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STUDENT WORKBOOK
for
STUDENT WORKBOOK
for
By
With THOMAS BOOKS careful attention is given to all details of manufacturing and
design. It is the Publisher’s desire to present books that are satisfactory as to their
physical qualities and artistic possibilities and appropriate for their particular use.
THOMAS BOOKS will be true to those laws of quality that assure a good name
and good will.
RC489.P72S27 2009
616.89’14–dc22
2009020443
INTRODUCTION
The Workbook is entirely organized in a “fill-in-the-blank” format. The wording of each ques-
tion almost exactly matches the lecture slide series Digital Radiography in Practice: Instructor
PowerPoint™ Slides, and closely matches the progression of concepts in the textbook. The guid-
ing philosophy is to provide immediate or short-term reinforcement of lecture and reading mate-
rial by focusing on keywords. The Workbook should therefore be used on a daily basis, not as
a self-test or review after whole units have been covered. Following are specific recommenda-
tions on how the student (and instructor) can most fully benefit from the Workbook and other
ancillaries to Digital Radiography in Practice:
This is the most recommended method, for use with the Digital Radiography in
Practice Instructor PowerPoint Slides. The workbook and slides are designed to work
in tandem with each other to actively engage the student in classroom learning while at the
same time minimizing the amount of notetaking so that the student is allowed to concen-
trate on the lecture. The sequence and wording of questions almost exactly matches the
slides, using a fill-in-the-blank approach connected to highlighted keywords on the slides.
Instructors may elect to require this type of classroom participation and award points for
completion of each unit.
2. HOMEWORK USE:
v
vi Student Workbook for Digital Radiography in Practice
For the purposes of review, self-testing or preparation immediately prior to a test, Chapter
Review Questions are provided at the end of each chapter in the textbook. Answer keys
to these questions may be made available from your instructor. These are better suited to
unit review and test preparation than the workbook material.
CONTENTS
Page
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Chapter
1. NATURE OF THE DIGITAL RADIOGRAPH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2. CREATING THE LATENT IMAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3. QUALITIES OF THE DIGITAL RADIOGRAPH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4. RADIOGRAPHIC TECHNIQUE FOR DIGITAL IMAGING . . . . . . . . . . . . . . . . . . . . . . . 23
5. PREPROCESSING AND HISTOGRAM ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
6. RESCALING (PROCESSING) THE DIGITAL RADIOGRAPH . . . . . . . . . . . . . . . . . . . . 38
7. DEFAULT POSTPROCESSING I: GRADATION PROCESSING . . . . . . . . . . . . . . . . . . 41
8. DEFAULT POSTPROCESSING II: DETAIL PROCESSING . . . . . . . . . . . . . . . . . . . . . 49
9. MANIPULATING THE DIGITAL IMAGE: OPERATOR ADJUSTMENTS . . . . . . . . . . . . 56
10. MONITORING AND CONTROLLING EXPOSURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
11. DIGITAL IMAGE ACQUISITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
12. DISPLAYING THE DIGITAL IMAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
13. ARCHIVING PATIENT IMAGES AND INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . 97
14. DIGITAL FLUOROSCOPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
15. QUALITY CONTROL FOR DIGITAL EQUIPMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
vii
STUDENT WORKBOOK
for
5. For CR, x-ray energy stored by a phosphor is emitted as ________ when stimu-
lated by a laser beam.
7. For indirect-conversion DR, a __________ first converts x-rays to light, then the
light is converted into electrical charge.
3
4 Student Workbook for Digital Radiography in Practice
11. Each ________ (picture element) is a single location designated by its column
and row.
12. Each pixel is assigned a pixel value that will become its _____________ upon
display.
13. Light images enter a camera, and x-rays enter a detector, in _____________
form.
14. To manipulate these images with a computer, they must first be converted into
__________ form.
15. Analog: Continuous, and infinitely ______________, like the rails of a railroad
track.
16. Digital: Discrete (separated into ____________ units), limited in subdivision and
in scale, like the wooden ties of a railroad track.
18. This rounding out makes digital information inherently less ______________
than analog information.
19. However, as long as the discrete units for a digital computer are smaller than
the human eye can detect, digitizing the information improves ______________
accuracy.
20. This is why ___________ equipment is used to clock the winner of a race in the
Olympics.
21. Rounding these input values (A) out to the nearest allowable discrete unit (B) so
the computer can manage them is the function of an ___________-to-
___________ converter (ADC).
Nature of the Digital Radiograph 5
1. ________________
2. ________________
3. ________________
24. Sampling: _______________ of light (or x-rays) is measured for each cell.
25. Scanning: In CR, the reader (processor) is set to scan the PSP plate in a pre-
designated number of _______, and samplings per ______.
26. In DR (and DF using CCDs), since the number of available pixels is the number
of detector elements (dels) embedded in the image receptor plate, collimation of
the x-ray beam is analogous to _____________.
30. Quantizing: Discrete numerical value is assigned to each cell from a pre-desig-
nated _______ _________.
31. The terms bit depth and dynamic range are often used interchangeably by
physicists and ______________________, which can be confusing for the stu-
dent. For clarity, we will define them according to their most dominant use by
experts.
6 Student Workbook for Digital Radiography in Practice
32. Bit Depth: The maximum range of pixel values a computer, display monitor, DR
detector or other _________________ device can store, expressed as an expo-
nent of base 2.
33. The human eye can only discern about 2__ = ___ shades of gray or levels of
brightness (a bit depth of __).
34. By not using the full range of bit depth of the computer, image processing
________ can be accelerated.
35. Dynamic range compression ________ off the extreme ends of the bit depth
that are not needed to construct images, to save processing speed. This does
not affect the displayed image.
36. Dynamic Range: The range of pixel values (from the bit depth) that the entire
system makes _______________ to build up images.
38. Dynamic range is also the number of gray shades with which each _________
can be represented by the system.
39. Gray Scale: The range of pixel values actually present in a ______________
image.
41. The greater the dynamic range, the ___________ the gray scale in the dis-
played image.
42. The longer the gray scale, the more ___________ can be represented in the
image.
44. Insufficient dynamic range prevents full post ________________ capabilities for
the image:
45. We must be able to double or cut in half both the brightness and contrast of the
image _____________ times without running out of dynamic range (data clip-
ping). Complex features such as subtraction require still more.
46. The dynamic range of the remnant x-ray beam is approximately 2___.
47. The enhanced contrast resolution and processing features of CT and MRI sys-
tems require a ____-bit deep range.
48. Most digital imaging systems have dynamic ranges set at 28 = 256, 210 = 1024
(___ and ___), or 212 = 4048.
What is a Pixel?
50. For displayed medical images, however, we define a pixel as the ____________
screen element which can represent all gray levels within the dynamic range of
the imaging system.
53. For an LCD display monitor, each hardware pixel is formed by the
__________________ of two flat, transparent wires. Their dimensions are typi-
cally ____mm square.
56. Each __________ in a radiographic image represents a voxel within the patient.
57. CT scanners can isolate a 3-D cube of tissue because they combine multiple
______________ from hundreds of angles.
58. Since DR and CR only use a single projection, the 3-D voxels sampled are in
the shape of long, square tubes that pass from the __________ to the
________ of the patient.
59. To assign a gray level to a pixel in the final image, within each voxel the attenu-
ation coefficients for various tissues must be ________________.
60. These attenuation coefficients must then be rounded out by the ADC to
_____________ values from the system’s dynamic range.
61. The ultimate brightness of each pixel brought up on the display monitor is con-
trolled by the amount of electrical voltage applied to it, which depends on the
_______ ________ number stored in the computer for that pixel.
62. We might say that to form a digital radiographic image, data from the
__________ in the patient are collected by the dels of the image receptor, then
computer processed to become the __________ of the displayed image.
Chapter 2
Overview of Variables
2. List the three general types of radiographic variables for the projected image:
__________
__________
__________
3. Give two examples for each of the three general types of radiographic variables
for the projected image:
__________ __________
__________ __________
__________ __________
5. Nearly ALL the effect of increased SID is due to the simple ___________ of the
inverse square law.
9
10 Student Workbook for Digital Radiography in Practice
10. Without attenuation, rather than various shades of gray representing different
tissues, a silhouette image would result with little ______________ in it.
11. Within the patient, photoelectric Interactions are primarily responsible for creat-
ing _________ shades.
14. Characteristic interactions result only in low-energy ultraviolet rays that do not
________ the patient’s body.
17. Compton Scatter: Mostly responsible for destroying subject contrast by adding
“fog” to the latent image reaching the _________ ____________.
18. In the remnant x-ray beam, the useful signal is created by variations in the pho-
toelectric/penetration _______ for different tissues of the body.
20. A “hardened” x-ray beam with higher __________ energy can be created by
either increasing the set kVp OR by adding filtration.
21. kVp is the primary controlling factor for x-ray beam ______________.
Creating the Latent Image 11
23. As average x-ray beam energy is increased, ALL x-rays have increased
____________ of penetration.
24. Therefore, _____ types of interactions within the patient’s body decrease in
probability.
25. However, as x-ray beam energy (keV) increases, the probability of photoelectric
interactions ___________.
26. While …the probability of Compton interactions only decreases slightly (<___%).
27. At 80 keV, in bone there are still more _________________ occurring than
Comptons, creating good subject contrast.
29. For this reason, at 80 keV soft tissues show up ________ while bone is still
demonstrated with subject contrast.
30. As the part becomes thicker, all types of interactions increase by equal
_____________.
31. For every 4-5 cm increase in part thickness, radiographic technique must be
_______.
33. As the number of molecules per volume, density can be changed by _________.
35. High atomic number (Z#) means that the atom also has many more electrons
concentrated into about the same space, called the “electron __________”.
36. This makes it much more likely that an x-ray will strike an ___________ electron.
37. X-ray absorption increases by the _______ of the atomic number. Example, car-
bon is 6 × 6 × 6 = 216 times more likely to absorb an x-ray than hydrogen.
12 Student Workbook for Digital Radiography in Practice
38. This is the main reason ____________ contrast agents, such as Iodine and
Barium, work so well absorbing x-rays.
40. Using the Z-cubed relationship, we find that positive contrast agents are approx-
imately _____ times more effective at X-ray absorption than soft tissue.
42. Negative contrast agents are gasses, and work primarily due to their
___________ difference in physical density.
(See textbook discussion for bone vs. soft tissue.)
43. List the 5 main variables affecting subject contrast in the projected image car-
ried by remnant x-ray beam:
46. At twice the mAs, there are twice as many penetrating x-rays, twice as many
photoelectrics, and twice as many Comptons. All interactions change by the
same ______________.
48. At ¾ the SID (due to the inverse square law), again, all interactions change by
the same proportion. Therefore … The distribution or ratio of different interac-
tions remains _____________.
49. At the image receptor, both mAs and SID change the overall intensity of expo-
sure, but NOT the ______________ of different types of interactions.
50. It is possible for an image to be twice as dark, yet still have the same
___________.
Creating the Latent Image 13
51. Neither mAs nor SID should be considered as ___________ factors for subject
contrast.
52. To simply provide _____________ signal reaching the IR, enough information
for the computer to process.
53. This depends on both beam ____________ controlled by mAs and SID, AND
beam _____________ controlled by filtration and kVp.
54. This allows great leeway in employing ______-kVp techniques to reduce patient
dose when the mAs is compensated according to the 15% rule.
56. It possesses:
Subject contrast
Noise in the form of scatter radiation and quantum __________.
Inherent _____________, magnification and distortion determined by beam
geometry and positioning.
58. The remnant beam signal does set important _________________ on what digi-
tal processing can do.
60. However, this is an extremely minor requirement in practice, because digital pro-
cessing has ____ times the contrast enhancement capability of film technology.
61. This high contrast enhancement allows us to use high kVp techniques to reduce
__________ dose.
63. A typical display monitor has a hardware pixel size of ____ mm.
14 Student Workbook for Digital Radiography in Practice
64. At typical SID, the SOD/OID ratio results in an “effective pixel size” comparable
to the display ___________.
65. This means that in some circumstances, using the large focal spot when the
small FS should be used could cause more ______than the display monitor.
66. Good x-ray beam geometry is still important, and the ________ focal spot
should be used whenever feasible, especially with distal extremities.
67. When discussing “controlling factors,” it is important to keep the projected image
and its contributing factors separate form the __________ image on the monitor.
68. Receptor _____________ is the quantity of x-rays reaching the image receptor.
69. ____ is the “primary” control for this, because it is under the immediate control
of the radiographer.
72. Absorption and __________________ are different sides of the same coin.
73. _____ is the factor most easily adjusted by the radiographer at the console,
that affects subject contrast.
74. Spatial resolution (sharpness), magnification, and shape distortion are all con-
trolled by ________________ geometry.
75. The radiographer is vitally concerned with the projected image only during the
______________ phase of image production.
76. In the second stage of image production, the ___________ image, still an ana-
log image, is held for only a short time by the IR and never seen by the radiog-
rapher.
Creating the Latent Image 15
77. In the third stage of image production, ________________ and monitor pro-
cessing determine the final qualities of the displayed image.
78. The characteristics of the projected image are not synonymous with the qualities
of the final digital image _____________ on the monitor.
79. With film imaging, _____ and _____ “controlled” the final image – this is no
longer true.
2. Brightness refers to the _____________ of light for any portion of the image.
3. The ideal level of brightness is an ____________ level in which all pixels within
the anatomy of interest are displayed as a level of gray, neither blank white nor
pitch black.
16
Qualities of the Digital Radiograph 17
8. Density: The _____________ of any portion of the image. (Still used especially
for hard copies of radiographic images.)
10. Again, ideal overall density is _____________, (neither minimum nor maximum).
13. Gray Scale: Defined as the __________ of different brightness levels (or densi-
ties) within an image.
14. Long gray scale presents _________ shades of gray. Short gray scale has only
a few different shades, counted on a scale from white to black.
15. Gray scale is associated with the amount of _____________ present in the image.
16. The more shades of gray available, the more different types of _____________
can be demonstrated.
18. Progressing from black to white, when more shades of gray are present, there
must be less _________________ between one step and the next.
19. With too long gray scale, there can be too little ________________ between
details, such that it is difficult to tell them apart.
22. Strictly speaking, as shown on the CT scans, when “windowing”, increasing win-
dow width gives a radiographic image more ________ _________.
25. Contrast must always be measured between tissues within the _____________
– not between the pitch-black background density and a tissue.
28. Example: Starting with two densities measuring 1 and 2: Add a fog density of 1.
30. Image noise is defined as any non-useful contribution to the image that inter-
feres with the ________________ of anatomy or pathology of interest.
1.______________
2.______________
3.______________
4.______________
5.______________
6.______________
7.______________
8.______________
34. In the digital age, image _____________ has far exceeded “fog” from scatter
radiation as the most common form of noise appearing in the final displayed
image.
35. Some authors have restricted the meaning of noise to only quantum mottle, but this
is misleading – For example, there are also four types of ______________ mottle.
36. Scatter radiation is also a form of noise, as are various artifacts that interfere
with ___________ of important diagnostic details
37. Scatter radiation and off-_______ radiation are both forms of noise that are
destructive to image contrast.
38. Exposure artifacts include ______ lines, extraneous objects, and false images
such as tomographic streaks.
39. Aliasing artifacts (Chap. 11) are _________ line patterns very common with
electronically displayed digital images.
41. Background fluctuations, surges and dips in electrical current which are present
in any electronic system, are classified as ______________ noise in the image.
44. The signal refers to all of the _______________, useful information carried by
the subject contrast in the remnant x-ray beam.
46. Defined as the proportion of all useful diagnostic information to all obstructing
__________________.
-Reduce noise
-Increase signal (x-ray intensity reaching the IR, either by ______________
[kVp] or original _____________ [mAs].
52. Sharpness of detail is defined as the _________________ with which the edges
of an image “stop”.
Qualities of the Digital Radiograph 21
53. While moving across the image, if the edge of a detail suddenly changes from
white to the black background, (A) the image is _________.
54. While moving across the image, if the edge of a detail ____________ changes
to the background density, the image is unsharp.
55. Spatial resolution (sharpness) is affected by the focal spot, beam projection
____________ and any motion during exposure.
57. Shape Distortion is defined as the difference between the shape of a real object
and the shape of its ______________ image.
59. Shape distortion is the one image quality that __________ processing does not
alter!
60. Geometric Magnification (also referred to as size distortion), is defined as the differ-
ence between the size of a real object and the size of its ______________ image.
1. A “____________” image
2. Aliasing patterns (Moire artifact)
67. Qualities of the Latent Image captured at the Image Receptor include:
1. ______________ exposure
2. Subject contrast
3. Noise
4. Inherent sharpness from beam projection geometry
5. Shape distortion
6. Geometrical magnification
68. These are NOT to be confused with qualities of the FINAL _____________
IMAGE.
71. In the displayed image, what two types of noise and sharpness are added to
“original noise and sharpness”:
72. In the displayed image, what type of magnification is added to geometrical mag-
nification:
73. Displayed brightness is first set by rescaling, then controlled by leveling, not by
_____.
74. Displayed contrast is first set by gradation LUTs, then controlled by windowing,
not by _____.
75. Resolution template images show that overall resolution can be lost by either
blurred edges resulting in poor _____________ even though contrast is high, or
by poor ___________ even though sharpness is high.
77. For a single detail (dot, or line), the exposure trace diagram can represent the
contrast of the detail as the vertical _________ of the “pit”.
Qualities of the Digital Radiograph 23
78. For a single detail (dot, or line), the exposure trace diagram can represent the
blur (penumbra) as the horizontal __________ of the slopes. These correlate to
contrast resolution and spatial resolution.
79. When a resolution template is exposed, the projection of several then lead strips
and slits results in a series of density trace diagrams that begin to look like a
sine ______.
80. As lines become smaller and closer together, eventually overlapping penumbras
cause a decline in the vertical dimension of the sine wave, representing reduced
___________ at the microscopic level.
1. In the digital age, the new role for set radiographic technique is to provide
___________ signal at the image receptor for the computer to be able to manip-
ulate the data.
7. All the IR “cares about” is its __________ exposure level from the remnant x-ray
beam, not the specific intensity of the primary beam.
8. Total exposure at the IR is not based on the mAs alone, but on the
________________ of kVp and mAs used.
9. If penetration is doubled at a higher kVp, then ____ the mAs can be used to
achieve equal dose to the IR.
24
Radiographic Technique for Digital Imaging 25
10. Subject Contrast is the ratio between adjacent areas of the remnant x-ray beam
representing different ____________ within the body.
12. For any image, a ________________ level of subject contrast must be present
to distinguish between tissue areas.
13. A CT scanner is able to distinguish between gray matter and white matter in
brain tissue, and display the eyeballs within periorbital fat. A conventional radi-
ograph is only able to demonstrate _________, _____, and ______
__________ generally.
15. Conventional film imaging required a minimum 10% subject contrast to distin-
guish between tissues. Digital imaging requires only ___% subject contrast,
because of its contrast-enhancing capabilities.
16. Digital technology provides ____X the contrast resolution of film technology!
17. Although it is technically true that a minimum amount of subject contrast is nec-
essary, this is a ____-issue for digital systems that only require 1% subject con-
trast.
20. Exposure latitude is also the margin for __________ in setting technique.
21. This margin for error includes use of different ________, filters, focal spots, and
distances.
26 Student Workbook for Digital Radiography in Practice
22. Generally, a latent image possessing higher subject contrast will present
______ exposure latitude.
23. High contrast (short gray scale) allows less ______ to move the displayed den-
sities (solid arrow) up or down the available dynamic range.
24. Lengthened gray scale allows greater changes in technique without “running
out” of available _____________.
25. Since digital systems require only 1% subject contrast, the result is a much
extended _________________ ________________. There is ______ margin for
technique error.
26. All technical aspects of the original exposure become _______ critical.
27. One result is the ______________ to use grids and filters less, lower grid ratios,
higher kVp’s, etc.
28. However, the increased exposure latitude of digital systems extends primarily in
an ____________ direction.
29. On reducing technique, if exposure levels at the IR reach less than 1/3 ideal
exposure, the appearance of ___________ is certain.
30. For increases in technique, the only restricting factor is the effect on
___________ dose. (Normally, there are no noticeable effects on the displayed
image.)
32. According to our professional Standards of Practice, grids should not be used
when they are ____________________.
34. Increased exposure latitude of digital systems allow flexibility to use _____-
______ techniques for some procedures that used to require grids.
Radiographic Technique for Digital Imaging 27
36. Both of these practices allow less mAs to be used, reducing __________
____________.
37. Non-grid technique requires ____ or less mAs to be used, reducing patient dose
to this amount.
38. Using a 6:1 grid ratio instead of 10:1 or 12:1 allows mAs to be cut in ______,
reducing patient dose to this amount.
39. By reducing grid use, some scatter radiation is allowed “back” into the beam,
BUT digital processing routinely restores nearly all the “damage” done by mod-
erate amounts of _____________.
40. Digital systems only require 1% subject contrast. If subject contrast is reduced
from 10% to 5%, the system can still ___________ for it.
42. _____ forms of noise increase the risk of digital processing errors.
43. Using a grid reduces noise in the form of scatter. However, if the technique is
not compensated, removing a grid reduces the probability of noise in the form of
_______.
44. Which is more important to remove? Reducing patient dose and the probability
of mottle can ______ be achieved:
45. First, remove the grid. By removing a 10:1 or 12:1 table bucky grid, one-
____________ of the mAs could be used. This would result in a 75% reduction
in patient dose.
46. Second, reduce the _____ only to 1/2 or 1/3 of the original grid technique,
(instead of 1/4).
47. The image receptor is now receiving more radiation than the grid technique
allowed, such that ___________ is less likely, yet patient dose has also been
cut by ____-____% from the grid technique!
28 Student Workbook for Digital Radiography in Practice
48. Several manufacturers now offer ____________ grid software that replaces the
.
need for grids except in the most extreme circumstances, (such as abdominal
projections on obese patients).
Even if conventional grids continue in use, the following are strongly recommended:
__________
__________
__________
__________
__________
55. Use a 6:1 grid ratio for all gridded ____________ procedures.
56. Reduce grid ratio to ____ in all fixed units, and reduce mAs values accordingly.
58. Digital technology is allowing us as a profession to explore and adopt tools that
will benefit the ____________ in various ways.
59. Starting with a long-scale input image, if shortened gray scale is desired, the
computer can select every other density. In this case, all final displayed informa-
tion consists of ______ values measured at the IR.
Radiographic Technique for Digital Imaging 29
60. Starting with a short-scale input image, if lengthened gray scale is desired, the
computer must extrapolate new values. In this case, new values are
______________ and constitute ______________ information.
61. Generally, for digital radiography, long gray scale in the latent image is
_____________ because it provides more real tissue information.
62. Long gray scale in the latent image is primarily achieved through the use of
_____ kVp techniques.
63. At 1/4 normal mAs, slight mottle is apparent, but the image is not
______________.
65. mAs can be increased more than ___ times before any visible change occurs.
67. There is no practical limitation for increasing mAs or kVp, and this has resulted
in dose-_________, a tendency to use too high mAs, over-exposing patients.
68. Because neither mAs nor kVp have a substantial impact on the final displayed
image (except for mottle when too low), this allows the 15% rule to used to
____________ patient dose.
69. For the displayed image, brightness and contrast are now controlled by
______________ and _______________.
70. Cutting the mAs in half results in ____ exposure at the IR (and for the patient).
71. A 15% increase in kVp restores exposure to the IR for two reasons: First,
increased penetration through the patient recovers about _____ of the exposure
to the IR.
72. Second, higher kVp results in ~35% more bremsstrahlung x-rays being pro-
duced in the x-ray tube. This recovers an additional _____ of the original expo-
sure to the IR.
30 Student Workbook for Digital Radiography in Practice
75. The increase in kVp adds back about ____% from increased bremsstrahlung
production.
77. Applying the 15% rule reduces patient dose to about 2/3 the original exposure.
Patient dose is cut by ____.
79. For example, assume that from 80 to 92 kVp, penetration increases from 6.7%
TO 10%. 6.7% of 1000 = 67. 10% of 670 = 67. Exposure to the IR is fully
______________ to 67.
80. The end result of cutting mAs in half and increasing kVp 15% is that patient
dose was reduced from 1000 x-rays to 670 x-rays (67%), while exposure to the
___ was maintained.
81. High kVp helps ensure sufficient x-ray ________________ through the patient
to the IR.
82. High kVp provides long gray scale _________ to the computer for manipulation
without interpolation.
83. High kVp reduces _____________ exposure when combined with lower mAs
values.
84. For digital systems, the overall reduction in image contrast is visually
_____________ for each 15% step increase in kVp, (proven for nine different
manufacturers).
Radiographic Technique for Digital Imaging 31
85. With digital systems, even a 52-kVp increase demonstrates only the expected
lengthening of gray scale due to increased penetration. There is no _____ pat-
tern in these high-kVp digital images (as there would be with film).
86. In addition, digital software can identify and correct for expected fog
___________ such as those encountered on the lateral lumbar spine projection.
88. Mottle was _________ significant for a single-step application of the 15 percent
rule.
89. Departments can apply a single 15% increase in kVp, and cut mAs in half,
across the board for ____ techniques.
90. With digital equipment, what is the recommended optimum kVp for the following
procedures:
1. All methods of capturing information from the remnant x-ray beam involve the
__________________ of atoms or molecules.
2. For film, ionization led to chemical changes that darkened the film. For digital
radiography, electrons “freed” by ionization are ____________ up on a capacitor.
4. All these numbers together make up the ______ set that will be processed by a
computer.
7. For digital processing, some steps (such as noise reduction) are even
______________ at different stages of processing.
32
Preprocessing and Histogram Analysis 33
9. The “raw” digital image from the IR is both very noisy and so extremely “washed
out” (low contrast) that it cannot be used for _______________.
10. Preprocessing and rescaling must compensate for these flaws in image
_____________ to make the image diagnostic.
________________
________________
________________
________________
_______________
_______________
_______________
_______________
_______________
15. The first seven steps listed above collectively make up _____________ pro-
cessing which brings the image to initial display.
16. Specifically, it is _______________ that gives the digital image the contrast nec-
essary for diagnosis.
17. Rescaling is the step that best fits the concept of _______________ the image -
It “normalizes” the appearance of the initially displayed image.
18. However, since digital rescaling is correcting for flaws in image acquisition, it
also falls under the category of ___________________.
34 Student Workbook for Digital Radiography in Practice
Preprocessing
19. Segmentation software scans across the receptor plate to determine the num-
ber of views taken, and where their borders are so they are not processed
together as a _________ image.
20. With segmentation failure, “blank” spaces between fields are interpreted as if
they were bones or metallic objects within the body part. Averaging all densities
between different exposures, the result is a final image that is _______ and low-
contrast.
21. Since DR units allow only _____ exposure at a time to be processed, the seg-
mentation step is unnecessary.
22. In DR systems, dead detector elements (dels) can result from ______________
failure of switching transistors.
23. The computer uses ________ reduction software to eliminate these “dead”
spots in the image.
24. The most common way to correct these is using a software ___________: The
values of the 8 pixels surrounding a dead pixel are averaged, then this value is
inserted into the dead pixel.
27. Software can compensate for moderate cases of del drop-out, but not for
__________ cases where whole sections of rows have dropped out.
28. There are two general types of mottle: ____________ mottle and ______________
mottle. When severe, the two types can be indistinguishable from each other at the
gross observational level.
29. Quantum mottle appears as __________ mottle - artifacts of variable size that
occur in an ______________, chaotic distribution.
31. All electronics have small “microcurrent” __________________ that occur natu-
rally from various causes (e.g., local magnetic fields or natural radiation).
32. Like a light rain shower, quantum mottle can be seen to follow a “Poisson distri-
bution,” that is randomly distributed and of varying _____.
33. With lots of signal present, the randomness is still there, but is _____ apparent,
eventually disappearing visually.
35. Frequency processing is ideal for removing electronic and other ___________
mottle.
37. Normal anatomy has many ______________ sizes, so it occurs at various fre-
quencies.
38. Therefore, frequency processing can eliminate the image __________ contain-
ing most of the electronic mottle without affecting normal anatomy very much.
40. Kernels can “attack” a broader range of _________ of mottle, such as occur
from the random distribution of x-rays in the beam.
42. Variations in __________ uniformity are due to electronic and optical flaws in
the image receptor and reader.
44. Examples of system noise include dark noise and del drop-out. Dark noise
includes background exposure to a CR phosphor plate and dark ___________
(background ___________) in a DR detector system.
46. The anode heel effect also contributes, but cannot be ________ compensated for.
47. Flat field uniformity corrections even out the _______________ across the area
of the field.
48. Field uniformity is tested using low exposure with ____ object in the field.
50. This is analogous to collecting pixels of different shades and sorting them into
buckets representing computer _______.
51. The histogram is really a _____ graph indicating the number of pixels counted
for each value (gray level).
53. The histogram is usually displayed as a “best-fit line” connecting the _______ of
the bars.
Histogram Analysis
55. This scale usually proceeds from _______ to _______ as read left to right,
(although this scale can be reversed).
56. Histograms acquire generally consistent _________ for different body parts.
57. The key distinction between histogram types is the number of ________ (high
points) generated within the data set.
58. The most common type of histogram has 2 lobes, the main lobe representing
tissues within the anatomy, and the tail lobe representing “raw”
_______________ exposure.
59. A histogram for an image with no background density is expected to have only
__ lobe.
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