Radiography Evaluation

Technique
drh. M. Arfan Lesmana, M.Sc.
Fakultas Kedokteran Hewan, Universitas Brawijaya
Email: arfan142002@yahoo.com, arfan_lesmana@ub.ac.id
RADIOGRAPHIC QUALITY
• To produce a quality radiograph, the radiographer must understand
predetermined aspects of quality
• Radiographic quality refers to how easily details can be perceived on a
radiograph
• Radiographic density is defined as the degree of blackness, or "darkness,"
on a radiograph
• Black areas on a developed radiograph are produced by deposits of metallic
silver in the film emulsion that result from exposure to x-rays and their
subsequent processing
• A radiograph that has many black areas and is dark when viewed has high
density.
• An important concept to remember is that x-rays make radiographic film
black
Factors Affecting Radiographic Density
• the total number of x-rays that reach the film
• the penetrating power of the x-rays
• the developing time
• the temperature of the developer
• the higher the tissue density, the lower the radiographic density
CONTRAST
• Contrast is defined as the visible difference between two adjacent radiographic
densities
Contrast is divided into two separate categories: radiographic contrast and subject
contrast
• Radiographic contrast is the density difference between two adjacent areas on a
radiograph
• Subject Contrast is defined as the difference in density and mass between two
adjacent anatomic structures
• radiograph with white bone and a black background has high contrast high (short
scale of contrast)
• A radiograph that exhibits many grays and a small density difference between
two adjacent areas has low contrast (long scale of contrast)
• A good radiograph should have a suitable range of differentiated
radiographic densities (blacks, whites, and grays) so that the eye can easily
see the detail.
Radiographic contrast is influenced by
• Subject contrast
• kVp level
• scatter radiation
• film type,
• film fog.
EXPOSURE FACTORS
• The most common cause of poor contrast on a radiograph is inappropriate
exposure factors
Milliamperage-Seconds
• The mAs may affect contrast only when insufficient or excessive mAs is used
• When a correct mAs setting is used, contrast depends primarily on the kVp
setting
• However, when the mAs factor is insufficient, the contrast is reduced
because the overall density of the radiograph is reduced
• If the quantity of x-rays reaching the film is too low, the film will be pale
• Close inspection reveals that dense structures have been penetrated and
that the anatomic silhouettes are visible, but the images lack density
• Overexposure, caused by too much mAs, will result in increased overall
density (overall black appearance) but has less effect on radiographic
contrast
Kilovoltage
• Both contrast and density are affected by kVp. The correct amount of kVp
will produce differential x-ray absorption of soft and dense anatomic
structures
• If the kVp is too low, the resulting radiograph will have a "soot and
whitewash" (gray-and-white) appearance and the anatomic image will be
imperceptible
• Increased kVp causes excessive scatter radiation. As a result of the
increased penetrating power of the x-rays with high kVp, more x-rays will
reach the film
SCATTER RADIATION
• Non-image-forming radiation that is scattered in all directions as a result of
objects in the path of the beam is called scatter radiation
• Scatter radiation is undesirable for a number of reasons. Because
inappropriate areas of the film are being exposed, contrast is decreased
• the film are being exposed, contrast is decreased. scatter radiation primarily
originates from the patient, but there are other sources as well. Materials
such as the table and film tray also act as sources of scatter. Trus
phenomenon is referred to as backscatter
• Limiting the size of the x-ray beam so that the field does not exceed the
image receptor is the most effective way to reduce backscatter
• A mechanism known as a grid reduces the scatter radiation when the high
kVp necessary for thick body parts is used
GRID
• A grid is a device placed between the patient and the
• radiographic film that is designed to absorb
non-imageforming x-rays (scatter radiation)
• A grid is composed of alternating strips of lead
and spacer material. The lead strips are
approximately 0.5 mm in thickness and number
between 500 and 1500 on edge
RADIOGRAPHIC DETAIL AND DEFINITION
• Radiographic detail and definition are terms used to describe image
sharpness, clarity, distinctness, and perceptibility.
• The radiographer tries to obtain as much diagnostic information as possible
about the internal structures of the patient.
• To achieve this goal, image clarity is essential. Lack of detail can result from
several different factors
Geometric Unsharpness
• Loss of detail due to some geometric distortion can result from a large focal spot
size or a decreased SID
• Motion is another possible cause of geometric unsharpness.
• Geometric unsharpness due to the screens and film is another possibility
Geometric Distortion and Magnification
• X-rays, like visible light, travel in straight lines that diverge from a central
projection.
• All geometric anomalies that occur with visible light also occur with x-rays and
can be explained using visible light as an analogy
• To maintain an accurate geometric projection, the subject under examination
must be parallel to the image receptor
Radiographic Technique Evaluation
• The ability of the technologist to evaluate a radiograph properly is
imperative
• Without this ability, the attempt to attain quality is futile
• Assessing what is wrong with the radiograph and making the proper
corrections are the skills that we seek
• Quality radiographs are not attained by "luck" but by a conscious
understanding of the variables
Physics of Radiography: A Review
• X-rays are generated in an x-ray tube
• In the tube a stream of fast-moving electrons is attracted and directed
• from the cathode to the anodeAs the electrons collide and interact with the
atoms of the target on the anode, a great amount of energy is produced; 1% of
this energy is in the form of x-rays
• The cathode consists of a wire filament that emits electrons when it is heated
• The temperature of the filament is controlled by the milliamperage (mA) setting
on the console of the machine
• The period during which the
• electrons (x-rays) are permitted to leave the x-ray tube is in fractions of seconds
• Therefore the milliamperage-seconds (mAs) controls the total number of x-rays
produced
Physics of Radiography: A Review
• The electron speed necessary to create a high-energy impact is achieved by
applying thousands of volts (kilovolts) across the anode and cathode
• High voltage produces x-rays with greater penetrating power and intensity
• Therefore the kilovoltage peak (kVp) controls the penetrating power of the x-rays.
Density and Contrast: A Review
• Radiographic density is defined as the degree of blackness on the radiograph
• Density is primarily affected by mAs. The higher the mAs, the greater the density
and the more blackness on the radiograph
• If x-rays make film black, more x-rays emitted by the machine will cause more
blackness on the film
Density and Contrast: A Review
• The kVp may also influence density and increase blackness on the
radiograph
• Radiographic contrast is defined as the density difference between two
areas of a finished radiograph
• If the difference between two areas is great, the contrast is described as
high
• If there is a slight difference in density (an overall gray appearance), the
contrast is low
• Radiographic contrast is affected primarily by the kVp. The higher the kVp,
the lower the contrast
Evaluation of Radiographic Technique
• In the technical evaluation of a radiograph, two basic questions should be asked
1. Is the film too light or too dark?
2. Is there proper penetration?
Question 1
• The x-rays (more exposure) make the film black.
• If a radiograph is underexposed, it will appear too light
• In this case, either kVp or mAs needs to be increased
• If the radiograph is too dark, it is overexposed and either the k V P or mAs should
be decreased
• To determine whether
• the k V P or the mAs should be altered, the second question needs to be asked
Evaluation of Radiographic Technique
Penetration Evaluation of a Radiograph That Is Too Light
• When looking at a radiograph that is too light, it is understood that either the kVp
or the mAs needs to be increased
• The second question, concerning penetration, must be asked: Have the x-rays
adequately penetrated the patient and reached the x-ray film?
• On a film with adequate penetration, the anatomic silhouettes (outlines) are
visible
• If the penetration is inadequate, the outlines of the abdominal structures would
not be visible and the radiograph would look almost completely white in some
areas
• Adequate penetration: Increase mAs 30% to 50%
• Inadequate penetration: Increase kVp 10% to 15%
Evaluation of Radiographic Technique
Penetration Evaluation of a Radiograph That Is Too Dark
• When a radiograph is too dark, either the kVp or the mAs must be decreased
• We then need to ask whether the radiograph has appropriate penetration
• Overpenetration of a patient is determined by looking at the contrast of the
radiographic image, specifically, by looking at the bone tissue compared with the
surrounding soft tissues
• Remember, as a general rule, high kVp results in low contrast-a gray radiograph
• If the bone tissue is gray and not much contrast exists between the bone and
adjacent soft tissue, there was too much penetration of the patient
• Not overpenetrated: Decrease mAs 30% to 50%
• Overpenetrated: Decrease kVp 10% to 15%
• A quality radiograph has adequate penetration, sufficient density, and good
contrast. These requirements differ for bone an
• d soft tissue
• Artifact: Anything that decreases the quality of theradiograph resulting in
difficult evaluation and interpretation.