Dentomaxillofacial Radiology (2012) 41, 361–366

’ 2012 The British Institute of Radiology

http://dmfr.birjournals.org

RESEARCH
Alternative X-ray filters for an intra-oral digital radiographic
system
J Stecke1, AD Cruz*,2, SM Almeida3 and FN Bóscolo3
1
Piracicaba Dental School of the State University of Campinas (UNICAMP), São Paulo, Brazil; 2Department of Specific
Formation, Area of Dental Radiology, Faculty of Dentistry of the Fluminense Federal University (UFF), University Center of Nova
Friburgo, Brazil; 3Department of Oral Diagnosis, Area of Dental Radiology, Piracicaba Dental School of the State University of
Campinas (UNICAMP), São Paulo, Brazil

Objective: The aim of this study was to evaluate the effect of the modulation of the
radiation spectrum with the use of alternative X-ray filters in the quality of intra-oral digital
images from storage phosphor plates.
Methods: The radiographic exposures were performed in a GE 1000 X-ray machine
(General Electric Co., Milwaukee, WI), operating at 65 kVp, 10 mA, 40 cm focus receptor
distance using three different exposure times: 0.05 s, 0.16 s and 0.35 s. The control filter (GC)
was 100% aluminium (Al) with a thickness of 1.5 mm. The tested filters were: G1, 97% Al and
3% copper (Cu) with 1.47 mm thickness; G2, 96% Al and 4% Cu with 1.53 mm thickness; G3,
95% Al and 5% zinc (Zn) with 1.56 mm thickness; G4, 98% Al and 2% Zn with 1.5 mm
thickness; and G5, 95% Cu and 5% Zn with 1.6 mm thickness. For formation of the image, a
12-step Al wedge (each step with increments of 1 mm in thickness) was radiographed 10
times. Pixel values measured in digital images were converted into optical density (OD).
Results: All replicates showed OD with high reproducibility (r . 0.95) for all exposure times
and tested filters. In comparison between filters, statistically significant differences in density
(p , 0.05) were observed. The OD curve of the G5 filter in all exposure times and G3 filter in
an exposure time of 0.05 s showed changes in shape (p , 0.05).
Conclusions: Excluding the G5 filter, all others tested filters can be used as a substitute for
GC without losses in image quality.
Dentomaxillofacial Radiology (2012) 41, 361–366. doi: 10.1259/dmfr/94751012

Keywords: X-rays; filtration; radiographic image enhancement; dental digital radiography

Introduction

Digital imaging systems are gradually replacing conven-
tional analogue film in dentistry. This is the result of
both innovations in image acquisition systems and in
programs for image manipulation. However, there has
been little investment in replacing the X-ray machine
for use with intra-oral digital imaging systems, despite
the current introduction of X-ray machines with auto-
matic exposure control (AEC) systems in direct digital
techniques. In these systems, the exposure time is
automatically standardized according to individual
*Correspondence to: Mrs Adriana Dibo da Cruz, Faculty of Dentistry of the
Fluminense Federal University, Polo of Nova Friburgo St Doutor Silvio
Henrique Braune, 22, Centro, Nova Friburgo, Rio de Janeiro, Brazil, 28625–
650. E-mail: adrianadibo@gmail.com
Received 9 December 2010; revised 5 March 2011; accepted 11 April 2011
characteristics of the patients, independently of the
control of operator.1
In accordance with the fundamental principle of
radiation protection known as ALARA (as low as
reasonably achievable), the desired amount of diag-
nostic information should be obtained with minimum
possible radiation exposure. As the dynamic range of
solid-state sensors is small, it requires careful selection
of the exposure time. However, storage phosphor plates
(SPPs) have a much larger dynamic range, enabling the
selection of a broad scale of exposure times without
causing saturation of the final image.2
Other factors, such as current, voltage of the tube
and filtration of the X-ray beam, can also modify the
number of photons in the X-ray beam, causing a
modulation of the radiation spectrum that affects
exposure dose and image quality.3–7 The X-ray filters
 Alternative X-ray filters
362
can decrease the exposure dose to radiation by
removing those low-energy photons from the X-ray
beam. The low-energy photons would be absorbed by
the soft tissue of the patient without affecting useful
diagnostic information.7 Shibuya et al8 evaluated
alternative filters to be used with digital systems of
solid-state sensors, in this case a charge-coupled device
(CCD), and observed that the KEY filter, an alloy of
aluminum (Al), copper (Cu) and tin, reduced the
exposure to radiation and enhanced the diagnostic
information. The aim of this study was to evaluate the
effect of the modulation of the radiation spectrum with
the use of alternative X-ray filters on the quality of
intra-oral digital images from SPPs.
Materials and methods
The study was based on five alternative X-ray filters
made of a combination of Al, Cu and zinc (Zn) in
different proportions as listed in Table 1.
The tested filters were individually attached in a GE
1000 X-ray machine (General Electric Co., Milwaukee,
WI), which operated at 65 kVp, 10 mA, 40 cm focus-
receptor distance, using three different exposure times:
0.05 s, 0.16 s and 0.35 s. The original Al filter from the X-
ray machine was removed since it has a thickness
of 2.5 mm which is greater than required by the law
governing the sector9 that states an X-ray machine up to
70 kVp requires an Al filter with a thickness of 1.5 mm.
The digital images were acquired using bitewing
projection geometry. A customized acrylic device was
used to standardize the position of the set (radiographed
object, cylindrical locator device of the X-ray tube and
image receptor) during radiographic exposure, so that it
could be easily reproduced. An aluminium wedge of 12
steps with increments of 1 mm in thickness in each step
was used as an object. A 1.2 cm thick acrylic plate was
placed between the object and the image receptor to
replicate soft tissue. For each combination, filter and
exposure time was repeated ten times.
Image receptor system
Five SPPs (DenOptixH; KaVo Dental Gendex Imaging,
Milan, Italy) were exposed to X-rays and were subse-
quently scanned by the DenOptix scanner in a secluded
room with a light intensity of 20 lux using an 8-bit
Table 1 Characteristics of the X-ray filters used in modulation of the radiation beam
Group Composition of the alloy (content by weight %)
Control (GC) Aluminum (100)
1 (G1) Aluminum (96) Copper (4)
2 (G2) Aluminum (97) Copper (3)
3 (G3) Aluminum (95) — Zinc (5)
4 (G4) Aluminum (98) — Zinc (2)
5 (G5) Copper (95) — Zinc (5)
G1, 97% aluminium (Al) and 3% copper (Cu) with 1.47 mm thickness; G2, 96% Al and 4% Cu with 1.53 mm thickness; G3, 95% Al and 5% zinc
(Zn) with 1.56 mm thickness; G4, 98% Al and 2% Zn with 1.5 mm thickness; G5, 95% Cu and 5% Zn with 1.6 mm thickness.
Dentomaxillofacial Radiology
J Stecke et al
depth and a resolution of 300 dpi. During the experi-
ment, the SPPs were conditioned in the light-tight
polymer envelopes of the system to avoid exposure to
the ambient light and to protect them from handling.
An EMBH (Electro Médica Brasileira, São Paulo,
Brazil) viewing box measuring 38648.5 cm, which
gives off 1700 lux of fluorescent light, was used to
erase the SPPs. Light intensity (from the viewing box
and procedure room) was measured by a PhotometerH
07–621 (Fluke Biomedical, Cleveland, OH). The SPPs
were positioned with the active side facing down and in
contact with the front surface of the viewing box for
130 s in order to completely erase them. All images were
saved and stored in TIFF format.
Objective assessment of the image
To quantitatively assess the image data the pixel
intensity analysis was performed using the histogram
tool of the Adobe Photoshop CS3H program (Adobe
System Inc., San Jose, CA). Pixel intensity measure-
ments were calculated from the mean grey value of
regions of interest (ROIs) on the image. 3 ROIs for each
step of the Al wedge (1 in the central portion and 2 in
lateral portions of the step) were selected, obtaining for
each image 36 ROIs in total. All steps were separately
measured and the average pixel intensity value was
calculated.
The average pixel intensity value (I) for each step was
converted into optical density (OD), as proposed by
Parissis et al,10 using the following equation:
255
OD~LN ð1Þ
I
Data analysis
The intraclass correlation coefficient (r) in SPSS version
17.0 for Windows (IBM Corporation, formerly SPSS
Inc, Armonk, NY) software was used to statistically
analyse the reproducibility of the OD for each filter
evaluated. ODs obtained in the same group at varying
exposure times and in different groups in the same
exposure time were analysed using analysis of variance
with Dunnett and Tukey tests. The data were tabulated
using OriginProH 7.5 software (Origin Lab Corpora-
tion, Northampton, MA), which generated the OD
curves for all filters in each exposure time. In the
Atomic number and scientific notation Thickness (mm)
13Al 1.50
13
Al — 29Cu 1.47
13
Al — 29Cu 1.53
13
Al — 30Zn 1.50
13
Al — 30Zn 1.56
29
Cu — 30Zn 1.60
 Alternative X-ray filters
J Stecke et al 363

control filter (GC), curve regression analyses were made

using a polynomial function of the third degree
(r2 . 0.98) to define a prediction limit of 5%. The level
of significance for all analyses was set at 5% (a 5 0.05).

Results

The comparison of results of OD values are shown in

Table 2. In the comparison between tested filters and
GC, a significant difference (p , 0.05) was only shown
in the G5 filter group (95% Cu and 5% Zn with 1.6 mm
thickness) in an exposure time of 0.32 s. Significant
differences (p , 0.05) were observed for smaller and
larger exposure times in filter groups G3 (95% Al and
5% Zn with 1.56 mm thickness) and G5. A signifi-
cant difference (p , 0.05) between exposure times was
observed in G5. Figure 1 Optical density curves of all filters in the exposure time of
0.05 s and regression analysis of the standard filter including a
Figure 1 shows the OD curves generated with an prediction limit of 5%. Al, aluminium; G1, 97% Al and 3% copper
exposure time of 0.05 s for different filters, and groups (Cu) with 1.47 mm thickness; G2, 96% Al and 4% Cu with 1.53 mm
G3 and G5 showed a curve conformation different thickness; G3, 95% Al and 5% zinc (Zn) with 1.56 mm thickness; G4,
from the GC, exceeding the prediction limit of 5%. In 98% Al and 2% Zn with 1.5 mm thickness; G5, 95% Cu and 5% Zn
with 1.6 mm thickness. GC, control filter
the exposure time of 0.16 s, only the G5 group exceeded
the prediction limit of 5%, showing curve conformation
different from the rest of the filters (Figure 2). This was from the radiation spectrum.11 Two parameters, the
also the case in an exposure time of 0.32 s (Figure 3). tube voltage and the X-ray filter, can influence the
In Figure 4, examples of images obtained with each radiation spectrum of an X-ray tube.4,12
tested filter in each exposure time are shown. The tube voltage is responsible for the maximum
energy of the radiation spectrum, whereas the filter
mainly controls the low-energy side of the spectrum.
The optimization of the radiation spectrum consists of
Discussion
working with the X-ray tube voltage above or close to
the optimal energy required to diagnosis, with an X-ray
In this study, alternative filters made with different
alloys were evaluated as substitutes for the standard Al
filter in order to try and enhance the quality of intra-
oral digital images from SPPs using a smaller radiation
dose. The exposure dose is increased excessively by the
radiation photons with higher wavelength, i.e. low-
energy photons. These photons are absorbed by the
patient’s organism and must be preferentially removed

Table 2 Average (standard deviation) of optical density values from

tested filters and the standard filter
Exposure time
Group 0.05 s 0.16 s 0.32 s
GC 0.41(0.04) 0.53(0.02) 0.55(0.03)
G1 0.44(0.06) ABa 0.54(0.04) Aa 0.55(0.05) Ba
G2 0.46(0.03) ABa 0.53(0.04) Aa 0.57(0.03) Ba
G3 0.53(0.05) Aa 0.58(0.03) Aa 0.62(0.01) ABa
G4 0.48(0.04) ABa 0.54(0.02) Aa 0.59(0.04) Ba
G5 0.28(0.05) Bb 0.74(0.03) Aa 0.86(0.03) Aaa
ANOVA, analysis of variance; GC, control filter; G1, 97% aluminium
(Al) and 3% copper (Cu) with 1.47 mm thickness; G2, 96% Al and 4%
Cu with 1.53 mm thickness; G3, 95% Al and 5% Zinc (Zn) with Figure 2 Optical density curves of all filters in the exposure time of
1.56 mm thickness; G4, 98% Al and 2% Zn with 1.5 mm thickness; 0.16 s and regression analysis of the standard filter including a
G5, 95% Cu and 5% Zn with 1.6 mm thickness. prediction limit of 5%. Al, aluminium; G1, 97% Al and 3% copper
a
Group differed from GC by Dunnett test (p , 0.05). Dissimilar (Cu) with 1.47 mm thickness; G2, 96% Al and 4% Cu with 1.53 mm
letters (upper case in columns and lower case in rows) represent thickness; G3, 95% Al and 5% zinc (Zn) with 1.56 mm thickness; G4,
groups that differed statistically (ANOVA by the Tukey test, 98% Al and 2% Zn with 1.5 mm thickness; G5, 95% Cu and 5% Zn
p , 0.05). with 1.6 mm thickness. GC, control filter

Dentomaxillofacial Radiology
 Alternative X-ray filters
364 J Stecke et al

filter appropriate to restrict the spectrum. A limited

Figure 3 Optical density curves of all filters in the exposure time of
0.32 s and regression analysis of the standard filter including a
prediction limit of 5%. Al, aluminium; G1, 97% Al and 3% copper
(Cu) with 1.47 mm thickness; G2, 96% Al and 4% Cu with 1.53 mm
thickness; G3, 95% Al and 5% zinc (Zn) with 1.56 mm thickness; G4,
98% Al and 2% Zn with 1.5 mm thickness; G5, 95% Cu and 5% Zn
with 1.6 mm thickness. GC, control filter
tube power can be compensated by increasing the
exposure time and/or decreasing the filter thickness, but
both methods can expand the spectrum which causes a
decrease in quality of the X-ray beam.4,12 However, in
ordinary dental X-ray machines, factors such as tube
current and tube voltage are unchanged and an
operator’s machine cannot manipulate them. It is
possible to remove the standard filter from the machine
and substitute it for other more adequate X-ray filters.
In the present study, although there was the
opportunity to alter factors in the X-ray machine, such
as current and voltage of the tube, these factors were
fixed to simulate a usual clinical practice. However, in
spite of the commonly used 2.5 mm thick Al dental
radiography filter,6 the original X-ray filter of the
machine was removed and then replaced by an Al filter
1.5 mm thick. This is because the governing law9 states
that an X-ray machine up to 70 kVp only requires an Al
filter with a thickness of 1.5 mm. Thus, the GC was Al
with 1.5 mm in thickness, which differs from other
studies.1,6,7,13,14 Mauriello et al6 evaluated the effects on
image contrast and on exposure dose caused by the
increased thickness of the Al filter. In their results was

Figure 4 Example of images obtained during the study. (a) Control filter (GC)—0.05 s, (b) G1 [97% aluminium (Al) and 3% copper (Cu) with
1.47 mm thickness]—0.05 s, (c) G2 (96% Al and 4% Cu with 1.53 mm thickness)—0.05 s, (d) G3 [95% Al and 5% zinc (Zn) with 1.56 mm
thickness]—0.05 s, (e) G4 (98% Al and 2% Zn with 1.5 mm thickness)—0.05 s, (f) G5 (95% Cu and 5% Zn with 1.6 mm thickness)—0.05 s, (g)
GC—0.16 s, (h) G1—0.16 s, (i) G2—0.16 s, (j) G3—0.16 s, (k) G4—0.16 s, (l) G5—0.16 s, (m) GC—0.32 s, (n) G1—0.32 s, (o) G2—0.32 s, (p) G3—
0.32 s, (q) G4—0.32 s, (r) G5—0.32 s

Dentomaxillofacial Radiology

observed a decrease in exposure doses but with some loss
on image contrast. The exposure dose was decreased from
25% to 40% over the voltage range of 65–90 kVp and the
contrast decreased from 4% to 12%. At 75 kVp, 2–3 mm
of added-in thickness to the conventional Al filtration
resulted in a lower contrast from 5% to 7%. However, it
was observed that with the incorporation of rare-earth,
samarium (Z 5 62) or gadolinium (Z 5 64) in the X-ray
filter a decrease in the exposure dose of the thinner thick
filters without a loss of contrast to intra-oral radiography
occurred.6
The increase in thickness of the filter generates more
secondary radiation which will be scattered, requiring
higher tube currents or exposure times and causing a
decline in the lifespan of the X-ray tube.15 This can be
considered a problem for the DenOptix system as this
system creates more noise than others and therefore
needs a higher radiation dose.2,16,17 In the present study
the noise was not evaluated; we evaluated the reprodu-
cibility of the contrast which showed high values, even
with the addition of a tissue-equivalent that produces
scattering similar to that caused by the soft tissue of a
patient. However, the DenOptix system uses a histo-
gram equalization algorithm (automatic range control)
during image acquisition that can correct the contrast
from images so that high reproducibility of the contrast
is observed.17 The tested filters in the present study had
similar thickness to GC, although the process of casting
alloy caused slight differences in thickness (maximum
variance 5 0.1 mm) between different alloy composi-
tions. The modulation in composition caused no loss of
contrast, except in the G5 filter which differed from the
GC filter in an exposure time of 0.32 s. The G5 filter
was made using an alloy with a high atomic number
(Z 5 29/30) which probably altered the radiation
spectrum and distorted the response of the histogram
equalization algorithm. The OD curves were used to
indirectly evaluate the radiation spectrum through the
attenuation caused by the object. Thus, conformational
changes in OD curves above of the prediction limit of
5% may indicate a loss of contrast that would be
clinically visible, as observed in images obtained with
the use of G5 filters.
In relation to the filter composition, a previous study8
added other materials with higher atomic numbers to the
Al filter to obtain a desired absorption. However, we
prefer the use of alloys made with Al and other metals
because we believe that a union among foils is not perfect
and creates a space between them that could cause
radiation scatter and increased image noise. The
absorbing and filtering properties of any material are
determined by its mass attenuation coefficient (m/r)
which strongly depends on the photon energy (E). For
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