the film or intensifying screen is sensitive to transformer  Device used to increase or decrease voltage (or current)
x-rays or light. Indicates the amount of optical density produced for a through electromagnetic induction.
given amount of radiation exposure. The greater the speed of the film, the transmission  X-ray photons that pass through the body to expose the
more sensitive it is. image receptor.
speed exposure point  The point on the sensitometric curve that indicates ultraviolet light  A low-energy, nonionizing electromagnetic radiation
the intensity of exposure needed to produce a density of 1 plus B 1 F just above visible light.
(speed point). values of interest (VOI)  Established values within histogram models that
speed point  The point on a sensitometric curve that corresponds to the determine what part of the data set should be incorporated into the dis-
optical density of 1 plus B 1 F. played image.
spiral (helical) computed tomography  Continuous rotation of the tube variable kVp–fixed mAs technique chart  A type of exposure technique
(and detectors) coupled with continuous movement of the table and chart that changes the kilovoltage peak for change in part thickness.
patient through the gantry. Instead of collecting data one slice at a time, view  In computed tomography, a snapshot of all the transmission mea-
data is collected for an entire volume of tissue (such as the head or chest) surements from that anatomic location, composed of rays.
at one time. visibility factors  Factors that make the anatomic structures visible and
standby control  An electric circuit that shuts off power to the roller include the brightness or density and contrast of the image.
assemblies when the processor is not being used. visible light  A low-energy, nonionizing electromagnetic radiation just
stator  A part of an induction motor made up of electromagnets arranged above infrared light.
in pairs around the rotor. VOI  See values of interest.
step-wedge densities  A series of uniform densities that resemble a step voxel  Volume element; determined by the size of the pixel and the thick-
wedge. ness of the slice, the actual small amount of tissue that will be represented
straight-line region  Portion of the sensitometric curve where the diag- by one pixel.
nostic or most useful range of densities are produced. voxel volume  The dimensions of the voxel.
streak artifact  A linear-shaped artifact that is caused by patient motion or wafer grid  A stationary grid placed on top of the image receptor.
the presence of metal in the anatomy being imaged during computed wavelength  The distance between the peak of one wave to the peak of the
tomography. next wave.
subject contrast  Refers to the absorption characteristics of the anatomic window level  Sets the midpoint of the range of brightness visible in the
tissue radiographed along with the quality of the x-ray beam. digital image.
target window  A thinned section of the x-ray tube enclosure that is the window level  A control that adjusts the radiographic contrast on the
desired exit point for the x-rays produced. digital image.
teleradiology  An electronic system that allows patients’ electronic records window width  A control that adjusts the radiographic contrast on the
(medical information and imaging studies) to be accessed from various digital image.
workstations within or outside of a facility. windowing  Adjusting the window width and window level on the digital
TFT  See thin-film transistor. image.
thermionic emission  The literal boiling off of electrons from a filament x-ray emission spectrum  A graphic representation of the x-ray beam as
by a flow of electrical current. a whole, combining the relevant parts of the discrete and continuous
thin-film transistor (TFT)  Electronic source-to-object distance compo- emission spectra.
nents layered onto a glass substrate that include the readout, charge col- x-ray scintillator  A material that absorbs x-ray energy and emits visible
lector, and light-sensitive elements. light in response.
tissue density  Matter per unit volume, or the compactness of the atomic x-rays  A very high-energy electromagnetic radiation originating
particles composing the anatomic part. through interactions between electrons and atoms with the ability to
toe region  Area of low density on the sensitometric curve. ionize matter.
tomographic angle  The arc created during total movement of the x-ray tube. Z axis  Direction from head to foot in computed tomography imaging.
 INDEX
A Anode, of x-ray tube, 51–55, 52f Automatic exposure control (Continued)
ABC (automatic brightness control), for anode heel effect with, 54, 55b, 55f and anatomically programmed radiography,
fluoroscopy, 208 defined, 8 193–194, 193f
Absorbing layer, of intensifying screen, 175b line-focus principle for, 53–54, 54f, 55b backup time in, 190, 190b
Absorption rotating, 52–53, 52f, 53b in cassette-based digital receptor systems,
beam attenuation and, 83, 83b stationary, 52, 52f 157–158
defined, 93b target angle for, 53–54, 54f compensating issues in, 192–193
differential, 77–79, 78b, 78f Anode cooling charts, 58, 58f collimation as, 193, 193b
and clinical practice, 79b Anode disk, 52f image receptor variations as, 193, 193b
defined, 78b Anode heel effect, 54, 55b, 55f patient considerations as, 192–193,
image production and, 82–83, 82b, 83b, Anode stem, of x-ray tube, 52f 192b
83f Aperture diaphragms, 142, 142f defined, 187
and patient dose, 79b Application-specific integrated circuits (ASIC), density adjustment in, 190
vs. transmission, 78 in fluoroscopy, 213 device for, 41–42, 187
Absorption efficiency, of intensifying screen, APR (anatomically programmed radiography), digital imaging and, 195b, 196t
175–176 193–194, 193f film-screen radiography and, 195t
AC (alternating current), 34, 34b Archival quality, of radiographs, 178b kilovoltage peak and milliamperage/second
Accelerating anode, in image intensifier, Archiving component, of PACS, 171 selection in, 189, 189b
206, 207f Array processor, for CT, 234 manual techniques versus, 194b
Acceleration, 6, 6b Artifacts, 99–100, 100f mAs readout in, 189, 189b
Adaptive statistical iterative reconstruction in CT, 240–241, 241f, 242f minimum response time in, 189–190
(ASIR), 234 in digital imaging, 100 principle of, 187b
ADC (analog-to-digital converter) minus-density, 99–100 quality control for, 194–195
in digital imaging, 101 plus-density, 99–100 calibration in, 194
in digital receptors, 158 film, 180–182 testing in, 194–195
in fluoroscopy, 213 dirt, 181f radiation detectors in, 187–189, 187b, 187f
Additive diseases, 200, 200t half-moon, 181f ionization chamber systems as, 188–189,
Adhesive, in film, 172b minus-density, 181f 188f, 189b
AEC. see Automatic exposure control (AEC) moisture, 181f phototimers as, 187, 188f
AgBr (silver bromide), in latent image plus-density, 181f Automatic exposure devices. see Automatic
formation, 174b scratch, 181f exposure control (AEC)
Air gap, and object-to-image receptor distance, static discharge, 181f Automatic film processing, 177–182
127, 128f As Low As Reasonably Achievable (ALARA) components of, 177–178, 177t
Air gap technique, for scatter control, 153–154, Principle, 10, 10b developing in, 177–178, 177b, 177t, 179f
153f, 154b a-Se (amorphous selenium), in direct-capture drying in, 177t, 178, 178b, 179f
ALARA (As Low As Reasonably Achievable) method, 160–161, 160f equipment for, 177, 177f
Principle, 10, 10b ASIC (application-specific integrated circuits), fixing in, 177t, 178, 178b, 179f
Algorithm, for CT image reconstruction, 234 in fluoroscopy, 213 inadequate, 180, 180t
Alignment considerations, in automatic ASIR (adaptive statistical iterative recirculation system in, 179
exposure control, 190–192 reconstruction), 234 replenishment in, 179, 179b
Alpha particles, 17–18, 18f, 29, 30b, 30f Asthenic body habitus, 133, 134f stages of, 177, 179f
Alternating current (AC), 34, 34b Atom, 16 systems for, 178–180, 179f
American Registry of Radiologic Technologists/ Bohr model of, 18, 18f temperature control in, 179, 179b
American Society of Radiologic complexity, 20f washing in, 177t, 178, 178b, 179f
Technologists (ARRT/ASRT) Code of parts of, 18f Automatic film processor, 177, 177f
Ethics, 10, 10b structure of, 16–20 Automatic tube current modulation, with CT,
Ammonium thiosulfate, as fixing agent, 178 historical overview of, 16–18, 17f 243, 243f
Amorphous selenium (a-Se), in direct-capture in modern theory, 18, 18f Autotransformer, 40f, 41b
method, 160–161, 160f Atomic charge, 19b
Ampere, 34 Atomic mass number, 21 B
Ampere, André-Marie, 34 Atomic number, 21, 21f Back screen, of intensifying screen, 175
Amplitude Atomic structure, 18b Backing layer, of photostimulable phosphor
of electromagnetic radiation, 27, 27f Atomic theory, 16–17, 17f plate, 157–158
tomographic, 225b Atomism, 16–17 Backup time, in automatic exposure control,
Analog-to-digital converter (ADC) Attenuation, beam. see Beam attenuation 190, 190b
in digital imaging, 101 Attenuation coefficient, in CT, 234 Base, of intensifying screen, 175b
in digital receptors, 158 Automatic brightness control (ABC), for Base plus fog (B + F), 111
in fluoroscopy, 213 fluoroscopy, 208 Battery, 35–36, 36t
Anatomic programming, 193, 193f Automatic collimators, 144–145 Beam, unrestricted primary, 140, 141f
Anatomically programmed radiography (APR), Automatic exposure control (AEC), 42b, 43b, 189b Beam attenuation, 83–88
193–194, 193f alignment and positioning considerations in, absorption and, 83, 83b
Annihilation event, 77 190–192 defined, 83
Annotation detector selection as, 190–191, 191b, 191f factors affecting, 86–88, 87b, 87t
of CT, 236 detector size as, 192 tissue density as, 87
of digital image, 164b patient centering as, 191–192, 191b, 192f tissue thickness as, 86, 86f
257
258 INDEX

Beam attenuation (Continued) Cathode, of x-ray tube, 51–52, 52f, 55, 55b, 55f Computed radiography (CR) systems, 157–158,
type of tissue as, 86–87 defined, 8, 55 157f
x-ray beam quality as, 87 Cathode ray tube, 1–2 Computed tomography (CT), 227–248
photoelectric effect and, 83, 83b, 84f, 85b CCD (charge-coupled device) development of, 228–231
scattering and, 83–85, 84b in digital radiography, 159, 159f additional advancements in, 230–231
transmission and, 85–86, 85f for fluoroscopy, 210, 210f generations in, 229–230, 229f, 230b
Beam quality, 66–67, 67b, 67t Central ray (CR) alignment, 130, 131f display field of view for, 236
beam attenuation and, 87 and shape distortion, 98 electron-beam, 230, 230f
and radiographic contrast, 95–96, 95f Cesium iodide, in digital radiography, 159 image data production in, 231–234
Beam quantity, 65–66, 67b, 67t Characteristic cascade, 62–63 bowtie filter for, 232, 232f
Beam restriction, 11b, 130–132, 140–145 Characteristic interactions, 61–63, 62f, 63b collimators for, 232–233, 232f, 233b
compensating for, 141–142, 142t Charge-coupled device (CCD) data acquisition system for, 233, 233f
devices for, 142–145 in digital radiography, 159, 159f detector array for, 233, 233f
aperture diaphragms as, 142, 142f for fluoroscopy, 210, 210f inside of gantry, 231, 232f
collimators as, 143–144, 144f, 145b Chemical compounds, 21 raw data in, 233, 233f, 234b
automatic, 144–145 Chemical energy, 7 scanning unit for, 231, 232f
cones and cylinders as, 142–143, 143f Chemical reaction, 17 x-ray tube for, 232
and image receptor exposure, 132b Chemical shorthand, 21, 21f image quality in, 238–241
and patient dose, 140b Chest units, dedicated, 221, 221f artifacts in, 240–241, 241f, 242f
and radiation protection, 132b, 136 Children, CT for, 244 contrast resolution in, 240, 240b, 241f
and radiographic contrast, 141, 141b Ci (curie), 7 noise in, 239, 239b, 239f
and scatter radiation, 140, 140b, 141f Circuit, x-ray. see X-ray circuit spatial resolution in, 240, 240f, 241f
unrestricted primary beam and, 140, 141f Circuit breakers, 36t, 40 image reconstruction in, 234, 234b
Beam-hardening artifact, 241, 242f C/kg (coulomb/kilogram), 7 algorithm for, 234
Beam-splitting mirror, in fluoroscopy, 207f Classical interactions, 73–74, 74b, 74f array processor in, 234
Becquerel, Henri, 17–18 Closed circuit, 35 CT number in, 234, 234b, 235f
Becquerel (Bq), 7 Closed-core transformer, 39f image data in, 234, 234b, 235f
Beta particles, 29, 30b, 30f Coherent scattering, 73–74 imaging controls and data storage in,
Binding energy, 19, 20b beam attenuation and, 84–85 235–236
electron, 19 Collimation, 140–145 equipment for, 235–236, 235f
nucleus, 19 in automatic exposure control, 193, protocols for, 236, 236f
of tungsten, 63, 63t 193b multislice, 231, 231f
Bismuth shields, 244 compensating for, 141–142, 142t operator’s console for, 235–236, 235f
Bit depth, 162 devices for, 142–145 pitch in, 236, 236f
Blur, in linear tomography, 225b aperture diaphragms as, 142, 142f postprocessing of, 236–238
Body habitus, and radiographic exposure, collimators as, 143–144, 144f, 145b annotation in, 236
133, 134f automatic, 144–145 multiplanar reformation in, 236, 237f
Bohr, Niels, 17–18 cones and cylinders as, 142–143, 143f multiple options for, 236
Bohr model, of atom, 18, 18f and patient dose, 140b region of interest in, 236
Bonding, 23, 23b and radiographic contrast, 141, 141b windowing in, 236–238, 237f, 238b, 238f,
Bone densitometry, 221–222, 222b, 222f and scatter radiation, 140, 140b, 141f 239f
Bowtie filter, 232, 232f unrestricted primary beam and, process of, 228, 228f
Bq (Becquerel), 7 140, 141f quality control for, 242
Bremsstrahlung interactions, 61–62, 63–65, 64b, Collimators, 143–144, 144f radiation protection with, 242–246, 242b
64f automatic, 144–145 radiographic image vs., 229f
Brightness in CT, 232–233, 232f, 233b scan field of view for, 236
of digital image, 101–103, 103b, 104f defined, 8 scan time for, 236
mAs and, 119b function of, 8–9 spiral, 230–231, 231f
radiograph, 93–94 quality control check for, 145b Computed tomography (CT) image,
Brightness gain, in fluoroscopy, 90, 90b, 207, x-ray field measurement guide for, 143–144, characteristics of, 234, 234f
208b 144f Computed tomography (CT) number, 234,
British system, 5 Color layer, of photostimulable phosphor plate, 234b
Bucky, 148 157–158 Computed tomography (CT) scanner, 231–234,
Bucky factor, 148, 149t Comparative anatomy, in exposure technique 231b, 232f
Bucky, Gustave, 145 chart development, 199 bowtie filter for, 232, 232f
Compensating filters, 65, 66f collimators for, 232–233, 232f, 233b
Compound, 21 data acquisition system for, 233, 233f
C Compton effect. see Compton scattering detector array for, 233, 233f
Calibration, with automatic exposure control, Compton electron, 74, 83 high-frequency generator in, 232
194 Compton interactions, 74–75, 75b, 75f inside of gantry, 231, 232f
Calipers, 197, 197f Compton scatter photon, 74 raw data in, 233, 233f, 234b
Camera tube, for fluoroscopy, 207f, 209–210, 209f Compton scattering, 74 table of, 231, 232f
Capacitor, 35–36, 36t beam attenuation and, 83–85, 84b, 85f “translate-rotate” types of, 229
C-arm mobile units, 220, 220f control of. see Scatter control x-ray tube for, 232
Cassette, 157, 157f in digital imaging, 99b Conduction band, 34
of film-screen image receptor, 176 kilovoltage peak (kVp), 123, 123b, 124b of photostimulable phosphor plate, 158
Cassette spot film, for fluoroscopy, 207f, 212, 212b probability of, 140b Conductive layer, of photostimulable phosphor
Casts, and exposure factors, 199–200 vs. photoelectric effects, 85b plate, 157–158
 INDEX 259

Conductors, 35–36, 35b D Detector size, 161–162

Cone(s), for beam restriction, 142–143, 143f Dally, Clarence, 3, 206f in automatic exposure control, 192
Cone beam, in MSCT, 231 Dalton, John, 17, 17f Developing, in film processing, 177–178, 177b,
Contact, electrification by, 33 DAP (dose-area product), 164 177t, 179f
Continuous emission spectrum, 67, 68f Darkroom Developing agents, 177–178, 177b
Contrast cleaning of, 180 DFOV (display field of view), in CT, 236
collimation and, 141, 141b hazards in, 180 Diamagnetic materials, 37
of digital image, 104–105 safelights in, 180 DICOM (Digital Imaging and Communications
and window width, 104, 104f, 105b, 105f Data acquisition system (DAS), in CT scanner, in Medicine), 169
of film, 108–109, 112–113, 173 233, 233f Differential absorption, 77–79, 78b, 78f, 79b
average gradient and, 113, 113b, 113f Data storage, in CT, 235–236 and clinical practice, 79b
exposure latitude and, 113–114, 113b, equipment for, 235–236, 235f defined, 78b
113f, 114f protocols for, 236, 236f and image production, 82–83, 82b, 83b, 83f
slope of sensitometric curve and, 112b, DC (direct current), 34 and radiographic contrast, 94, 95f, 96
112f Dedicated units, 221–223 Digital fluoroscopy, 213–215, 214b
film-screen, 94–96, 108–109 for bone densitometry, 221–222, 222b, 222f Digital image acquisition, 161, 161b, 161f
beam quality and, 96 chest, 221, 221f Digital image characteristics, 101–106
defined, 94 for mammography, 222–223, 222f, 223b binary digits as, 103b
differential absorption and, 94, 95f, 96 for panoramic x-ray, 221, 222f brightness as, 101–103, 103b
high (short-scale), 108, 108f DELs (detector elements), 159–160, 160f and window level, 102–103, 103b, 104f,
high subject, 94, 95f Democritus of Abdera, 16–17 105f
lack of, 94, 95f Densitometer, 107–108, 107f, 110 contrast as, 104–105
levels of, 96 Density, radiographic, grid ratio and, 149b and window width, 104, 104f, 105b, 105f
low (long-scale), 108, 109f Density adjustment, in automatic exposure dynamic range as, 101, 101b
low subject, 96f control, 190 and exposure technique selection, 106b
and radiographic density, 108 Density controls, in automatic exposure image matrix as, 101f
scale of, 108 control, 190 defined, 101
sharpness and, 97, 98f Density differences, 94 pixel bit depth in, 101, 103f, 104b
grid ratio and, 146b Density(ies), 93–94 pixels in, 101, 101f
grids and, 130b defined, 93 size of, 101, 102b, 102f
Contrast agent, and exposure factors, 200–202, diagnostic, 108 image noise as, 105–106, 106f
201f diagnostic range of, 107–108 number of photons and, 105b
Contrast media, and exposure factors, 200–202, film-screen, 107–108 kVp and, 121b
201f defined, 107 radiation exposure, 94
Contrast resolution diagnostic range of, 107–108 spatial resolution as, 105, 105f
in CT, 240, 240b, 241f formula for, 107b and pixel density, 105, 105b
of digital image, 101, 103b, 104, 104b light transmittance and, 107, 107b, 108b visibility and accuracy as, 101, 103f
Control panel, 10 and mAs, 120b windowing and, 104f, 105f
Convergent line, of grid, 147, 148f optical, 107–108, 107b, 108b, 108t Digital image display, 162–164, 163b, 163f, 164b
Convergent point, of grid, 147, 148f optical, 107–108 Digital image extraction, 161–162, 162b, 162f
Conversion efficiency, of intensifying screen, defined, 107 Digital image noise, 105–106, 106f
175–176 diagnostic range of, 107–108 and number of photons, 105b
Conversion factor, in fluoroscopy, 90, 207, exposure density and, 107–108, 108b Digital image receptors. see Digital receptors
208b formula for, 107b Digital Imaging and Communications in
Cooling charts, for x-ray tubes, 57, 58f light transmittance and, 107, 107b, 108b, 108t Medicine (DICOM), 169
Cooling fan, in tube housing, 50–51 optimal, 93–94, 94f Digital receptors, 88, 105, 157–161
Cormack, Alan, 228 and quantity of radiation, 94 cassette for, 157, 157f
“Coulomb,” 33 radiographic, 93–94 detector for, 157–161
Coulomb/kilogram (C/kg), 7 defined, 107 direct radiography systems for, 158–161
Coulomb’s law, 33 differential absorption and, 94, 95f charge-coupled device in, 159, 159f
Covalent bonding, 23, 23f excessive, 93–94, 94f detector array in, 158–161, 159f
CR (central ray) alignment, 130, 131f insufficient, 93–94, 94f direct-capture, 160–161, 160f, 161b
shape distortion and, 98 and kVp, 121, 122f indirect capture, 159, 159f, 160b, 160f
CR (computed radiography) systems, 157–158, and mAs, 119, 120f thin-film transistor array in, 159–160, 160f
157f optimal, 93–94, 94f dose-area product with, 164
Cross-hatched grid, 146, 146f and radiographic contrast, 108 exposure indicators with, 164, 164b
Cross-sectional area, and resistance, 35 range of, 94 image noise with, 165–166, 165f
Crossed grid, 146, 146f step-wedge, 109, 109f kilovoltage peak with, 166, 166b
Crosshairs, 8–9 Derived quantities, 5, 5f lookup table with, 166
CT. see Computed tomography (CT) Dermatitis, x-ray, 3f mAs with, 119, 119b, 166, 166b
CT dose index (CTDIvol), 243 Destructive diseases, 200, 200t rescaling with, 166, 167f
Curie, Marie, 17–18 Detective quantum efficiency (DQE), 165, 165b scatter with, 99b
Curie, Pierre, 17–18 Detector array control of, 167, 167b
Curie (Ci), 7 in CT scanner, 233, 233f spatial resolution with, 165–166
Current, 33–35 in digital receptors, 158–161, 159f speed class with, 165, 165b
types of, 34b Detector elements (DELs), 159–160, 160f troubleshooting with, 167–168
voltage and, inverse relationship of, 39b Detector selection, in automatic exposure use of, 164–168
Cylinders, for beam restriction, 142–143, 143f control, 190–191, 191b, 191f tips for, 167, 168b
260 INDEX

Diode, 35–36, 36t Electrical energy, 7 Energy, 7

Direct attached storage, 172 Electrical phenomena, expressions of, 34b chemical, 7
Direct current (DC), 34 Electricity, nature of, 33, 33b electrical, 7
Direct radiography systems, 158–161 Electrodynamics, 33 electromagnetic, 7
charge-coupled device in, 159, 159f Electrolytic method, of silver recovery, 182 kinetic, 6–7
detector array in, 158–161, 159f Electromagnet, 37 potential, 6–7
direct-capture, 160–161, 160f, 161b Electromagnetic energy, 7, 27b thermal, 7
indirect capture, 159, 159f, 160b, 160f Electromagnetic induction, 36–40, 37b Energy levels, 19–20
thin-film transistor array in, 159–160, 160f Electromagnetic radiation, 25–29, 26f Equalization, of digital image, 164b
Direct-capture method, in digital receptors, amplitude of, 27, 27f Equipment
160–161, 160f, 161b defined, 25–26 for automatic film processing, 177, 177f
Dirt artifacts, 181f energy of, 26–27 for CT imaging controls and data storage,
Discrete emission spectrum, 67, 68f frequency of, 27 235–236, 235f
Display calculation of, 27b for radiology, 8–10
for CT, 236 in Planck’s constant, 27 mobile, 8
of digital image, 162–164, 163b, 163f, 164b wavelength and, 27 permanently installed, 8
Display field of view (DFOV), in CT, 236 inverse square law for, 28, 28b, 28f for sensitometry, 109–110, 109f, 110f
Distance nature and characteristics of, 25–28, 26b Erg, 7
beam quantity and, 65 wavelength of, 27, 27f Europium, in photostimulable phosphor plate,
object-to-image receptor. see Object-to-image calculation of, 28b 158
receptor distance frequency and, 27 Exit radiation, 86f, 88
source-to-image receptor. see Source-to-image Electromagnetic spectrum, 25–26, 26f, 29b Exit-beam intensities, and kVp, 123, 123f, 124f
receptor distance rest of, 29 Exposure factors
source-to-object, 129, 129f summary of, 29t patient factors in, 133–136, 134f
Distortion, 97–98 wavelengths of, 25–26 body habitus as, 133
in fluoroscopy, 209, 209f Electromagnetic wave measures, 27f part thickness as, 135–136, 135f
shape, 98, 98f Electromagnetism, 36–40 pediatric patients as, 136
and central ray alignment, 98 Electron(s), 17 primary, 118–124
size, 97–98 binding energy of, 19 kVp as, 121–124, 121b, 121f, 122–123b,
object-to-image receptor distance and, in Bohr model, 18, 18f 122b, 122f, 123b, 123f, 124b, 124f
97–98, 127–128, 128b, 128f Compton (secondary), 74, 83 milliamperage and exposure time as,
source-to-image receptor distance and, discovery of, 17 118–120, 118b, 118f, 119b, 120b, 120f
97–98, 127, 127b, 127f electrical charge of, 19 radiation protection review for, 136–137
Dmax, 111 in modern theory, 18, 18f beam restriction in, 136
Dmin, 111 orbit, 19 excessive radiation exposure and digital
Dose alert value, 244, 246f photo-, 75–76, 83 imaging in, 137
Dose-area product (DAP), 164 shared, 23f film-screen speed in, 136
Dose descriptors, in CT, 243, 243f Electron-beam computed tomography (EBCT), grid selection in, 136
Dose length product (DLP), 243, 243f 230, 230f kVp and mAs in, 136
Dose notification value, 244, 245f, 245t Electron cloud, 56 secondary, 124–133, 125t
Dose optimization, in CT, 242 Electron gun, in fluoroscopy, 210–211, 211f beam restriction as, 130–132, 132b
Dose report, 243, 244f Electron shells, 19–20, 19f central ray alignment as, 130, 131f
Double-emulsion film, 172 Electron transfer, 23f compensating filters as, 133
DQE (detective quantum efficiency), 165, 165b Electronic devices, 35–36 film-screen relative speed as, 133, 133b
Drying, in film processing, 177t, 178, 178b, Electronic timer, 41 focal spot size as, 125–126, 125b
179f Electrostatic attraction, 23f generator output as, 132
Dual-energy x-ray absorptiometry (DXA), 221, Electrostatic focusing lenses, in image grids as, 130, 130b, 132b, 132f, 132t
222b, 222f intensifier, 89–90, 206, 207f magnification factor as, 128–130, 129b,
Dual-focus tubes, 55 Electrostatics, 33 130b
Duplitization, 172 defined, 33 object-to-image receptor distance as,
Dynamic imaging, 87f, 89–90, 90b general principles of, 33 127–128, 128b, 128f
Dynamic range Element(s) source-to-image receptor distance as,
of digital image receptor, 101, 101b, classification of, 21 126–127, 126b, 126f
162–163 defined, 21 source-to-object distance as, 129, 129f
of film-screen image receptor, 107b periodic table of, 21, 22f tube filtration as, 132–133, 132b
radioactive, 30 Exposure indicators, 102, 164, 164b
Elemental mass, 22f Exposure intensity, and optical density,
E Elongation, 98, 98f 107–108, 108b
EBCT (electron-beam computed tomography), Emission spectrum, 67–70, 67f Exposure latitude, 162–163
230, 230f continuous, 67, 68f Exposure rate, and age of image intensifier,
Edge enhancement, of digital image, 164b discrete, 67, 68f 208b
Edge-enhancement filter, for CT, 239, 240f factors affecting, 70t Exposure technique, 117–138
Edison, Thomas, 3, 205, 206f generator type as, 69, 69f, 70b charts for, 195–199
EI (exposure index), 164–165 kVp as, 68, 69b, 69f conditions for, 196–197
Einstein, Albert, 7 milliamperage as, 68, 68b, 69f defined, 195
Electric circuit, 35 target material as, 70, 70b, 70f design characteristics of, 197
Electric potential, 33–35 tube filtration as, 69, 69b, 69f development of, 199
Electrical charge, 19, 33 Emulsion layer, of film, 172, 172b and radiographic quality, 196b
 INDEX 261

Exposure technique (Continued) Fiberoptic bundle, in fluoroscopy, 210 Film-screen (Continued)

special considerations in, 199–202 Field of view, 161–162 differential absorption and, 94, 95f, 96
types of, 197–199, 198t for CT, 236 high (short-scale), 108, 108f
for linear tomography, 225 Field size. see Collimation high subject, 94, 95f
patient factors in, 133–136, 134f 15% rule, and kilovoltage, 122, 122–123b, 122b lack of, 94, 95f
body habitus as, 133 Filament(s), 46, 46f levels of, 96
part thickness as, 135–136, 135f of x-ray tube, 51–52, 55b low (long-scale), 108, 109f
pediatric patients as, 136 Filament circuit, 45–47, 46f low subject, 96f
primary factors in, 118–124 Filament current, 45 and radiographic density, 108
kVp as, 121–124, 121b, 121f, 122–123b, Film scale of, 108
122b, 122f, 123b, 123f, 124b, 124f characteristics of, 111–114, 173 sharpness and, 97, 98f
milliamperage and exposure time as, average gradient of, 113b, 113f x-ray beam quality and, 96
118–120, 118b, 118f, 119b, 120b, 120f contrast of, 112–113, 112b, 112f recorded detail as, 114
radiation protection review in, 136–137 exposure latitude as, 113–114, 113b, 113f, sensitometry as, 109–114
beam restriction in, 136 114f equipment for, 109–110, 109f, 110f
excessive radiation exposure and digital film contrast as, 173 log relative exposure in, 110–111, 110f, 111b
imaging in, 137 film latitude as, 173 Film-screen image receptors, 88–89, 172–176
film-screen speed in, 136 spectral sensitivity as, 173 artifacts in, 180–182, 181f
grid selection in, 136 speed as, 111, 111b, 112f, 173 automatic exposure control with, 195t
kVp and mAs in, 136 speed exposure point as, 111–112, 112f automatic processing of, 177–182
secondary factors in, 124–133, 125t speed point as, 111, 111f developing in, 177–178, 177b, 177t, 179f
beam restriction as, 130–132, 132b construction of, 172, 172b drying in, 177t, 178, 178b, 179f
central ray alignment as, 130, 131f double-emulsion, 172 fixing in, 177t, 178, 178b, 179f
compensating filters as, 133 as image receptor. see Film-screen image inadequate, 180, 180t
film-screen relative speed as, 133, 133b receptors recirculation system in, 179
focal spot size as, 125–126, 125b latent image formation in, 172–173, 173b, replenishment in, 179, 179b
generator output as, 132 174b stages of, 177, 177t, 179f
grids as, 130, 130b, 132b, 132f, 132t screen, 172 systems for, 178–180, 179f
magnification factor as, 128–130, 129b, 130b silver halide and film sensitivity as, 173b temperature control in, 179, 179b
object-to-image receptor distance as, single-emulsion, 172 washing in, 177t, 178, 178b, 179f
127–128, 128b, 128f storage of, 180 characteristics of, 173
source-to-image receptor distance as, Film base, 172b film contrast and film latitude as, 173
126–127, 126b, 126f Film cameras, 212–213 film speed as, 173
source-to-object distance as, 129, 129f Film contrast, 112–113, 173 silver halide and film sensitivity as, 173b
tube filtration as, 132–133, 132b average gradient and, 113, 113b, 113f spectral sensitivity as, 173
x-ray beam intensity as, 126b exposure latitude and, 113–114, 113b, 113f, construction of, 172, 172b
special considerations in, 199–202 114f darkroom for
with casts and splints, 199–200 slope of sensitometric curve and, 112b, 112f cleaning of, 180
with contrast media, 200–202, 201f Film latitude, 162–163, 173 hazards in, 180
with pathologic conditions, 200, 200t Film processing, automatic, 177–182 safelights in, 180
projections and positions as, 199 components of, 177–178, 177f, 177t intensifying screen for, 173–176, 175b
with soft tissue, 200, 201f developing in, 177–178, 177b, 177t, 179f maintenance of, 176, 177f
Exposure technique charts, 195–199 drying in, 177t, 178, 178b, 179f screen speed of, 175–176, 175b, 175t, 176f
conditions for, 196–197 fixing in, 177t, 178, 178b, 179f latent image formation in, 172–173, 173b,
defined, 195 inadequate, 180, 180t 174b
design characteristics of, 197 recirculation system in, 179 quality control for, 180–182, 182b
development of, 199 replenishment in, 179, 179b silver recovery from, 182, 182b
and radiographic quality, 196b stages of, 177, 179f Film-screen relative speed, 133
special considerations in, 199–202 systems for, 178–180, 179f adjusting mAs for changes in, 133b
types of, 197–199, 198t temperature control in, 179, 179b and exposure to image receptor, 133, 133b
Exposure time washing in, 177t, 178, 178b, 179f and radiation protection, 133b
adjustment of, 119b Film-screen contact, 176, 177f Film-screen speed, radiation protection and,
to maintain mAs, 119b Film-screen density, 107–108 136
milliamperage and, 118–120, 119b diagnostic range of, 107–108 Film sensitivity, silver halide and, 173b
milliamperage/second and, 118f formula for, 107b Film speed, 173
Exposure timer light transmittance and, 107, 107b, 108b Filter, for CT, 239, 240f
in filament circuit, 46 and mAs, 120b Filtered back projection algorithm, in CT, 234
in primary circuit, 41 optical, 107–108, 107b, 108b, 108t Filtration, 65b
Extrapolation, in exposure technique chart Film-screen image characteristics, 106–114 beam quality and, 67
development, 199 density as, 107–108 beam quantity and, 66
defined, 107 525-line systems, 210–211
diagnostic range of, 107–108 Fixed kVp-variable mAs technique chart,
F formula for, 107b 198–199, 198b, 198t
Fan-beam geometry, 229 light transmittance and, 107, 107b, 108b Fixer solution, replenishment of, 179, 179b
Faraday, Michael, 37 optical, 107–108, 107b, 108b, 108t Fixing, in film processing, 177t, 178, 178b, 179f
Feed tray, of automatic film processor, 178–179, dynamic range as, 107b Fixing agent, 178
179f radiographic contrast as, 94, 108–109 removal of, 178, 178b
Ferromagnetic materials, 37 defined, 94 Flash drives, 172
262 INDEX

Flat-panel detectors, in fluoroscopy, 213, 214b G Grid(s) (Continued)

Fluorescence, 175 Gadolinium oxysulfide, in digital receptors, removal of, 149, 149b
Fluoroscope, 10 159–160 and scatter absorption, 130, 132f, 145f
shoe-fitting, 5f Gamma rays, 25, 29t stationary, 148
Fluoroscopic chain, 206, 206f in electromagnetic spectrum, 25–26, 26f, 28– types of
Fluoroscopic units, mobile, 220–221, 220f 29, 28b long-versus short-dimension, 148, 148f
Fluoroscopy, 87f, 89–90, 90b particulate characteristics of, 28 reciprocating, 148
automatic brightness control for, 208 x-rays vs., 28–29 stationary, 148
brightness gain in, 90, 90b, 207, 208b Gantry, 228 typical, 153b
controls and settings of, 214–215 inside of, 232f usage of, 151–153, 153b
conversion factor in, 207, 208b GCF (grid conversion factor), 148, 149t Grid cap, 148
digital, 213–215, 214b Generations, of CT, 229–230, 229f, 230b Grid cassette, 148
distortion in, 209, 209f Generator(s), 38–40 Grid conversion factor (GCF), 148, 149t
flat-panel detectors in, 213, 214b in CT scanner, 232 Grid cutoff, 150–151
fluoroscopic chain in, 206, 206f and x-ray circuit, 38–40, 38f defined, 150
flux gain in, 90, 207 Generator output, and radiographic exposure, errors in, 150–151, 152t
image intensification in, 88f, 89–90 132 off-center, 150, 151f, 152f
image-intensified, 204–218 Generator type, and emission spectrum, 69, off-focus, 150–151
construction of, 206–207, 206f, 207f 69f, 70b off-level, 150, 151f
history of, 205, 206f Geometric distortion, with image receptors, upside-down focused, 150, 150f
principles in, 207–209 168, 168f Grid focus, 147
image noise in, 209 Glass envelope, of x-ray tube, 52, 52f convergent line in, 147, 148f
magnification mode in, 208, 208b, 208f Gray (Gy), 7 convergent point in, 147, 148f
minification gain in, 90, 207 Grayscale, 104, 162 focused, 147, 147b, 147f
quality control for, 215–217, 216t Grayscale image, image data to, in CT, 237f parallel, 147, 147b, 147f
recording systems for, 212–213 Grid(s), 130, 145–154 Grid frequency, 145
cassette spot film as, 212, 212b adding of, 149, 149b grid ratio and, 145
film cameras as, 212–213 adjusting mAs for changes in, 130, 130b Grid pattern, 146, 146f
spatial resolution in, 208–209 construction of, 145–147 Grid ratio, 145
viewing systems for, 209–212 and contrast, 130b calculation of, 146b
camera tube as, 209–210, 209f conversion chart for, 132t decreasing, 150b
charge-coupled device for, 210, 210f crossed or cross-hatched, 146, 146f defined, 145, 146f
coupling of devices to image intensifier in, focused, 147, 147b, 147f and grid conversion factor, 149t
210 grid conversion factor or Bucky factor for, and grid frequency, 145
liquid crystal display monitors as, 211, 148, 149t increasing, 149b
211f grid cutoff of, 150–151 and lead content, 146
plasma monitors as, 211–212, 212f defined, 150 and patient dose, 150, 150b
television monitor as, 210–211, 211f, 212b errors in, 150–151, 152t radiographic, 152t
vignetting in, 209 off-center, 150, 151f, 152f and radiographic contrast, 146b
Flux gain, in fluoroscopy, 90, 207 off-focus, 150–151 and radiographic density, 149b
Focal plane, in linear tomography, 224–225, off-level, 150, 151f Grounding, 36, 36b
224f, 225b upside-down focused, 150, 150f Gurney-Mott theory, of latent image formation,
Focal spot size, 47 grid focus of, 147 172–173, 174b, 174f
actual vs. effective, 53–54 convergent line in, 147, 148f Gy (gray), 7
and radiographic exposure, 125–126, 125b convergent point in, 147, 148f
and recorded detail, 125b, 125f focused, 147, 147b, 147f
and spatial resolution, 125b parallel, 147, 147b, 147f H
Focused grid, 147, 147b, 147f grid frequency of, 145 Half-life, 30
Focusing cup, of x-ray tube, 51–52, 52f grid pattern of, 146, 146f Half-moon artifacts, 181f
Fog, 88 grid ratio of, 145 Half-value layer (HVL), 67
Foot, as unit of measure, 5 calculation of, 146b Half-wave rectification, 43–44, 43f
Force, 6 decreasing, 150b Hard beams, 66–67
Foreshortening, 98, 98f defined, 145, 146f H&D (Hurter and Driffield) curve, of digital
Frequency, of electromagnetic radiation, 25–26, and grid conversion factor, 149t receptor versus film response, 162–163, 163f
27f increasing, 149b Heat, production of, 62
calculation of, 27b and patient dose, 150, 150b Heat units (HUs), 57–58
in Planck’s constant, 27 radiographic, 152t Helical CT, 230–231, 231f
wavelength and, 27 and radiographic contrast, 146b Hertz (Hz), 25–26
Friction, electrification by, 33 and radiographic density, 149b High contrast, 108, 108f
Front screen, of intensifying screen, 175 and image receptor exposure, 130b High-frequency generator, in CT scanner, 232
Fulcrum, in linear tomography, 224, 224b linear, 146, 146f High-quality beams, 66–67
Full-wave rectification long-versus short-dimension, 148, 148f High subject contrast, 94, 95f
single-phase, 44–45, 44f, 45b Moiré effect with, 151, 152f Histogram analysis, of digital image, 161, 161b,
solid-state, 43, 43f parallel or nonfocused, 147, 147b, 147f 161f, 163
three-phase, 45f performance of, 148–150 Holographic disk device, 172
Fundamental particles, 18 quality control check for, 153b Homogeneous object, 94, 95f
Fundamental quantities, 5, 5f and radiation protection, 132b, 136 Hounsfield, Godfrey, 228
Fuses, 35, 36t reciprocating, 148 Hounsfield scale, 235f
 INDEX 263

Hounsfield units, 234 Image (Continued) Image production (Continued)

Housing, for x-ray tube, 50–51 levels of, 96 photoelectric effect and, 83, 83b, 84f, 85b
Housing cooling charts, for x-ray tubes, 58, 58f low (long-scale), 108, 109f scattering and, 83–85, 84b
Hurter and Driffield (H&D) curve, of digital low subject, 96f transmission and, 85–86, 85f
receptor versus film response, 162–163, and radiographic density, 108 differential absorption and, 82–83, 82b, 83b,
163f scale of, 108 83f
HUs (heat units), 57–58 sharpness and, 97, 98f dynamic imaging (fluoroscopy), 87f, 89–90,
HVL (half-value layer), 67 x-ray beam quality and, 95–96, 95f 90b
Hydroquinone, as developing or reducing recorded detail as, 114 brightness gain in, 90, 90b
agents, 177–178 sensitometry as, 109–114 image intensification in, 88f, 89–90
Hypersthenic body habitus, 133, 134f equipment for, 109–110, 109f, 110f image receptors in, 88–89
Hypo, as fixing agent, 178 log relative exposure in, 110–111, 110f, defined, 82
Hz (hertz), 25–26 111b differential absorption and, 89b
recorded detail as, 96–97 digital, 88
defined, 96 film-screen, 88–89
I and patient movement, 97, 98f imaging effect in, 86f, 88
Image sharpness and visibility of, 97, 98f Image quality, in CT, 238–241
formation of, 90b scatter as, 99, 99b, 99f artifacts in, 240–241, 241f, 242f
histogram analysis of, 161, 161b, 161f Image data, in CT, 234, 234b, 235f contrast resolution in, 240, 240b, 241f
latent, 88, 172 to gray-scale image, 237f noise in, 239, 239b, 239f
formation of, 172–173, 173b, 174b Image data production, in CT, 231–234 spatial resolution in, 240, 240f, 241f
manifest, 88, 172 bowtie filter for, 232, 232f Image receptors (IRs), 88–89, 156–185
radiographic, 172 collimators for, 232–233, 232f, 233b defined, 82
Image acquisition, digital, 161, 161b, 161f data acquisition system for, 233, 233f differential absorption and, 89b
Image artifacts. see Artifacts detector array for, 233, 233f digital, 88, 157–161
Image brightness, 88, 88b inside of gantry, 231, 232f cassette for, 157, 157f
mAs and, 119b raw data in, 233, 234b detector for, 157–161
Image characteristics, 92–116, 93f scanning unit for, 231, 232f direct radiography systems for, 158–161
digital, 101–106 x-ray tube for, 232 charge-coupled device in, 159, 159f
binary digits as, 103b Image density. see Density(ies) detector array in, 158–161, 159f
brightness as, 101–103, 103b Image display direct-capture, 160–161, 160f, 161b
and window level, 102–103, 103b, 104f, 105f for CT, 236 indirect capture, 159, 159f, 160b, 160f
contrast as, 104–105 digital, 162–164, 163b, 163f, 164b thin-film transistor array in, 159–160,
and window width, 104, 104f, 105b, 105f Image extraction, digital, 161–162, 162b, 162f 160f
contrast resolution as, 101, 103b, 104 Image flip, of digital image, 164b extraction and processing with, 161–162,
dynamic range as, 101, 101b Image Gently campaign, 244 162b, 162f
image matrix as, 101f Image intensification histogram analysis with, 161, 161b, 161f
defined, 101 with film-screen image receptors, 88–89 image acquisition with, 161, 161b, 161f
pixel bit depth in, 101, 103f, 104b in fluoroscopy, 88f, 89–90, 204–218 image display with, 162–164, 163b, 163f
pixels in, 101, 101f construction of, 206–207, 206f, 207f Picture Archiving and Communication
size of, 101, 102b, 102f history of, 205, 206f Systems with, 169–172, 169b
image noise as, 105–106, 106f principles of, 207–209 postprocessing with, 163, 164b
number of photons and, 105b Image intensifier preprocessing with, 163
spatial resolution as, 96–97 exposure rate and age of, 208b quality assurance and quality control with,
distortion in, 97–98 operation, 207b 168–169
shape, 98, 98f parts of, 206, 207f daily, 168, 168f
size, 97–98 Image inversion, of digital image, 164b geometric distortion in, 168, 168f
film Image manager, 171 luminance dependencies in, 169, 171f
average gradient as, 113b, 113f Image matrix, 101, 101f luminance response in, 168, 170f
contrast of, 112–113, 112b, 112f defined, 101 monthly or quarterly, 168–169
exposure latitude as, 113–114, 113b, 113f, pixel bit depth in, 101, 103f, 104b overall visual assessment in, 168, 168f
114f pixels in, 101 reflection in, 168, 169f
speed as, 111, 111b, 112f size of, 101, 102b, 102f resolution in, 169, 171f
speed exposure point as, 111–112, 112f Image noise film-screen, 88–89, 172–176
speed point as, 111, 111f in CT, 239, 239b, 239f artifacts in, 180 180–182, 181f
film-screen, 106–114 digital, 105–106, 106f, 165–166, 165f automatic processing of, 177–182
density as, 93–94, 107–108, 107b in fluoroscopy, 209 developing in, 177–178, 177b, 177t, 179f
and contrast, 94, 95f quantum, 99, 100f drying in, 177t, 178, 178b, 179f
diagnostic range of, 107–108 in CT, 239, 239b, 239f fixing in, 177t, 178, 178b, 179f
optical, 107–108, 107b, 108b, 108t Image processing, digital, 161–162, 162b, 162f inadequate, 180, 180t
radiographic, 93–94 Image production, 81–91 recirculation system in, 179
range of, 94 beam attenuation in, 83–88 replenishment in, 179, 179b
radiographic contrast as, 94–96, 108–109 absorption and, 83, 83b stages of, 177, 177t, 179f
defined, 94 factors affecting, 86–88, 87b, 87t systems for, 178–180, 179f
differential absorption and, 94, 95f, 96 tissue density as, 87 temperature control in, 179, 179b
high (short-scale), 108, 108f tissue thickness as, 86, 86f washing in, 177t, 178, 178b, 179f
high subject, 94, 95f type of tissue as, 86–87 characteristics of, 173
lack of, 94, 95f x-ray beam quality as, 87 film contrast and film latitude as, 173
264 INDEX

Image receptors (Continued) Inverse square law, 28, 28b, 28f Length, 5
film speed as, 173 and beam quantity, 65, 66b and resistance, 35
silver halide and film sensitivity as, and source-to-image receptor distance, 126, Lenz’s law, 38
173b 126b, 126f Leucippus, 16–17
spectral sensitivity as, 173 Ion lgM (log mean) numbers, 164
construction of, 172, 172b negative, 19 Light emission, screen speed and, 175b
darkroom for positive, 19 Light source, 8–9
cleaning of, 180 Ion chamber, in automatic exposure control, Light transmittance
hazards in, 180 188, 188f, 189b formula, 107b
safelights in, 180 Ion pair, 7, 173b optical density and, 107, 107b, 108b, 108t
intensifying screen for, 173–176, 175b Ionic bonding, 23, 23f Limiting spatial resolution (LSR), 165–166
maintenance of, 176, 177f Ionization, 7, 28, 83, 173b Line compensator, 40
screen speed of, 175–176, 175b, 175t, Ionization chamber, 41–42 Line pairs per millimeter (Lp/mm), 96, 97f
176f systems, in automatic exposure control, 188– Linear attenuation coefficient, in CT, 233
latent image formation in, 172–173, 173b, 189, 188f, 189b Linear grid, 146, 146f
174b Ionizing radiation, 5 Linear tomography, 223–225, 223f
quality control for, 180–182, 182b IRs. see Image receptors (IRs) amplitude in, 225b
silver recovery from, 182, 182b Isobars, 21 angle in, 224
Image receptor (IR) exposure Isomers, 21 blur in, 225b
and beam restriction, 132b Isos, 21, 21b defined, 223
and film-screen relative speed, 133, 133b Isotones, 21 exposure technique for, 225
and grids, 130b Isotopes, 21 focal plane in, 224–225, 224f, 225b
Image receptor (IR) variations, in automatic fulcrum in, 224, 224b
exposure control, 193, 193b J principle of, 223–224, 224f
Image reconstruction, in CT, 234, 234b Joule (J), 6 use of, 223
algorithm for, 234 Line-focus principle, 53–54, 54f, 55b
array processor in, 234 Liquid crystal display (LCD) monitors, for
CT number in, 234, 234b, 235f
K fluoroscopy, 211, 211f
image data in, 234, 234b, 235f K-characteristic x-rays, 68, 68f Log mean (lgM) numbers, 164
Imaging artifacts. see Artifacts Kilogram, 5 Log relative exposure, 110–111, 110f, 111b
Imaging controls, in CT, 235–236 Kilograms-meters per second (kg-m/s), 6 Long-dimension grids, 148, 148f
equipment for, 235–236, 235f Kilohertz (kHz), 27 Lookup table (LUT), with digital receptor, 166
protocols for, 236, 236f Kilovoltage peak (kVp), 34, 34b, 121–124, Low-quality beams, 66–67
Imaging effect, 86f, 88 121b Low subject contrast, 96f
Imaging protocols, for CT, 236, 236f 15% rule of, 122, 122–123b, 122b Lp/mm (line pairs per millimeter), 96, 97f
Indirect capture methods, in digital receptors, in automatic exposure control, 189, 189b LSR (limiting spatial resolution), 165–166
159, 159f, 160b, 160f and Compton scattering, 123, 123b, 124b Luminance dependencies, with digital receptors,
Induction and digital image quality, 121b 169, 171f
electrification by, 33 with digital receptor, 166, 166b Luminance levels, maximum, 163
electromagnetic, 36–40 emission spectrum and, 68, 69b, 69f Luminance response, with image receptors,
Induction motor, 38–39 and exit-beam intensities, 123, 123f, 124f 168, 170f
for x-ray tube, 51–52, 53f and film-screen image receptors, 121, 121f Luminescence, 175
Inertia, 6 and radiation exposure, 121, 121f photostimulable, 158
Infrared light, 29, 29t and radiation protection, 124, 124b, 136 LUT (lookup table), with digital receptor, 166
Input phosphor, in image intensifier, 89–90, and radiographic contrast, 121, 123–124,
206, 207f 124b
Insulation, in tube housing, 50–51 and radiographic density, 121, 122f M
Insulator, 35–36, 35b and radiographic image, 121b mA. see Milliamperage (mA)
Intensifying screen, 173–176 Kilovoltage peak (kVp) meter, in primary Macromolecules, 79
composition of, 173–175, 175b circuit, 42f damage to, 79f
defined, 173 Kilovoltage peak (kVp) selector, 40 Magnetic dipoles, 37
maintenance of, 176, 177f Kilovoltage peak (kVp) setting, 40 Magnetic field, 37
screen speed of, 175–176, 175b, 175t, 176f Kinetic energy, 6–7 Magnetic flux, 37, 37f
Interactions kVp. see Kilovoltage peak (kVp) Magnetic resonance imaging (MRI), radiowaves
target, 61–65, 62b, 65b in, 29
bremsstrahlung, 61–62, 63–65, 64b, 64f L Magnetic tape storage, 172
characteristic, 61–63, 62f, 63b Latent image, 88, 172 Magnetism, 36–37
of x-rays with matter, 73–80, 73b, 74f formation of, 172–173, 173b, 174b Magnification, 97–98
classical, 73–74, 74b, 74f Latent image centers, sensitivity specks and, calculating, 128–130
Compton, 74–75, 75b, 75f 173, 173b, 174b in postprocessing of digital image, 164b
differential absorption due to, 77–79, 78b, Lateral decentering, 150, 151f, 152f Magnification factor (MF)
78f, 79b LCD (liquid crystal display) monitors, for fluo- calculating, 128–130, 129b, 130b
pair production due to, 77, 77f roscopy, 211, 211f in fluoroscopy, 208
photodisintegration due to, 77, 78f L-characteristic x-rays, 67–68, 68f Magnification mode, in fluoroscopy, 208, 208b, 208f
photoelectric, 75–77, 76b, 76f, 77b Lead content, 146 Mammography, 222–223, 222f, 223b
probability of, 76, 77b Lead shielding, 8 Manifest image, 88, 172
Interspace material, in grid construction, for scatter control, 154, 154f mAs. see Milliamperage/second (mAs)
145 Leakage radiation, 50–51 Mass, 5
 INDEX 265

Material, and resistance, 35 Minus-density artifacts Occupational exposure, 75

Matrix in digital imaging, 99–100 Oersted, Hans, 37
in CT, 234 in film-screen imaging, 181f Off-center grid cutoff, 150, 151f, 152f
digital images, 101, 101f Mirror, 8–9 Off-focus grid cutoff, 150–151
defined, 101 Mobile equipment, 219–221 Off-level grid cutoff, 150, 151f
pixel bit depth in, 101, 103f, 104b Mobile units Offline storage, 172
pixels in, 101, 101f fluoroscopic, 220–221, 220f Ohms, 34–35
size of, 101, 102b, 102f radiographic, 219–220, 220b, 220f Ohm, Georg Simon, 34–35
Matter, 5 Modulation transfer function (MTF), 165–166 Ohm’s law, 34–35, 35b
x-ray interactions with, 73–80, 73b, 74f Moiré effect, 151, 152f OID. see Object-to-image receptor distance (OID)
classical, 73–74, 74b, 74f Moisture artifacts, 181f Oil bath, in tube housing, 50–51
Compton, 74–75, 75b, 75f Molecule, 17, 21 1024-line systems, 210–211
differential absorption due to, 77–79, 78b, Momentum, 6 Online storage, 171
78f, 79b Motion, Newton’s first law of, 6 Open circuit, 35
pair production due to, 77, 77f Motors, 38–40 Operator’s console
photodisintegration due to, 77, 78f MPR (multiplanar reformation), 236, 237f for CT, 235–236, 235f
photoelectric, 75–77, 76b, 76f, 77b MRI (magnetic resonance imaging), radiowaves of x-ray circuit, 42–43, 45, 47
probability of, 76, 77b in, 29 Optical density, 107–108
Maximum luminance levels, 163 m/s (meters per second), 6 defined, 107
Maxwell, James, 25–26 MSCT (multislice computed tomography), 231, diagnostic range of, 107–108
Megahertz (MHz), 27 231f exposure density and, 107–108, 108b
Mendeleev, Dmitri, 17 MTF (modulation transfer function), 165–166 film speed and, 111b, 112f
Metal(s), transitional, 21–23 Multidetector CT, 230–231 formula for, 107b
Metal envelope, of x-ray tube, 52 Multiplanar reformation (MPR), 236, 237f light transmittance and, 107, 107b, 108b, 108t
Metallic replacement, 182 Multislice computed tomography (MSCT), 231, Optical disk, 172
Meter, 5 231f Optical lens system, in fluoroscopy, 210
Meters per second (m/s), 6 Multislice detector array, in CT scanner, 233f Optimal density, 93–94, 94f
Metric system, 5 Mutual induction, 37, 38f Optimal kVp, 198–199
MF (magnification factor) Osteoporosis, bone densitometry for, 221, 222b
calculating, 128–130, 129b, 130b N Output phosphor, in image intensifier, 89–90,
in fluoroscopy, 208 206, 207f
N (newton), 6
MHz (megahertz), 27 Overhead tube head assembly, 9, 9f
Narrow latitude film, 113–114
Microwaves, 25–26, 29t Nearline storage, 171
Milliamperage (mA) Negative contrast agents, 200–202, 201f P
and emission spectrum, 68, 68b, 69f Negative ion, 19 PACS (Picture Archiving and Communication
and exposure time, 118–120, 118b, 118f, Network attached storage (NAS), 172 System), 169–172, 169b
119b Neutrons Pair production, 77, 77f
Milliamperage (mA) selector, 45b in Bohr model, 18, 18f Panoramic x-ray, 221, 222f
Milliamperage/second (mAs), 45b, 118b discovery of, 18 Parallel-beam geometry, 229
adjusting milliamperage and exposure time electrical charge of, 19 Parallel circuits, rules for, 36b
to maintain, 119, 119b in modern theory, 18, 18f Parallel grid, 147, 147b, 147f
adjustment of Newton (N), 6 Paramagnetic materials, 37
for changes in part thickness, 135, 135f Newton, Isaac, 6 Part thickness
for density errors, 120, 120f Newton’s first law of motion, 6 calipers to measure, 197, 197f
film-screen relative speed changes and, Noise, image and radiographic exposure, 135–136, 136f
133b in CT, 239, 239b, 239f and scatter radiation, 136
grid changes and, 130, 130b, 132t digital, 105–106, 106f, 165–166, 165f Partial-volume artifacts, 241
in automatic exposure control, 189, 189b in fluoroscopy, 209 Particulate radiation, 29–30, 30b
and beam quantity, 65 quantum, 99, 100f Pathologic conditions, and exposure factors,
and digital image brightness, 119b in CT, 239, 239b, 239f 200, 200t
with digital receptor, 166, 166b Noise reduction filter, for CT, 239 Patient centering, in automatic exposure
and film-screen density, 120b Nonfocused grid, 147, 147b, 147f control, 191–192, 191b, 192f
and generators, 119, 119b Nonmagnetic materials, 37 Patient considerations, in automatic exposure
and image receptors, 119, 119b, 120f n-type crystal, 43 control, 192–193, 192b
and radiation exposure, 118, 118b, 118f Nucleus, 18 Patient dose
and radiation protection, 119b, 136 binding energy, 19 absorption and, 79b
and radiographic density, 119, 120f structure of atom, 18f beam restriction and, 140b
and source-to-image receptor distance, Nyquist frequency, 165–166 grid ratio and, 150, 150b
126, 126b magnification mode and, 208b
Milliamperage/second (mAs)/distance
compensation formula, 127, 127b O screen speed and, 175–176, 175b, 175t
Patient exposure
Milliamperage/second (mAs) readout, in Object plane, in linear tomography, 224 in CT, 244–246b
automatic exposure control, 189, 189b Object size, determining, 129b factors in. see Exposure factors
Milliamperage/second (mAs) timer, 41 Object-to-image receptor distance (OID) Patient factors, in radiographic exposure,
Milliampere meter, 43 and air gaps, 127, 128f 133–136, 134f
Minification gain, in fluoroscopy, 90, 207 and exposure factors, 127–128 body habitus as, 133
Minimum response time, in automatic and size distortion, 97–98, 127–128, 128b, 128f part thickness as, 135–136, 135f
exposure control, 189–190 and spatial resolution, 127, 128b pediatric patients as, 136
266 INDEX

PBL (positive beam-limiting) device, 144–145 Plus-density artifacts Quantities

Pediatric patients in digital imaging, 99–100 derived, 5, 5f
CT radiation dose in, 242 in film-screen imaging, 181f fundamental, 5, 5f
radiographic exposure in, 136 PM (photomultiplier) tube, 187 radiologic, 5, 5f
Penetration, 66–67 Port, of x-ray tube, 52f special, 5f
Penetrometer, for sensitometry, 109, 109f Position(s), and exposure factors, 199 Quantum mottle, 99
Periodic table, 21, 22f Positioning considerations, in automatic Quantum noise, 99, 100f
Permanently installed equipment, 8 exposure control, 190–192 in CT, 239, 239b
Phenidone, as developing or reducing agents, Positive beam-limiting (PBL) device, 144–145 digital, 105, 106f
177–178 Positive contrast agents, 200–202, 201f number of photons and, 105b
Phosphor layer Positive ion, 19 Quantum theory, 18
of intensifying screen, 173–175, 175b Positron, 30
and screen speed, 175–176, 175t Postpatient collimator, 232–233 R
of photostimulable phosphor plate, 157–158, Postprocessing R (roentgen), 7
158f of CT, 236–238 Rad, 7
Photocathode, 206, 207f annotation in, 236 Radiation
Photocathode, in image intensifier, 89–90 multiplanar reformation in, 236, 237f dose, 11b
Photoconductor, in direct-capture method, multiple options for, 236 electromagnetic. see Electromagnetic radiation
160–161 region of interest in, 236 exit (remnant), 86f, 88
Photodetector, in photostimulable phosphor windowing in, 236–238, 237f, 238b, 238f ionizing, 5
plate, 158 of digital image, 163, 164b leakage, 50–51
Photodiode, 187 Potential difference, 34 particulate, 29–30, 30b
Photodisintegration, 77, 78f Potential energy, 6–7 quantity of, milliamperage/second and, 118,
Photoelectric effect, and beam attenuation, 83, Potter-Bucky diaphragm, 148 118b
83b, 84f, 85b Pound, 5 scatter. see Scatter(ing)
Photoelectric interactions, 75–77, 76b, 76f, 77b Power, 6 Radiation burns, 3, 3f
probability of, 76, 77b Predetector collimator, 232f Radiation detectors, in automatic exposure
Photoelectron, 75–76, 83 Pregnancy, screening for, 12b control, 187–189, 187b, 187f
Photoemission, 206 Prepatient collimator, 232–233 ionization chamber systems as, 188–189,
Photomultiplier (PM) tube, 187 Preprocessing, of digital image, 163 188f, 189b
Photons, 61–65, 65b Primary beam, 67 phototimers as, 187, 188f
bremsstrahlung, 61–62, 63–65, 64b, 64f Primary circuit, 40–43, 42f Radiation exposure
characteristic, 61–63, 62f, 63b Primary coil, 41 kilovoltage peak (kVp) and, 121, 121f
Compton scatter, 74 Profile, in CT, 233 milliamperage/second (mAs) and, 118, 118b,
frequency of, 27 Projections, and exposure factors, 199 118f
secondary, 74 Protective devices, 35–36, 36t Radiation intensity, source-to-image receptor
Photospot camera, in fluoroscopy, 207f, Protective housing, for x-ray tube, 50–51, distance and, 126, 126f
212–213 51b, 51f Radiation protection
Photostimulable luminescence, 158 Protective layer and beam restriction, 132b
Photostimulable phosphor (PSP) plate, of intensifying screen, 175b for CT, 242–246, 242b
157–158, 158b, 158f of photostimulable phosphor plate, and film-screen relative speed, 133b
Phototimers, in automatic exposure control, 157–158 fundamentals of, 10–12, 12b
187, 188f Protons and grids, 132b
Phototiming, 187. see also Automatic exposure in Bohr model, 18, 18f and kilovoltage, 124, 124b
control (AEC) discovery of, 18 and milliamperage/second (mAs), 119b
Picture Archiving and Communication System electrical charge of, 19 review for, 136–137
(PACS), 169–172, 169b in modern theory, 18, 18f Radioactive decay, 30
Pincushion distortion, in fluoroscopy, 209, 209f PSP (photostimulable phosphor) plate, Radioactive elements, 30
Pitch 157–158, 158b, 158f Radioactivity, 30
in CT, 236, 236f p-type crystal, 43 Radiodermatitis, acute, 3, 3f
pixel, 105, 105f Radiographic contrast. see Contrast
sampling, 161–162
Pivot point, in linear tomography, 224, 224b Q Radiographic density, 93–94
differential absorption and, 94, 95f
Pixel(s) Quality control excessive, 93–94, 94f
in CT, 234, 234f with automatic exposure control, 194–195 grid ratio and, 149b
in digital imaging, 101, 101f for CT, 242 insufficient, 93–94, 94f
Pixel bit depth, 101, 103f, 104b with digital receptors, 168–169 optimal, 93–94, 94f
Pixel density, 105 daily, 168, 168f range of, 94
Pixel pitch, 105, 105f geometric distortion in, 168, 168f Radiographic equipment, 8–10
Pixel value, 101, 103f luminance dependencies in, 169, 171f mobile, 8
Planck, Max, 27 luminance response in, 168, 170f permanently installed, 8
Planck’s constant, 27 monthly or quarterly, 168–169 Radiographic exposure technique. see Exposure
Plasma monitors, for fluoroscopy, 211–212, overall visual assessment in, 168, 168f technique
212f reflection in, 168, 169f Radiographic film. see Film
Plate reader, photostimulable phosphor, resolution in, 169, 171f Radiographic grids. see Grid(s)
157–158 for film, 180–182, 182b Radiographic image, 172
“Plum pudding model,” 17, 17f for fluoroscopy, 215–217, 216t Radiographic units, mobile, 219–220, 220b,
Plumbicon tube, for fluoroscopy, 209–210 for x-ray tube, 56–58 220f
 INDEX 267

Radiologic physics, 5 Resolution Scatter control (Continued)

Radiologic quantities, 5, 5f contrast, 101, 103b, 104 grid cutoff of, 150–151
Radiology in CT, 240, 240b, 241f errors in, 150–151, 152t
equipment for, 8–10 of digital image, 101, 103b, 104, 104b off-center, 150, 151f, 152f
mobile, 8 defined, 96 off-focus, 150–151
permanently installed, 8 of digital image, 169, 171f off-level, 150, 151f
general principles of, 5–7 spatial, 165–166 upside-down focused, 150, 150f
primary exposure factors of, 12b in CT, 240, 240f, 241f grid focus of, 147
units of measure in, 5–7, 7b in fluoroscopy, 208–209 convergent line in, 147, 148f
x-rays limiting, 165–166 convergent point in, 147, 148f
discovery and, 1–5, 2b, 2f, 5b Resolution test pattern, 96, 97f focused, 147, 147b, 147f
evolution and use of, 2–5, 3f Rheostat, 35–36, 36t parallel, 147, 147b, 147f
Radiology Information System (RIS), 169 in circuit operation, 47 grid frequency of, 145
Radiolucent structures, 79 in filament circuit, 45 grid pattern of, 146, 146f
Radiopaque structures, 79 Ring artifacts, 240–241 grid ratio of, 145, 146b, 146f, 149b
Radiowaves, 25, 29t Ripple, 44–45 decreasing, 150b
RAID (redundant array of independent disks), RIS (Radiology Information System), 169 increasing, 149b
172 Roentgen, Wilhelm Conrad, 1, 2f and patient dose, 150b
Rare earth elements, intensifying screen, Roentgen (R), 7 radiographic, 152t
173–175 ROI (region of interest) Moiré effect with, 151, 152f
Raster pattern, in fluoroscopy, 209–210 in CT, 236 performance of, 148–150
Rating charts, for x-ray tubes, 57, 57b, 57f in digital image, 164b quality control check for, 153b
Raw data, in CT, 233, 233f, 234b Rotating-anode design, 52–53, 52f, 53b removal of, 149, 149b
Rays, in CT, 233 Rotor, of x-ray tube, 52–53, 52f and scatter absorption, 145f
Reciprocating grids, 148 Rutherford, Ernest, 18f types of
Recirculation system, in film processing, 179 long-versus short-dimension, 148, 148f
Reconstruction filter, for CT, 239 S reciprocating, 148
Recorded detail, 96–97 S (sensitivity) numbers, 164 stationary, 148
defined, 96 Safelights, in darkroom, 180 typical, 153b
film-screen, 114 Sampling pitch, 161–162 usage of, 151–153, 153b
focal spot size and, 125b, 125f SAN (storage area network), 172 shielding accessories for, 154, 154f
motion unsharpness and, 97, 98f Scan field of view (SFOV), for CT, 236 Scatter radiation. see Scatter(ing)
screen speed and, 175–176, 175b, 175t Scan time, for CT, 236 Scintillation-type detector, in CT, 233
sharpness and visibility of, 97, 98f Scatter(ing), 99, 99f Scintillator, in digital receptors, 159
Recording systems, for fluoroscopy, 212–213 beam restriction and, 140, 140b, 141f Scratch artifacts, 181f
cassette spot film as, 212, 212b coherent (Thomson), 73–74, 74b, 74f Screen film, 172
film cameras as, 212–213 beam attenuation and, 84–85 Screen speed, of intensifying screen, 175–176,
Rectification Compton, 74, 99b 175b, 175t, 176f
of alternating current, 43f beam attenuation and, 83–85, 84b, 85f Second, as unit of measure, 6
in circuit operation, 47 control of. see Scatter control Secondary circuit, 43–45
full-wave in digital imaging, 99b rectification
high-frequency, 45f kilovoltage peak (kVp), 123, 123b, 124b full-wave
single-phase, 44–45, 44f, 45b probability of, 140b single-phase, 44f, 45b
solid-state, 43f and digital image receptors, 99b solid-state, 43f
three-phase, 45f factors affecting, 140b three-phase, 45f
half-wave, 43–44, 43f and image quality, 145b rectifier bank, 44f
Rectifier, 44–45, 44f and part thickness, 136 rectifier in, 43–44
solid-state, 43, 43f Scatter absorption, grids and, 130, 132f, 145f solid-state, 43, 43f
Rectifier bank, 44–45, 44f Scatter control, 139–155 Secondary coil, 38f
Reducing agents, 177–178, 177b air gap technique for, 153–154, 153f, 154b Secondary electron, 74, 83
Redundant array of independent disks (RAID), beam restriction (collimation) for, 140–145 Secondary photons, 74
172 compensating for, 141–142, 142t Sections, in linear tomography, 224
Reflection, with image receptors, 168, 169f devices for, 142–145 Self-induction, 38
Reflective layer aperture diaphragms as, 142, 142f Sensitivity (S) numbers, 164
of intensifying screen, 175, 175b, 175t, 176f automatic collimators as, 144–145 Sensitivity specks, and latent image centers,
of photostimulable phosphor plate, collimators as, 143–144, 144f, 145b 173, 173b, 174b
157–158 cones and cylinders as, 142–143, 143f Sensitometer, for sensitometry, 110, 110f
Region of interest (ROI) and patient dose, 140b Sensitometric curve, 110, 110b, 110f
in CT, 236 and radiographic contrast, 141, 141b film contrast and slope of, 112–113, 112b, 112f
in digital image, 164b and scatter radiation, 140, 140b, 141f regions of, 111, 111f
Relative speed, of intensifying screen, 176 unrestricted primary beam and, 140, 141f Sensitometric strip, 110
Rem, 7 with digital receptor, 167, 167b Sensitometry, 109–114
Remnant beam, 67 radiation protection and, 153 equipment for, 109–110, 109f, 110f
Remnant radiation, 86f, 88 radiographic grids for, 145–154, 145f log relative exposure in, 110–111, 110f, 111b
Replenishment, in film processing, 179, 179b adding of, 149, 149b Series circuits, rules for, 36b
Rescaling, with digital receptor, 166, 167f construction of, 145–147 SFOV (scan field of view), for CT, 236
Resistance, 33–35 grid conversion factor or Bucky factor for, Shape distortion, 98, 98f
Resistor, 35–36, 36t 148, 149t and central ray alignment, 98
268 INDEX

Sharpness, of recorded detail, 97, 98f Speed (Continued) Television monitor, for fluoroscopy, 210–211,
Shell-type transformer, 39f and speed exposure point, 112b 211f, 212b
Shielding, 75 of intensifying screen, 175–176, 175b, 175t, Temperature, and resistance, 35
with CT, 243–244 176f Temperature control, for film processing, 179,
Shielding accessories, for scatter control, 154, Speed class, 165, 165b 179b
154f Speed exposure point, 111–112, 112b, 112f Tesla (T), 37
Shoe-fitting fluoroscope, 5f Speed of light, 27b Tesla, Nikola, 37
Short-dimension grids, 148, 148f Speed point, 111, 111f TFT (thin-film transistor) array
Shoulder region, of sensitometric curve, 111, Spiral CT, 230–231, 231f in direct-capture method, 160–161
111f Splints, and exposure factors, 200 in indirect capture methods, 159–160, 160f
Shutters, 8–9, 8f Standby control, of automatic film processor, TG18-AD test pattern, 168, 169f
SI (system international), 5 179 TG18-CX test pattern, 169, 171f
SID. see Source-to-image receptor distance Static discharge artifact, 181f TG18-LN01 test pattern, 168, 170f
(SID) Stationary-anode design, 52, 52f TG18-LN08 test pattern, 168, 170f
Sievert (Sv), 7 Stationary grids, 148 TG18-LN18 test pattern, 168, 170f
Silver bromide (AgBr), in latent image formation, Stator, of x-ray tube, 52–53, 52f TG18-QC test pattern, 168, 168f
174b Step-down transformer, 38–39 TG18-UNL10 test pattern, 169, 171f
Silver halide in circuit operation, 47 TG18-UNL80 test pattern, 169, 171f
in film, 172 in filament circuit, 46, 46f Thermal energy, 7
and film sensitivity, 173b Step-up transformer, 38–39 Thermionic emission, 55
in latent image formation, 174b in primary circuit, 41, 42f Thickness
Silver recovery, 182, 182b in secondary circuit, 41 of body part
Single-emulsion screen film, 172 Step-wedge density, 109, 109f calipers to measure, 197, 197f
Size distortion, 97–98 Sthenic body habitus, 133, 134f and radiographic exposure, 135–136, 136f
object-to-image receptor distance and, Storage and scatter radiation, 136
97–98, 127–128, 128b, 128f of CT data, 235–236 tissue, beam attenuation and, 86, 86f
source-to-image receptor distance and, equipment for, 235–236, 235f Thin-film transistor (TFT) array
97–98, 127, 127b, 127f protocols for, 236, 236f in direct-capture method, 160–161
Slip-ring technology, in spiral CT, 230–231 of film, 180 in indirect capture methods, 159–160, 160f
Slope, of sensitometric curve, film contrast and, in PACS, 171–172 Thiosulfate, as fixing agent, 178
112b, 112f direct attached, 172 Thomson, Joseph John (J.J.), 17, 17f
“Slow scan,” 161, 162f magnetic tape, 172 Thomson scattering, 73–74, 74b, 74f
Smoothing, of digital image, 164b nearline, 171 Three-phase power, 44–45, 45f
Smoothing filter, 239 network attached, 172 Tiling, in digital receptors, 159
SOD (source-to-object distance), 129, 129f offline, 172 Timer
Soft beams, 66–67 online, 171 electronic, 41
Soft tissue, and exposure factors, 200, 201f optical disk, 172 exposure
Solenoid, 37 Storage area network (SAN), 172 in filament circuit, 46
Solution replenishment, in film processing, Straight-line region, of sensitometric curve, in primary circuit, 41
179, 179b 111, 111f mAs, 41
Source-to-image receptor distance (SID), Streak artifacts, 240–241, 241f photo-, in automatic exposure control, 187,
126–127, 126b Structured phosphor layer, of photostimulable 188f
and inverse square law, 126, 126b phosphor plate, 157–158 Timer circuit, 41, 42f
and mAs, 126, 126b Subject contrast, 95–96 Tissue beam attenuation, part thickness and,
and radiation intensity, 126, 126f “Sun tanning,” of x-ray tube, 52 135–136, 135f
and size distortion, 97–98 Superadditivity, 178 Tissue density, beam attenuation and, 87
Source-to-object distance (SOD), 129, 129f Supercoat, of film, 172b Tissue thickness, beam attenuation and, 86, 86f
Space charge, 56 Support layer, of photostimulable phosphor Tissue type, beam attenuation and, 86–87
Space-charge effect, 56 plate, 157–158 Toe region, of sensitometric curve, 111, 111f
Spatial resolution, 96–97, 165–166 Sv (Sievert), 7 Tomographic angle, 224, 225b
in CT, 240, 240f, 241f Switch, 35–36, 36t Tomography
defined, 96 Synchronous time, 41 computed. see Computed tomography (CT)
digital, 105, 105f Synergism, 178 linear. see Linear tomography
pixel density and, 105, 105b System international (SI), 5 Transformers, 36t, 38–40
in fluoroscopy, 208–209 auto-, 40f, 41b
and focal spot size, 125b T in circuit operation, 47
limiting, 165–166 T (tesla), 37 in primary circuit, 40, 42f
and object-to-image receptor distance, 127, Target angle, and line-focus principle, 53–54, closed-core, 39f
128b 54f shell-type, 39f
and source-to-image receptor distance, 127, Target interactions, 61–65, 62b, 65b step-down, 38–39
127b bremsstrahlung, 61–62, 63–65, 64b, 64f in circuit operation, 47
Special quantities, 5f characteristic, 61–63, 62f, 63b in filament circuit, 46, 46f
Spectral emission, 173 Target material, and emission spectrum, 70, step-up, 38–39
Spectral matching, 173 70b, 70f in circuit operation, 47
Spectral sensitivity, of film, 173 Target window, of x-ray tube, 52 in primary circuit, 41, 42f
Speed Teleradiology, 169 in secondary circuit, 41
film, 111, 112f, 173 Telescoping cylinder, for beam restriction, types of, 39f
and optical density, 111b 143f Transitional metals, 21–23
 INDEX 269

“Translate-rotate” types, of CT scanners, 229 Wavelength, 27 X-ray circuit (Continued)

Transmission of electromagnetic radiation, 27, 27f, 28b full-wave
vs. absorption, 78 of electromagnetic spectrum, 25–26 single-phase, 44f, 45b
beam attenuation and, 85–86, 85f Weight, 5 three-phase, 45f
defined, 93b Wide latitude film, 113–114 half-wave, 43–44, 43f
Transmittance, and optical density, 107, 107b, Window level (WL) resistance and, 33–35
108b, 108t in CT, 236–237, 238f secondary, 43–45
Tube current, 45 for digital image, 102–103, 103b, 104f, 105f transformers, 36t, 38–40
Tube filtration, 65b postprocessing of, 164b X-ray field measurement guide, 143–144, 144f
and beam quality, 67 Window width (WW) X-ray film. see Film
and beam quantity, 66 in CT, 236–237, 239f X-ray interactions, with matter, 73–80, 73b, 74f
and emission spectrum, 69, 69b, 69f for digital image, 104, 104f, 105f classical, 73–74, 74b, 74f
and radiographic exposure, 132–133, 132b postprocessing of, 164b Compton, 74–75, 75b, 75f
and x-ray beam quality, 133 Windowing, in CT, 236–238, 237f, 238b, 238f, 239f differential absorption due to, 77–79, 78b,
Tube head assembly, 8, 8f Wire mesh test tool, 176, 177f 78f, 79b
overhead, 9, 9f WL (window level) pair production due to, 77, 77f
Tube housing, 8 in CT, 236–237, 238f photodisintegration due to, 77, 78f
Tube mount, 9 for digital image, 102–103, 103b, 104f, 105f photoelectric, 75–77, 76b, 76f, 77b
variations, 9f postprocessing of, 164b probability of, 76, 77b
Tube stand, 9 Work, 6 X-ray machine control panel, 33f
Tungsten, binding energies of, 63, 63t WW (window width) “X-ray mania,” products taking advantage of, 4f
Turbid phosphor layer, of photostimulable in CT, 236–237, 239f X-ray production, 56b, 56f, 61–72
phosphor plate, 157–158 for digital image, 104, 104f, 105f emission spectrum in, 67–70, 67f
postprocessing of, 164b continuous, 67, 68f
U discrete, 67, 68f
Ultraviolet light, 29, 29t X factors affecting, 70t
generator type as, 69, 69f, 70b
Units of measure, 5–7, 6b, 7b X-ray(s), 25, 29t
kVp as, 68, 69b, 69f
Unrestricted primary beam, 140, 141f discovery of, 1–5, 2b, 2f, 5b
milliamperage as, 68, 68b, 69f
Upside-down focused grid cutoff, 150, 150f of electromagnetic radiation, 28–29
target material as, 70, 70b, 70f
evolution and use of, 2–5, 3f
tube filtration as, 69, 69b, 69f
V panoramic, 221, 222f
photons (target interactions) in, 61–65, 65b
particulate characteristics of, 28
Values of interest (VOI), in histogram analysis, bremsstrahlung, 61–62, 63–65, 64b, 64f
vs. gamma rays, 28–29, 28b
161, 161b, 161f characteristic, 61–63, 62f, 63b
X-ray beam
Variable kVp-fixed mAs technique chart, properties of x-ray beam in, 65–67, 65b
emission spectrum of, 67–70, 67f
197–198, 198b, 198t beam quality as, 66–67, 67b, 67t
continuous, 67, 68f
Velocity, 6, 6b beam quantity as, 65–66, 67b, 67t
discrete, 67, 68f
Vidicon tube, for fluoroscopy, 209–210, 209f X-ray scintillator, in digital receptors, 159
factors affecting, 70t
View, in CT, 233 X-ray tube, 8, 8f, 50–52, 52b, 62f
generator type as, 69, 69f, 70b
Viewing systems, for fluoroscopy, 209–212 anode of, 51–55
kVp as, 68, 69b, 69f
camera tube as, 209–210, 209f anode heel effect with, 54, 55b, 55f
milliamperage as, 68, 68b, 69f
charge-coupled device for, 210, 210f line-focus principle for, 53–54, 54f, 55b
target material as, 70, 70b, 70f
coupling of devices to image intensifier in, rotating, 52–53, 52f, 53b
tube filtration as, 69, 69b, 69f
210 stationary, 52, 52f
properties of, 65–67, 65b
liquid crystal display monitors as, 211, 211f target angle for, 53–54, 54f
beam quality as, 66–67, 67b, 67t
plasma monitors as, 211–212, 212f cathode of, 8, 51–52, 55, 55b, 55f
beam quantity as, 65–66, 67b, 67t
television monitor as, 210–211, 211f, 212b defined, 55
X-ray beam intensity, and source-to-image
Vignetting, in fluoroscopy, 209 causes of failure of, 57b
receptor distance, 126, 126b
Visible light, 29, 29t cooling charts for, 57, 58f
X-ray circuit, 32–49
VOI (values of interest), in histogram analysis, of CT scanner, 232
basic, 41f
161, 161b, 161f dual-focus, 55
conductors and, 35–36
Volt, 34 extending life of, 56–58
current and, 34
Voltage, current and, inverse relationship of, general construction of, 50–55
electric potential and, 33–35
39b heat units for, 57–58
electromagnetism and, 37–38, 37b
Voxel, in CT, 234, 234f housing for, 50–51
electromagnetic induction and, 38
Voxel volume, in CT, 234 induction motor for, 51–52, 53f
electronic devices and, 35–36
parts of, 52f
filament, 45–47, 46f
W general, 40–47
photograph of, 51f
W (watts), 6 principles of operation of, 55–58
generators and, 38–40, 38f
Wafer grid, 148 quality control for, 56–58
insulators and, 35–36
Wall unit, 10 rating charts for, 57, 57b, 57f
magnetism and, 36–37
Warm-up steps, for x-ray tubes, 58 warm-up steps for, 58
motors and, 38–40
Washing, in film processing, 177t, 178, 178b, X-ray units, mobile, 220, 220b, 220f
nature of electricity and, 33, 33b
179f parts of, 42f
Watts (W), 6 primary, 40–43 Z
Wave-particle duality, of electromagnetic principles of circuit operation and, 47 Z axis, in MSCT, 231
radiation, 28b rectification in Zebra pattern, 151, 152f
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 RADIOLOGIC UNITS OF MEASURE
Unit SI Equivalent Use
Roentgen (R) Coulomb per Kilogram (C/kg) Quantify radiation intensity
Rad Gray (Gy) Quantify biological effects of radiation on humans and animals
Rem Seivert (Sv) Quantify occupational exposure or dose equivalent
Curie Becquerel (Bq) Quantify radioactivity

SUMMARY OF ELECTROMAGNETIC SPECTRUM

Electromagnetic Ionize
Radiation Common Use Matter?
Radiowaves Broadcasting of music/MRI No
Microwaves Cell phone signals/microwave ovens No
Infrared Light Communication between electronic devices No
Visible Light The colors and part of the spectrum we see as No
humans
Ultraviolet light Tanning beds No
X-rays Medical imaging and radiation therapy Yes
Gamma rays Nuclear medicine imaging and radiation therapy Yes

Useful Formulas
Heat Units kVp 3 mA 3 s 3 c where kVp is the kilovoltage selected, mA is the milliamperage station
selected, and s is the exposure time in seconds. The c represents a
correction factor and depends on the generator type. Its value is as
follows:
Single-phase 5 1.0
Three-phase, 6-pulse 5 1.35
Three-phase, 12-pulse 5 1.41
High-frequency 5 1.45
Inverse Square Law I1 (D2 )2 Where I1 is the original intensity, I2 is the new intensity, D2 is the new
=
I2 (D1)2 distance, and D1 is the original distance
Grid Conversion formula mAs1 Grid conversion factor1 Where mAs1 is the original mAs, mAs2 is the new mAs, Grid conversion
=
mAs2 Grid conversion factor2 factor1 is the original factor and Grid conversion factor.
mAs/distance mAs1 (SID1)2 Where mAs1 is the original mAs, mAs2 is the new mAs, SID1 is the
=
compensation formula mAs2 (SID2 )2 original distance and SID2 is the new distance.

Magnification factor SID Where SID is the source to image receptor distance and SOD is the
MF =
SOD source to object distance
Object size Im age Size Where image size is the size as measured from the image and MF is
Object size =
MF the calculated magnification factor

FACTORS AFFECTING BEAM QUANTITY

Increase In: Affect on Quantity
mAs Increases
kVp Increases
Distance Decreases
Filtration Decreases

FACTORS AFFECTING BEAM QUALITY

Increase In: Affect on Quality
kVp Increases
Filtration increases
 THE BUCKY FACTOR/GRID CONVERSION FACTOR (GCF)
Grid Ratio BuckyFactor/GCF
No grid 1
5:1 2
6:1 3
8:1 4
12:1 5
16:1 6

FACTORS AFFECTING ATTENUATION

Factor Beam Attenuation Absorption Transmission
Tissue Thickness
• Increasing thickness h h g
• Decreasing thickness g g h
Tissue Atomic Number
• Increasing atomic # h h g
• Decreasing atomic # g g h
Tissue Density
• Increasing tissue density h h g
• Decreasing tissue density g g h
X-ray Beam Quality
• Increasing beam quality g g h
• Decreasing beam quality h h g

SOME COMMON ADDITIVE AND DESTRUCTIVE DISEASES AND CONDITIONS BY ANATOMIC AREA
Additive Conditions Destructive Conditions
Abdomen
Aortic aneurysm Bowel obstruction
Ascites Free air
Cirrhosis
Hypertrophy of some organs (e.g., splenomegaly)

Chest
Atelectasis Emphysema
Congestive heart failure Pneumothorax
Malignancy
Pleural effusion
Pneumonia

Skeleton
Hydrocephalus Gout
Metastases (osteoblastic) Metastases (osteolytic)
Osteochondroma (exostoses) Multiple myeloma
Paget disease (late stage) Paget disease (early stage)

Nonspecific Sites
Abscess Atrophy
Edema Emaciation
Sclerosis Malnutrition
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