EMILIO AGUINALDO COLLEGE

CAVITE

APPLICATION OF RADIOLOGIC TECHNOLOGY INTERNS IN

CONTROLLING SCATTERED RADIATION AFFECTING QUALITY
OF RADIOGRAPHS IN SELECTED HOSPITALS IN CAVITE

A Thesis Presented to the Faculty

of the School of Radiologic Technology
Emilio Aguinaldo College-Cavite

In Partial Fulfilment of the

Requirements for the Degree of
Bachelor of Science in Radiologic Technology

CARLOS, KLIFFORD L.
DELA CRUZ, JOHN ARRDIE G.
ANGELES, VAL NORENZ L.
PATIÑO, NHONEALA MAE R.

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Chapter One

Introduction and Background of the study

Dating back 1895, a German physicist named Wilhelm Conrad roentgen

discovered a new type of energy and named it x-ray. By performing lots of test with

his newly discovered mysterious rays, he determined that it had a degree of

penetrative power depending on the materials density. The ability to take an x-ray

was a huge advancement in the medical field. It allowed for the diagnosis of

fractures, broken bones, ailments and many more.

When an x-ray beam enters a patient’s body, a large portion of the photons

engage in Compton interaction and produce scattered radiation. Some of this

scattered radiation leaves the body in the same general direction as the primary

beam and exposes the image receptor. This scattered radiation reduces image

contrast. The degree of contrast loss depends on the scatter content of the radiation

emerging from the patient’s body. In most radiographic and fluoroscopic

procedures, the major portion of the x-ray beam leaving the patient’s body is

scattered radiation. This, in turn significantly reduces contrast. (Sprawls, 1995).

Scattered radiation from Compton interaction can create a serious radiation

exposure hazard in radiography and particularly in fluoroscopy. Two types of x-rays

are responsible for the optical density and contrast on a radiograph, those that pass

through the patient without interacting and those that are scattered within the

patient through Compton interaction. X-ray that exits from the patient are remnant x-

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ray and those that exit andEMILIO AGUINALDO
interact COLLEGE
with the image receptor are called image-
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forming x-rays. Primarily,

three factors contribute to increased scatter radiation; increased kVp, increased x-

ray field size, and increased patient thickness.

Scattered radiation has long been recognized as a main cause for degraded

image quality in projection imaging as it decreases he image contrast and contrast-

to-noise ratio for the object being detected or visualized (Boone, 2000). Since then,

various techniques have been investigated and implemented to control scattered

radiation during image acquisition, the most practical of which being the beam

restrictors, the air-gap technique and the anti-scatter or radiographic grids.

Beam restricting devices are designed to control and minimize scatter radiation

by limiting the x-ray field size to only anatomy of interest. Limiting the beam to focus

only on the area of interest not only reduces irradiation of other tissues but also

reduces scatter radiation, patient dose and it also improves image contrast. Ideally,

only those x-rays that do not interact with the patient should reach the image

receptor. The air gap technique is a technique in radiography that reduces scattered

radiation by increasing the distance between the patient and the detector. However,

air gaps may lead to an increased in patient dose, reduce field-of-view, and

increase focal spot blurring-effect. Grid, both stationary and moving, function to

remove a large percentage of scattered (primary Compton) radiation from the

remnant beam before it reaches the image receptor, thereby improving radiographic

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 EMILIO
contrast, but necessitate an AGUINALDO
increase COLLEGE
in exposure (Saia, 2008). It has been widely
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used in many

radiographic and fluoroscopic procedures with conventional S/F or image intensifier

based imaging systems. Even after transitioning from analog to digital imaging

techniques. The main advantage of the radiographic grid is its simplicity. Grids

reject scattered radiation effectively, but also they attenuate a substantial fraction of

the primary x-rays resulting in a substantial loss of information and an increased

relative noise level in the image (Liu, 2002).

As scattered radiation increase the radiograph loses contrast and appears grey

and dull. One of the most important characteristic of image quality is contrast; the

visible difference between the light and dark areas of an image contrast is the

degree of difference in OD between areas of radiographic image. Contrast

resolution is the ability to image and distinguish soft tissue. Even under the most

favourable condition, must remnant x-ray are scattered. (Bushong,2009)

The radiographer must strive to minimize the quantity of scatter that reaches

the IR, restrict the x-ray beam size to size of the anatomical structures required to

demonstrate in the image, do not leave collimators open to extend beyond IR size

and always remember that the objective is to decrease patient radiation dose, and

achieve optimum contrast. Furthermore, radiographic images are such that slight

differences in quality do not necessarily rule out the diagnostic value of the image.

Radiologist can ordinarily make satisfactory adjustment by reason of their

experience and knowledge (Martensen, 2011), although passing less than optimal

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images may compromiseEMILIO AGUINALDO
the diagnosis COLLEGE
and treatment and result in additional
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imaging at a higher expense and radiation dose to patient.

Radiographer must conscientiously avoid unnecessary radiation exposure not

only to keep patient dose to an absolute minimum but also to produce quality

radiograph with the desired contrast. Radiographer must follow the ALARA Principle

(As low as reasonably achievable) as they carry out their task. The researchers

choose this topic to know the knowledge of radiologic technology interns in

controlling scattered radiation affecting contrast of radiographs. The researchers

want to know how the interns are capable of producing quality radiographs, how

knowledgeable interns are when it comes to the effects of scattered radiation in

quality of radiographs and how they control such things.

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Statement of the problem

This study aims to know the application of radiologic technology interns in

controlling scattered radiation affecting quality of radiographs in selected hospitals

in Cavite.

Specifically, it will answer the following:

1. What is the demographic profile of the respondents in terms of;

1.1 Age

1.2 Sex

1.3 School

2. How radiologic technology interns controls scattered radiation in terms of

using;

2.1 Beam restriction

2.2 Grid

2.3 Air-gap technique

3. Is there a significant relationship between the respondent’s demographic

profile and their application in controlling scattered radiation affecting quality

of radiographs.

Hypothesis

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 The below hypothesis EMILIO AGUINALDO
will be tested COLLEGE
for this research.
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There is no significant relationship between the respondent’s

demographic profile and their application in controlling scattered

radiation

Conceptual Framework

Figure 1

INPUT PROCESS OUTPUT

1. Respondent’s
profile
1.1. Age
1.2. Sex Application of
1.3. School Researchers radiologic
Self-made technology interns
2. Application in in controlling
Questionnaire
controlling scattered
3
scattered Retrieval of radiation affecting
radiation in terms questionnaire quality of
of using radiographs
Analysis of
2.1 Beam
data
restriction
p 2.2 Grid
2.3 Air-gap
technique

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Figure 1. The relationship between three variables

The figure above demonstrated the conceptual framework of this study wherein

the prior demographic profile of the participants and their knowledge in controlling

scattered radiation in terms of using beam restriction, grid, and air gap technique

served as the input of this study. After which, analysis of the data through

questionnaire was done as the process of this study to augment the application in

controlling scattered radiation affecting quality of radiographs of radiologic

technology interns.

Significance of the Study

This study aims to determine the application of radiologic technology interns

in controlling scattered radiation affecting quality of radiographs in selected

hospitals in Cavite. Conducting this study will benefit the following:

School of Radiologic Technology Faculties. The main beneficiary of this study is

the faculties of the School of Radiologic Technology. It may serve as their reference

if their educational program is in line with producing quality radiographs. It may also

serve as a lecture material and presentation on their program.

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Students. It may provideEMILIO AGUINALDO
them knowledge aboutCOLLEGE
controlling scattered radiation
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through different techniques to improve quality of radiographs and apply it when

they are on the working environment.

School Administrators. It may serve as their reference for the efficiency and

effectivity of the program educational objective.

Future researchers. The future researchers may use this study as their reference

for their future study.

Scope of Limitations of the study

The researchers aim to determine the application of radiologic technology

interns in controlling scattered radiation affecting quality of radiographs. The

respondents of the study were the Radiologic Technology interns of Pagamutan ng

Dasmarinas, GEAMH, and EAC-MC from the month of June to November 2019.

Definition of Terms

This part of the research will be composed of the important research

terminologies to help the readers to easily understand some technical and

radiographic terms.

Aperture diaphragm - is a hole or an opening through which light travels. More

specifically, the aperture and focal length of an optical system determine the cone

angle of a bundle of rays that come to a focus in the image plane.

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Air-Gap technique - is aEMILIO AGUINALDO
radiographic techniqueCOLLEGE
that improves image contrast
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resolution through reducing the amount of scattered radiation that reaches the

image

detector. In select situations, this technique can be used instead of an anti-scatter

gridas the primary scatter reduction method in order to reduce patient dose. It

utilizes both plain radiography and mammography.

ALARA - an effort, approach, or policy that aims to maintain the level of exposure to

radiation or other hazardous material ( such as toxic chemical) as far below

regulatory limits as possible. ALARA stands for As low as reasonably achievable.

Beam Restrictor - device that reduces the size of the beam of radiation from x-ray

equipment. Three basic types of restrictors are variable-aperture collimators, cones

or cylinders, and aperture diaphragms

Bucky-Slot - a protective device to shield the user from scattered radiation when

the undertable cassette is not used.

Collimation - the act of collimating or something being collimated aligning lenses

along line of sight to minimize abberation

Collimator - device that narrows a beam of particle or waves. To narrow can mean

either to cause the directions of motion to become more aligned in a specific

direction

Compton Scattering - occurs when the incident x-ray photon is deflected from its

original path by an interaction with an electron

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 EMILIOaperture
Cones and Cylinder - essentially AGUINALDO COLLEGE
diaphragms with the metals extensions
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that can be either straight or flared and attach to the x-ray tube housing.

Field Size - projection that, on a plane perpendicular to the beam axis of the light

field, corresponds to the area being treated by radiation.

Grid - a device used to reduce the amount of scatter radiation reaching an x-ray

film. It is consist of parallel strips of radiopaque materials alternating with strips of

radiolucent materials.

Kvp - the control on a radiographic machine that selects the kilovoltage for a given

radiographic film.

Optical Density - the degree to which a refractive medium retards transmitted rays

of light

Photon - particle representing a quantum of light or nother electromagnetic

radiation. A photon carries energy proportional to the radiation frequency but has

zero rest mass.

Radiation - the emission of energy as electromagnetic waves or as moving

subatomic particles, especially high-energy particle which cause ionization.

Radiographic Contrast - density difference between neighboring regions on a

plain radiograph

Radiography - process of occupation of taking radiographs to assist in medical

examination

Remnant Beam - the beam that passes through an object and can produce and

image on an x-ray film

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 EMILIOthat
Scattered Radiation - radiation AGUINALDO
spreads outCOLLEGE
in different directions from a
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radiation beam when the beam interacts with a substance.

Review of Related Literature

Foreign Literature

According to Stewart C Bushong (2009) Production of scatter radiation. Two

types of x-rays are responsible for the optical density and contrast on a radiograph,

those that pass through the patient without interacting and those that are scattered

within the patient through Compton interaction. X-ray that exist from the patient are

remnant x-ray and those that exit and interact with the image receptor are called

image-forming x-rays.

Proper collimation of the x –ray beam has the primary effect of reducing patient

dose by restricting the volume of irradiated tissue. Proper collimation also improve

image contrast. Ideally, only those x-rays that do not interact with the patient should

reach the image receptor.

As scattered radiation increase the radiograph loses contrast and appears grey

and dull. Three primary factors influence the relative intensity of scatter radiation

that reaches the image receptor. Kvp, field size and patient thickness.

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 EMILIO
. One of the most important AGUINALDO
characteristic COLLEGE
of image quality is contrast, the visible
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difference between the light and dark ares of an image contrast is the degree of

difference in OD between areas of radiographic image. Contrast resolution is the

ability to image and distinguish soft tissue. Even under the most favourable

condition, must remnant x-ray are scattered.

Foreign Literature

Beam restriction, or limitation of field size is probably the single most

important factor in keeping patient dose to a minimum. The primary beam must be

confined to the area of interest, thus, only tissues of diagnostic interest will be

irradiated. Benefit of beam restriction is that, because a smaller quantity of tissue is

irradiated, less scattered radiation will be produced. Remember , scattered radiation

does not carry useful information; it degrades the radiographic image by adding a

layer of fog that impairs image visibility.

Three basic type of beam restrictor, aperture diaphragms, cones and

cylinder and collimation. Aperture diaphragm is the most elementary of three types,

and is frequently used in dedicated-head units and many of today’s dedicated-chest

units. It is simply a flat piece of lead (Pb) with a central opening whose size and

shape determines the size and shape of the x-ray beam. Whereas head units have

a variety of aperture diaphragm sizes available for various tyoe of skull exams and

required film sizes. Cones are circular, lead-lined devices that slide into place in the

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tubehead. They may be EMILIO AGUINALDO
the straight COLLEGE
cylinder type, whose proximal and distal
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diameter are identical, proximal diameter. Cylinder cones are frequently able to

extend, like a telescope, by means of a simple thumbscrew adjustment. The

collimator is overall, the most efficient beam restricting device. It is attached to the

tube head and its upper aperture, the first set of shutters is placed as close possible

to the x-ray tube’s port window. This is done to control the amount of image

degrading “off focus” radiation leaving the x-ray tube. Ie, radiation produced when

electrons strike anode surfaces other than the focal track. The next set of lead

shutters (or “blades”, or “leaves”) actually consist of two pairs of adjustable shutters-

one pair for field length and other pair for field width. It is these shutters that the

radiographer adjust when changing the field size and shape.

Foreign Studies

In order to reduce radiation exposure it is necessary to decrease the area of

the x-ray beam. Proper beam restriction will reduce the amount of primary photons

emitted from the tube and collimator thereby reducing the dose to the patient. Also,

beam restriction will keep the total amount of tissue irradiated to a minimum so

fewer scattered photons are created consequently the image will be improved. It is

important to control scatter since it has no useful diagnostic effect. Another principle

factor in reducing scatter is kilovoltage or the penetrability of the beam. As kVp is

increased, fewer atoms interact with the tissue, and more pass through to end up

on the image receptor. In radiography, kilovoltage is selected based predominantly

on the size of the part examined. Whenever kilovoltage is increased more scatter

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 EMILIO AGUINALDO
will result unless it is accompanied COLLEGE
by a reduction in mAs thereby reducing scatter
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and the dose to the patient. Thus beam restriction along with technical factors is

very important aspects of radiation protection by reducing the patient dose and

improving the image quality. (Bushong,2008)

Foreign Studies

Aperture diaphragms are the simplest type of beam-restricting device. It is a

flat piece of lead containing a hole in the center that attaches to the x-ray tube port.

The opening can be made in any size or shape, but rectangular is the most

common. The main disadvantage is the increase in the unsharpness around the

periphery of the image known as penumbra. Other disadvantages include off-focus

radiation and no light field for use in positioning. Aperture diaphragms are used in

special procedure angiography studies. (Carlton & Adler, 2006)

Cones and cylinder are essentially aperture diaphragms with the metals

extensions that can be either straight or flared and attach to the x-ray tube housing.

Cones are extensions that flare and cylinders are straight but both are routinely

called cones. The longest cone with the smallest diameter will provide the greatest

beam restriction. The advantage of cone is there low cost and ease of use. One

difficulty with using cones is alignment. The physical weight of the cones can

sometimes cause the tube to angle slightly when used with a horizontal beam

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causing cone cutting if theEMILIO AGUINALDO
central ray COLLEGE
us not checked carefully. Today, cones are
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reserved for selected areas of radiology such as sinuses, L5/S1 spine, and dental

radiographs. (Forshier, 2009)

Collimators are the most widely used beam restricting device because they

contain a light source to help the radiographer center the x-ray beam. They are

composed of a lamp, mirror, and a pair of upper and lower leadshutters that are at

right angles to each other and move independently. Upper shutters absorb the off

focus radiation before it leaves the tube and the lower shutters further restrict the

beam area of interest. Collimators permit an infinite number of field sizes using only

one device and hence reduce the light field to only the area of interest resulting in

reduced patient exposure. Some equipment is supplied with automatic collimators

that are electronically interlocked with the bucky tray so the x-ray beam is

automatically restricted to the size of the cassettes. These devices are known as

positive beam limitation (PBL) devices. Accuracy within 2% of the SID is required

with all PBL devices.

Foreign Studies

According to Ulrich Neitzel (2000) Grids or Air Gaps for scatter reduction in

digital radiography: A model calculation, in any radiographic examination, scattered

radiation is inevitably generated in the patient. Part of this scatter reaches the

detector and superposes on the image-forming transmitted primary radiation. For

thick objects, the intensity of scatter can amount to up to ten times the primary

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 EMILIO
radiation. As a result the image AGUINALDO
contrast is reduced COLLEGE
and the scatter intensity acts as
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an additional noise source.

Therefore, various measures have been proposed ro reduce the amount of

scattered radiation which reaches the detector: grids, air gaps, slit, or area scanning

devices. In clinical practice grids are used almost exclusively, while the air gap

technique survives in some niches; paediatrics, magnification mammography and –

to some degree- chest radiography. Slit scanning systems, although most effective

in scatter reduction, are hampered by technical problems such as high tube loading,

scanning artifacts, and mechanical complexity.

The predominance of the grid technique in conventional radiogtraphy is due

to the effective contrast improvement that can be accomplished with a properly

designed and aligned grid. The drawback of this approach in film-based

radiography is the increase of exposure to the patient which is necessary to

compensate for the reduction of radiation reaching the film. Optimization of scatter

radiation method was thus aimed at a balance between the contrast improvement

factor and the bucky factor which describes the necessary exposure increase.

Local Studies

According to Lorega, Cuenca, Luneta & Paiton (2018), Quality Control

Management of Radiologic technologist in selected quality Diagnostic Clinics’ in

Cavite, Maintenance of beam quality was ranked first; followed by the maintenance

of x-ray beam bucky alignment and checking of grid in the quality control

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management of radiologic EMILIO AGUINALDO
units by the COLLEGEin selected diagnostic
radiologic technologist
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clinics in cavite.

Local Studies

According to Reyes, Cruz, Delos Santos, Guzarem & Rubia (2017),

Common errors of radiologic technology interns in performing x-ray procedure in

selected tertiary hospitals in cavite. Most of the respondents answered Always, the

common error of radiologic technology interns in performing x-ray procedure are

proper use of collimator, ranked 1st.

Chapter Two

Methodology

This chapter describes the research design, research locale, research

participants, sampling technique, data gathering procedure, research instruments

and data analysis.

Research Design

The researchers will utilize descriptive quantitative method. Quantitative

methods emphasize objective measurements and the statistical, mathematical, or

numerical analysis of data collected through polls, questionnaires, and surveys, or

by manipulating pre-existing statistical data using computational techniques. A

descriptive quantitative study establishes only association between variables

(Babbie, 2010).

Research Locale

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 The study will be EMILIO
conductedAGUINALDO
at PagamutanCOLLEGE
ng Dasmarinas, GEAMH, and
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EAC-MC. This place was selected for knowing the knowledge of radiologic interns

in controlling scattered radiation affecting quality of radiographs.

Research Participants

The respondents of this study will be the radiologic technology interns of

Pagamutan ng Dasmarinas, GEAMH, and EAC-MC from the month of June to

November 2019.

Data gathering procedures

The researchers will request permission to the Department of Radiology of

the said hospitals (Pagamutan ng Dasmarinas, GEAMH, and EACMC) to

disseminate the questionnaires to the Radiologic Technology interns. In the duration

of gathering the data from the respondents, the researchers will explain the purpose

of the study. After collecting the questionnaires, it will be tallied and recorded. The

gathered data will be computed in a statistical method.

Research Instruments

This study will use a self-made questionnaire. The questionnaire will serve

as the primary instrument for data gathering. The instruments will be validated by

few consultants and professors before it will be use on the study.

Data Analysis

The following tools will be used in this study.

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 EMILIO
1. Frequency- is a systematic AGUINALDO
arrangement COLLEGE
of the data that illustrate the data in
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ascending order. This will be used to determine the number of respondents in

this study. (Corty 2017)

Formula :

2. Mean- it is a set of measurements defined to be sum of the measurements

divided by the total number of measurements (Scott and Mazhindu, 2005).

This will be used in this study to analyze the average number of the

respondents.

Formula :

3. Chi Square is commonly used to test relationships between categorical data.

(Ling, 2008). This will be used in this study to determine the relationship

between respondent’s demographic data and their application in controlling

scattered radiation affecting quality of radiographs

Formula:

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 EMILIO AGUINALDO COLLEGE
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EMILIO AGUINALDO COLLEGE – CAVITE

Congressional Road, Burol Main, Dasmariñas City, Cavite
School of Radiologic Technology

Darwin Reyes, RRT,RSO,MaED,MSRT

Asst. Dean ,School of Radiologic Technology

Good Day !
Dear Sir,
We the 4th yr students of Bachelor of Science in Radiologic technology in Emilio
Aguinaldo College- Cavite currently enrolled in the subject research writing, are conducting
a research study entitled “Application of Radiologic Technology Interns in Controlling
Scattered Radiation affecting Quality of Radiographs in selected hospitals in Cavite “
In this regard, we are humbly asking permission from your good office to validate our
survey questionnaire. Any suggestion and comments will be highly appreciated. Thank you
we are hoping for your favorable response .

Respectfully Yours,

Carlos, Klifford L. Dela Cruz, John Arddie G. Angeles, Val Norenz L.

Noted By

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 EMILIO AGUINALDO COLLEGE
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Yolanda C. MAgnaye, RRT, MaEd
Dean, School of Radiologic Technology

Charmaine Kelly Orculo Posadas

Research Adviser

Approved By
Darwin Reyes, RRT,RSO,MaED,MSRT
Asst. Dean ,School of Radiologic Technology

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