CHAPTER 15

RADIOGRAPHIC TECHNIQUE

Radiographic Technique mA
 The combination of settings selected on the  It determines the number of x-rays produced
control panel (radiation quantity)
 Purpose: to produce a high-quality image  1 A = 1 C/s = 6.3 x 1018 per second
 Higher mA:
EXPOSURE FACTORS o More electrons produced
o Higher x-ray quantity
Exposure Factors o Higher patient dose
 Factors that influence & determine the o No change in x-ray quality
quantity & quality of x-rays to which the
patient is exposed With a constant exposure time, mA controls x-
 Four Prime Factors: kVp, mA, exposure ray quantity & therefore patient dose!
time & SID
 Secondary Factors: focal-spot size, distance X-ray quality remains fixed with a change in
& filtration mA!

FACTORS THAT INFLUENCE X-RAY Exposure Time

QUANTITY & QUALITY  Kept as short as possible (ALARA)
WILL RESULT IN o Purpose: to minimize the motion
X-ray blur due to patient motion
An increase in X-ray Quality  Decreased Exposure Time: mA must be
Quantity
kVp Increase Increase increase
mA Increase No change o Rationale: to provide the required x-
Exposure time Increase No change ray intensity
Milliampere-  mAs: milliamperes (mA) x exposure time (s)
Increase No change o Function: to control OD
second
Distance Decrease No change o It principally controls radiation
Voltage ripple Decrease Decrease quantity
Filtration Decrease Increase o Doubled mAs: doubles x-ray quantity

kVp Equivalent Exposures of Equal mAs

 The primary control of x-ray beam quality  Formula:
(beam penetrability) mA (first exposure) Time (second exposure)
 Function: mA (second exposure)
=
Time (first exposure)
o Controls radiographic contrast
o Influences beam quantity
o Determines the average OD Total Projectile Electrons
 Higher kVp:  mA = mC/s
o Higher beam quality mAs = mC/s x s = mC
o Greater beam penetrability
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o More scatter radiation mAs is one measure of electrostatic charge!

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 Rationale: more Compton

effect interaction Falling-Load Generator
o Less differential absorption  Design in which exposure factors are
 Result: reduced image adjusted automatically to the highest mA at
contrast the shortest exposure time allowed by high-
voltage generator
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 15
RADIOGRAPHIC TECHNIQUE

Filtration
Only the x-ray quantity is affected by changes  Three Types: inherent, added &
in mAs! compensating

Distance Inherent Filtration

 It determines the intensity of the x-ray beam  Permanently installed components of an x-
at the image receptor ray tube housing assembly & the glass
 Tabletop Radiography: 100 cm (40 in) window
 Chest Radiography: 180 cm (72 in)  Equivalent: 0.5 mm Al

Distance has no effect on radiation quality! Added Filtration

 Equivalent: 2.0 mm Al
Direct Square Law  Variable-Aperture Light-Localizing
 mAs versus SID Collimator
 Formula: o Equivalent: 1.0 mm Al
o Due to the reflective surface of the
New mAs New distance squared
= mirror
Old mAs Old distance squared
 Between X-ray Tube Housing & Collimator
o Equivalent: 1.0 mm Al
Distance (SID) affects OD!
 Increased Added Filtration:
o Increased x-ray beam quality
IMAGING SYSTEM CHARACTERISTICS o Increased x-ray beam penetrability
 Results: increased scatter
Focal-Spot Size radiation & reduced image
 Sizes: small or large contrast
 Large Focal Spot:
o For imaging thick/dense body parts Total Filtration
o More x-rays are produced  Inherent Filtration + Added Filtration
o Higher anode heat capacity  Equivalent: 2.5 mm Al
o It provides for a shorter exposure
time When added filtration is changed, make sure
 Result: minimizes motion to return it to its normal position before
blur beginning the next examination!
 Small Focal Spot:
o For imaging thin body parts Compensating Filter
o For fine-detail & extremity  Material inserted between an x-ray tube & a
radiography patient
o Always used for magnification  Purposes:
radiography o To deliver a more uniform exposure
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to the image receptor
Changing the focal spot for a given kVp/mAs o To make the remnant beam more
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setting does not change x-ray quantity or uniform in intensity

quality! High-Voltage Generation
Microfocus Tube  Influenced the radiation quantity & quality
 A mammographic tube designed specifically produced in the x-ray tube
for imaging very small microcalcifications
at relatively short SIDs
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 15
RADIOGRAPHIC TECHNIQUE

 Three Basic Types: single phase (half-wave o More x-rays are produced
& full wave), three phase (6-pulse & 12-
pulse) & high frequency Three-phase power results in higher x-ray
quantity & quality!
Half-Wave Rectified Generator
 X-rays are produced & emitted only half the High-Frequency Generator
time  Voltage Ripple: <1%
 During Negative Cycle: no x-rays are  Relative Quantity: 300
produced  Advantage:
 Voltage Ripple: 100% o Voltage waveform is nearly constant
 Relative Quantity: 100  Applications:
 Applications: mobile & dental x-ray o Mammography systems
imaging system o Computed tomography systems
o Mobile x-ray imaging systems
Half-wave rectification results in the same
radiation quality as is produced by full-wave High-frequency generation results in even
rectification but radiation quantity is halved! greater x-ray quantity & quality!

Full-Wave Rectified Generator PATIENT FACTORS

 Identical to half-wave
 Advantages Over Half-Wave: Three Groups of Factors
o No dead time 1. Patient Factors – anatomical thickness &
o Half exposure time required body composition
 Advantages Over Half-Wave: 2. Image Quality Factors – optical density
o Radiation quantity increased by half (OD), contrast, detail & distortion
 Voltage Ripple: 100% 3. Exposure Technique Factors – kVp, mA,
exposure time, SID, grids, screens, focal-
 Relative Quantity: 200
spot size & filtration
Radiation quality does not change when going Evaluation of Patient
from half-wave rectification to full-wave  The most difficult task for radiologic
rectification; however, radiation quantity technologists
doubles!

Three-Phase Power Generator Body Habitus

 Two Principal Forms: 6 pulse & 12 pulse  The general size & shape of a patient
 Voltage Ripple:  Four States:
o 6 pulse – 14% o Sthenic Patient – means strong,
o 12 pulse – 4% active; the average patient
o Hyposthenic – thin but healthy
 Relative Quantity:
appearing
71
o 6 pulse – 260
o Hypersthenic Patient – big in frame
o 12 pulse – 280
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& usually overweight

 Advantages Over Single Phase:
o Asthenic Patient – small, frail,
o More efficient
sometimes emaciated & often elderly
o Higher average energy
Thickness
o X-ray emitted is nearly constant
 Thicker Patient: more radiation required
 Disadvantages Over Single Phase:
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 15
RADIOGRAPHIC TECHNIQUE

 Caliper: used to measure the thickness CLASSIFYING PATHOLOGY

of the anatomy Radiolucent Radiopaque
(Destructive) (Constructive)
Patient thickness should not be guessed!
Active tubercolosis Aortic aneurysm
Composition Atrophy Ascites
 Soft Tissue: low kVp & high mAs Bowel obstruction Atelectasis
 Thin Body Part: low kVp Cancer Cirrhosis
 Chest: high subject contrast Degenerative arthritis Hypertrophy
 Abdomen: low subject contrast Emphysema Metastases
 Lung Tissue: low mass density Osteoporosis Pleural effusion
 Bone Structure: high mass density Pneumothorax Pneumonia
 Mediastinal Structure: intermediate mass Sclerosis
density
IMAGE-QUALITY FACTORS
Radiolucent Tissue
 It attenuates few x-rays Image Quality Factors
 Appearance: black  It refers to the characteristics of the
radiographic image
Radiopaque Tissue o OD, contrast, image detail &
 It absorbs x-rays distortion
 Appearance: white  The language of radiography

Optical Density (OD)

RELATIVE DEGREES OF RADIOLUCENCY
 The degree of blackening in the radiograph
Radiographic Body Tissue
 It determines the amount of light transmitted
Appearance Habitus Type
Radiolucent Black Asthenic Lung through a radiograph
Hyposthenic Fat  Black: 3 OD or greater
Sthenic Muscle  Clear: <0.2
Radiopaque White Hypersthenic bone  Controlled by Two Major Factors: mAs
(primary) & SID
Pathology  OD is directly proportionate to mAs
 Influence Radiographic Technique:  Other Factor: kVp
o Type of pathology o The increase in OD is not
o Size of pathology proportionate (kVp2)
o Composition of pathology
When the OD of the radiograph is the only
Destructive Pathology characteristic that is to be changed, the
 It causes the tissue to be more radiolucent appropriate factor to adjust would be the mAs!
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Constructive Pathology Overexposure

 It cause the tissue to be more radiopaque  Radiograph: too dark or high OD
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o Rationale: due to increase mass o Rationale: too much x-rays reaches

density or composition the image receptor
Underexposure
 Radiograph: too light or low OD

STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO

 CHAPTER 15
RADIOGRAPHIC TECHNIQUE

o Rationale: too little x-rays reaches RELATIONSHIP BETWEEN kVp AND

the image receptor SCALE OF CONTRAST
High kVp Produces Low kVp Produces
The mAs value must be changed by Long scale Short scale
approximately 30% to produce a perceptible Low contrast High contrast
changed in OD. The kVp setting must be Less contrast More contrast
changed approximately 4% to produce a
perceptible change in OD! EXPOSURE TECHNIQUE FACTORS THAT
MAY AFFECT RADIOGRAPH CONTRAST
Fifteen Percent Rule (in approximate order)
 An increase in 15% is equivalent to Results in the
doubling the mAs An Increase in This
Following Change in
o Result: same OD Factor
Contrast
kVp Decrease
TECHNIQUE FACTORS THAT MAY Grid ratio Increase
AFFECT OPTICAL DENSITY Beam restriction Increase
Effect on Optical Image receptor used Variable
Factor Increased
Density Development time Decrease
mAs Increase mAs Decrease (toe, shoulder)
kVp Increase
SID Decrease Five Percent Rule
Thickness of part Decrease  An increase in 5% in kVp may be
Mass density Decrease accompanied by a 30% reduction in mAs
Development time Increase o Results: same OD but slightly
Image receptor speed Increase reduced contrast
Collimation Decrease
Grid ratio Decrease Detail
 The sharpness of appearance of small
Contrast structures on the radiograph
 The difference in OD between adjacent  Two Means of Evaluation:
anatomical structures o Recorded detail
 The variation in OD in the radiograph o Visibility of image detail
 One of the most important factors in
radiographic quality Sharpness of Image Detail
 Function: to make anatomy more visible  It refers to the structural lines or borders of
 High Contrast: black & white tissues in the image & the amount of blur of
 Low Contrast: many shades of gray the image
 Controlling Factors:
kVp is the major factor used in controlling o Geometric factors
 Focal spot size
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radiographic contrast!
 SID
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Gray Scale of Contrast  OID

 It refers to range to the range of ODs from  Influencing Factors:
whitest to the blackest part of the radiograph o Type of intensifying screen used
o The presence of motion

STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO

 CHAPTER 15
RADIOGRAPHIC TECHNIQUE

 Sharpest Image Detail: PRINCIPAL RADIOGRAPHIC IMAGE

o Small focal spot size QUALITY FACTORS
o Longest SID Controlled
o Minimize OID Factor Influenced by
by
kVp
Sharpness of image detail is best measured by
Distance
spatial resolution!
Thickness of part
Visibility of Image Detail Mass density
Optical Density mAs Development
 The ability to see the detail on a radiograph
time/temperature
 Best Visibility of Image Detail:
IR speed
o Collimation
Collimation
o Use of grids
Grid ratio
o Other methods that prevent scatter
radiation from reaching the image
mAs (toe, shoulder)
receptor
Development
time/temperature
Loss of Visibility Contrast kVp
IR speed
 It refers to any factor that causes
Collimation
deterioration or obscuring of image detail
Grid ratio
The visibility of image detail is best measured
SID
by contrast resolution!
OID
Distortion Focal-spot Motion
Detail
size All factors related
 The misrepresentation of object size &
to density &
shape on the radiograph
contrast
 Cause: poor alignment of the IR, the tube &
the anatomical part Alignment of tube,
Patient
 Minimized by: proper alignment of the IR, Distortion
positioning
anatomical part &
the tube & the anatomical part IR

Elongation EXPOSURE TECHNIQUE CHARTS

 The anatomical part of interest appears
bigger than normal Radiographic Technique Charts
 Cause: poor alignment of the IR or the tube  Tables that provide a means of determining
the specific technical factors to be used by
Foreshortening the radiographic examination
 The anatomical part appears smaller than  It allows for consistently good diagnostic
images
74
normal
 Cause: poor alignment of the anatomical  Four Principal Types:
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part o Variable kilovoltage

o Fixed kilovoltage
Distortion is reduced by positioning the o High kilovoltage
anatomical part of interest in a plane parallel o Automatic exposure
to that of the image receptor!

STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO

 CHAPTER 15
RADIOGRAPHIC TECHNIQUE

 Principal Advantage:
o The consistency in exposure that kVp varies with the thickness of the
occurs from one technologist to anatomical part by 2 kVp/cm!
another
 Type of Chart Selected Depends on: Fixed-kVp Radiographic Technique Chart
o Technical director of radiology in  Most often used
place  A method of selecting exposures that
o Type of imaging systems available produce radiographs with a longer scale of
o Screen-film combination used contrast
o Accessories available  Result: Higher kVp values than variable-
kVp technique
Radiographic technique charts from books,  Arthur Fuchs: developed this chart
pamphlets & manufacturers should not be  Benefits:
used as printed! o Lower patient dose
o Greater latitude
Consideration Before Preparation of Radiographic o More consistency with exposures of
Technique Chart the same anatomical part
 X-ray equipment must be calibrated
 Processing system must be thoroughly High-kVp Technique charts
evaluated  Ideal for Barium Work
 Total filtration should be determined o Purpose: to ensure adequate
 Type of grid should be known penetration of the barium
 Collimators are checked for accurate light  kVp: greater than 100
field & x-ray beam coincidence  Advantages:
o Improved visualization of tissue
Variable-kVp Radiographic Technique Chart markings
 It uses a fixed mAs value & a kVp that o Reduced patient dose
varies according to the thickness of the  For Routine Chest Radiography
anatomical part o Purpose: to attain improved
 Basic Characteristic: inherent short scale of visualization of the various tissue
contrast mass densities
o Rationale: low kVp used  Lower/More Conventional kVp Settings:
 Exposure Directed: o Provide increased subject contrast
o Results in: higher patient dose & less between bone & soft tissue
exposure latitude
o Attention: anatomical structure must AUTOMATIC EXPOSURE TECHNIQUES
be accurately measured before
selecting exposure factors from the Computer-Assisted Automatic Exposure System
chart  It uses an electronic exposure timer
 For High Frequency  Radiation Intensity: measured by a photocell
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o Formula: Beginning kVp = 2 x or ionization chamber

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thickness (cm) + 23 (additive factor)

 For Single Phase: 30 additive factor Automatic Control X-ray Systems
 For Three-Phase: 25 additive factor  They are not completely automatic
 RT does not need to select kVp & mAs
settings & time for each examination

STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO

 CHAPTER 15
RADIOGRAPHIC TECHNIQUE

 RT must use a guide  RT is guided by the graphics on the console

o Purpose: for the selection of kVp or on a video touch screen rather than
 Patient positioning must be absolutely selecting a desired kVp & mAs
accurate  RT needs only to select the part & its
o Purpose: to ensure proper exposure relative size before each exposure
 Lead Rubber: absorbs scatter radiation that
FACTORS TO CONSIDER WHEN may reach the sensing cells
CONSTRUCTING AN EXPOSURE CHART
FOR AUTOMATIC SYSTEM TOMOGRAPHY
Factor for Selection Rationale for Selection
To select for each Tomographic Examination
Kilovolt peak
anatomical part  Designed to image only that anatomy that
To fine-tune for lies in a plane of interest while blurring
Optical density control differences in field size structures on either side of that plane
or anatomical part o Result: radiographic contrast of
To reduce patient dose tissue is enhanced
& ensure proper  Designed for linear movement with a
Collimation
response of automatic general purpose imaging system
exposure control  Principal Advantage: improved contrast
To optimize the resolution
Accessory selection radiation dose-image o Rationale: subject contrast is
quality ratio enhanced through blurring of
overlying & underlying tissues
Automatic Exposure Control (AEC) System  Principal Disadvantage: increased patient
 Feature that determines radiation exposure dose
during radiography in most x-ray imaging o Rationale:
systems  X-ray is on during the entire
 RT selects appropriate kVp, mA & backup period of travel
time, as well as proper sensor & OD  It requires several exposures
 Technique Chart: includes mA, kVp, to ensure that the
backup time, sensor selection & OD setting tomographic section of
 Microprocessor: interest is imaged
o It allows the operator to select  Application: high contrast procedures
digitally any kVp or mAs setting o e.g. imaging calcified kidney stones
o It activates appropriate mA station &
exposure time General Purpose X-ray Imaging System
 In Falling-Load Generator: the  Image receptor & tube are designed to move
microprocessor begins the exposure at a tomographically within a plane
maximum mA setting & then causes the
Tomography X-ray Imaging System
76
tube to be reduced during exposure
o Overall Objective: to minimize  Image receptor & tube are designed to move
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exposure time to reduce motion blur within an arc

Automatically Programmed Radiography (APR) Linear Tomography

 A widely used electronic technique for  The simplest tomographic examination
patient exposure control
 It uses microprocessor technology
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 15
RADIOGRAPHIC TECHNIQUE

 Fulcrum: the imaginary pivot point about  X-ray tube & image receptor move around
which the x-ray tube & image receptor the head
move
 Position of the Fulcrum: determines the During tomography, parallel grid must be
object plane used & the grid lines must be oriented in the
 Object Plane: same direction as the tube movement!
o Only objects lying on this plane are
properly imaged MAGNIFICATION RADIORAPHY
o Above & below this plane are
blurred Magnification Radiography
 Larger Tomographic Angle: the more  A technique that is used mainly for
blurred are the images of structures above & mammography, neurovascular &
below the object plane interventional radiography
 Fulcrum Plane: o Rationale: it enhances the
o Objects lying outside this plane will visualization of small vessels
exhibit increasing motion blur  It deliberately increases the OID (constant
 Linear Anatomical Structure: e.g. foot SID)
o Less Blur: if the length of the o Rationale: to increase magnification
structure is positioned parallel to the  Focal Spot: small must be used
x-ray tube motion o Rationale: to help reduce the loss of
o More Blur: if the length of the image detail
structure is positioned perpendicular  Grids: not needed
to the x-ray tube motion o Rationale: large OID is used

The farther from the object plane an Magnification Factor

anatomical structure is, the more blurred its  Give the degree of magnification
image will be!  Formulas:
o MF = SID/SOD
Tomographic Section o MF = Image Size/Object Size
 The thickness of tissue that will be imaged

Tomographic Angle
 It determines the section thickness
 Larger Angle: thinner section
 Smaller Angle: larger section

Zonography
 Thick-slice tomography with a tomographic
angle of less than 10 degrees
 Applications: chest & renal examination
77
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Panoramic Tomography
 First developed for a fast dental survey
 Diagnostic Application: curve body
structures of the head (e.g. mandible)

STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO