Image Quality

Factors
Presented by
Madam Joyce
Tetteh
1. Radiographic Exposure
Controlled by Four Primary
Factors:
 • Exposure Time (T)
 • Milliamperage (mA)
 • Kilovoltage Peak (kVp)
 • Source–Image Distance (SID)

 These factors determine image quality and

patient dose.
Exposure Time (T) – Definition

 Exposure time is how long the x-ray tube

produces radiation.

 Measured in:
 • Seconds
 • Milliseconds (ms)

 Modern timers allow very precise control.

 Exposure Time
– Image Effect

 Exposure Time (T) Controls the

quantity of x-rays.

 Duration of x‑ray production

Measured in seconds, fractions,
or milliseconds

 • Longer time → more x-rays →

darker image

 • Shorter time → fewer x-rays →

lighter image

 Image Shorter times reduce

motion blur
Exposure Time – Clinical Considerations

 • Patient dose increases with longer exposure

time
 • Longer times increase motion blur risk

 Short exposure times preferred for:

 • Pediatrics
 • Chest radiography
 • Uncooperative patients
Milliamperage (mA) – Definition

mA measures the rate of It determines how many x-ray

electron flow across the x-ray photons are produced per
tube. second.
Milliamperage
(mA)

Controls electron flow rate in the

x‑ray tube
Determines number of x‑ray
photons produced per second

Higher mA → more radiation → darker

image

Lower mA → less radiation → lighter

image
Milliamperage – Image
Effect
 • Higher mA → more electrons → darker image
 • Lower mA → fewer electrons → lighter image

 Think of mA as beam intensity.

mA and Focal Spot

 Dual‑focus tubes use different

filaments:
 ≤150 mA → small filament → small
focal spot
 ≥200 mA → large filament → large
focal spot
 Focal spot affects image sharpness
 Higher mA increases anode heat
Typical mA Settings

 Common mA stations:
 • 50
 • 100
 • 200
 • 300
 • 400
 • 500

 Advanced systems may reach 1000–1500 mA.

mA Example:

 100 mA × 0.1 s = 10 mAs

 200 mA × 0.05 s = 10 mAs

 Same density, but second exposure is shorter →

less motion blur
Clinical Use of mA

 High mA:
 • Trauma
 • Mobile radiography

 Low mA:
 • Extremities
 • Situations where motion is minimal
mA and Exposure
Time Relationship
 mAs = mA × time

 mAs represents the total radiation

quantity.
 Radiographers adjust mA to allow
shorter exposure times.
mAs: The Key Relationship

mAs = mA × Time

Indicates total quantity of radiation produced

Exposures with the same mAs look similar,

regardless of mA/time combination

Mastering exposure time and mA is the foundation

of radiographic technique.
mAs in Practice

 Modern consoles allow direct mAs selection

 Typical mAs range: 1–500 mAs

 Lower mA + longer time reduces heat load (if

motion is not a concern)
Kilovoltage Peak (kVp)

What is kVp?
Measures potential difference across the x‑ray tube

Determines:

 Electron speed
 X‑ray photon energy
 Beam penetration

Higher kVp → more penetrating beam → darker image

Lower kVp → less penetration → lighter image

kVp and Wavelength

 High kVp → shorter wavelength, higher energy

 Low kVp → longer wavelength, lower energy

 More penetrating photons reach the IR → increased

exposure
kVp and Image Contrast

kVp affects differential penetration

Higher kVp → lower contrast (long scale)

Lower kVp → higher contrast (short scale)

Optimal kVp varies by examination

Typical kVp Ranges

 Hand/Wrist/Foot: 50–60 kVp

 Spine: 75–85 kVp

 Chest: 100+ kVp

 Barium studies: 100–120 kVp

Automatic Exposure
Control (AEC)
 AEC systems:
 • Monitor radiation reaching the IR
 • Automatically stop exposure at correct level

 Radiographer must select correct chambers.

 AEC automatically terminates
exposure

 Ensures consistent image density

 Radiographer selects appropriate

chambers

 Common in table and upright bucky

systems
 Source–Image Distance
(SID)

Distance from x‑ray tube

target to IR

Affects beam intensity

Distance (inverse square law)

(SID) Greater SID → lower

intensity

Shorter SID → higher

intensity
Also influences
magnification and
sharpness
 The distance between the source of
the x-ray beam (the tube target) and
the IR is referred to as the source-
image distance (SID).

This distance is a prime factor of

exposure because it affects the
intensity of the x-ray beam.
Radiation intensity can be considered as the number of
photons per square inch striking the surface of the IR.
Because the x-ray beam diverges from its source, the size
of the beam expands as the distance from the source
increases.

As the total quantity of x-ray photons in the beam spreads

out, there are fewer photons in any given area (see
Diagram).

The change in x-ray beam intensity that results from

changes in the SID is expressed by the Inverse-square
law, which states that the intensity of the radiation is
inversely proportional to the square of the distance.
Inverse-square
Law

The radiation field is four

times greater in area. As a
result, the number The field area would be
photons per unit area within increased in size nine-old
the field is one-fourth the and the radiation intensity
original would be one-ninth the
amount. original amount.
Likewise, if the distance
were tripled,
 The distance between the tube
target and the IR is referred to as
the source-image distance (SID).
The inverse square law states the
relationship between radiation
intensity and the SID: radiation
intensity is inversely proportional
to the square of the SID.

 Of course, as the radiation

intensity changes, expo sure to the
IR will also change. To maintain the
same degree of image darkness
when the SID changes, the mAs
must be adjusted correspondingly
 Technique Charts
 A technique chart located near the
control console usually provides the
radiographer with a listing of
recommended mAs and kVp
settings, as well as the SID, for each
of the various body parts for
different sizes of patients.

 Some computerized control

consoles are preprogrammed with
the required exposure settings for
the selected body part and size.
IMAGE RECEPTOR
SYSTEMS
 There are two basic types of filmless
radiography that have replaced
conventional plain film and x-ray cassettes:

 Computed radiography (CR)

 Digital radiography (DR).

 CR systems use conventional x-ray equipment
with a cassette containing a photostimulable
phosphor that must be processed in a laser device
to create a digital image.

 DR systems have radiation receptors within the

radiographic table, upright bucky, or stand-alone
DR receptors that transmit digital signals directly
to the computer system
2. IMAGE QUALITY

The more exposure received by a specific portion of the IR, the darker that
portion of the image will be.

The visibility of the radiographic image depends on two factors:

The overall blackness of the image

The differences in blackness between the various portions of the image.

The clarity and sharpness of the image are also important, as is the degree
to which the image is a true representation of the subject. These features
make up the four elements of radiographic quality: density, contrast, detail,
and distortion.
 Radiographers using digital imaging
systems must monitor exposure
index numbers to use adequate
exposures for image quality and
avoid excessive exposure to patients
The overall blackness of the image
is referred to as the optical density
(OD).
With CR/DR systems:

OD is influenced less by exposure

factors such mAs than by the
computer processing techniques
Care should be taken, not to
confuse radiographic
density with tissue density.
Tissue density refers to the
mass density of anatomic
parts.
Whereas increased optical
or radiographic density
indicates that the image is
darker.
An increase in tissue density
will result in an image that
is lighter.
The computer hardware and software
technology used to manage digital images
is called a picture archiving and
communication system (PACS).

These systems provide archives for the

storage of images from all imaging
modalities.

Connect images with patient database

information.

Facilitate laser printing or transfer to CD-

ROM media.

Display both images and information at

workstations throughout the network as
needed.
Image Contrast

The difference in
the OD of adjacent
structures within the
image is referred to
as the image
contrast.
 kVp is the primary
contrast control
factor.
 Radiographic
contrast is also
influenced by a
number of other
factors, including the
computer image
processing algorithm
3. Image Detail
The third element of image quality is image detail.

This term refers to the sharpness of the image. When detail is high, the
edges and lines that make up the image are crisp and precise.

With low detail, these lines and edges are less distinct and

appear somewhat blurred or out of focus.

Among the factors that affect image detail:

the distance between the source of x-rays and the IR (the SID)

The distance between the object and the IR, referred to as the object-image
distance (OID).
Increasing the SID sharpens the image,

whereas increasing the OID reduces sharpness.

Other factors include:

The size of the pixels in digital systems,

The x-ray tube focal spot size (the smaller the focal spot, the
greater the detail)

Whether the patient is able to hold still during the exposure.

Image detail refers to the sharpness of the image.

Among the factors that affect image detail are the

SID,
the OID, the size of the pixels in digital systems,
the
focal spot size, and patient motion
Distortion
 The fourth element of image quality is distortion.
This term refers to a variation in the size or shape of the image
compared with the object it represents.

 Size distortion is always in the form of magnification,

 All radiographic images are magnified to some degree.

 The factors that affect magnification are the OID and the

SID.
The angulation of the diverging x-rays that define the edges of a subject
affects the degree of magnification.
When the x-ray tube is farther from
the IR, the central,

more parallel rays will define the

subject, resulting in less
magnification.

When the SID is shorter, the rays that

define the subject are those that
diverge at a greater angle, increasing
the magnification.

As the x-ray beam continues past the

subject to the IR, the rays continue to
diverge, increasing the magnification.

Likewise, when the OID is increased,

the increased angle of divergence
between the object and the IR causes
increased magnification.
 The closer the object is to the receptor, the less magnification
there will be.

Shape distortion is the result of unequal magnification of various

parts of the subject.
 The least shape distortion occurs when the plane of the object is
parallel to the plane of the IR and the central ray is perpendicular
to it.

Angulation of the x-ray beam, the IR, or the object in relation to the
IR will all cause some degree of distortion

 Distortion refers to a variation in the size or shape of the image

compared with the object it represents. SID and OID control
magnification distortion. Shape distortion is caused by
misalignment of the tube, part, and IR.
Key Point:
 • Exposure Time controls duration of exposure

 • mA controls intensity of exposure

 • mAs controls total radiation quantity

 Kvp controls beam energy and contrast

 kVp SID affects intensity and geometric properties

• AEC helps ensure consistent image exposure

 All factors must be balanced for optimal image

quality
Overview

Radiographic exposure is
controlled by four prime factors:
• mA (milliamperage)
• Exposure Time (T)
• kVp (kilovoltage peak)
• SID (source–image distance)

These determine:
• Quantity of radiation
• Beam penetration
• Image appearance
• Patient dose