R e s i d e n t s ’ S e c t i o n • P hy s i c s M i n i m o d u l e
Huda and Abrahams
Resolution on Radiographs
Residents’ Section
Physics Minimodule
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Residents
X-Ray-Based Medical Imaging and
inRadiology Resolution
Walter Huda1
T
he purpose of most radiologic im-
R. Brad Abrahams 2 aging examinations is to either
identify abnormalities in a patient
Huda W, Abrahams RB or to classify a patient as being
healthy while minimizing radiation exposure
[1]. To achieve these goals, it is of obvious im-
portance to ensure that the radiologic image
quality is sufficient for a given imaging task.
Medical image quality is normally character-
ized in terms of contrast, noise, and spatial
resolution. The achieved quality for any im-
age will depend on both the intrinsic proper-
ties of the imaging system and the manner in
which the images were obtained, including
the choices of image acquisition tube voltage
(kilovoltage) and output (tube current–expo-
sure time product).
To be detectable, a lesion must transmit a
different x-ray beam intensity compared to
the surrounding normal tissues. The differ-
ence in x-ray beam intensity through a lesion
relative to the normal background is called
subject contrast. The appearance of this sub-
ject contrast in the resultant image is called
Keywords: focal blur, image quality, motion blur, image contrast. Noise has both random and
radiographic imaging, receptor blur, resolution structural components, with the latter being
fixed for a given patient, such as ribs in chest
DOI:10.2214/AJR.14.13126
radiographs. The random noise in virtual-
Received May 9, 2014; accepted after revision ly all radiographic imaging is due to quan-
May 30, 2014. tum mottle, which can be reduced by using
more x-ray photons to create the image, but
1
Department of Radiology and Radiological Science, which will also increase the patient dose [2].
Medical University of South Carolina, 96 Jonathan Lucas
Contrast and noise are directly related to the
St, MSC 23, Charleston, SC 29425-3230. Address
correspondence to W. Huda (walterhuda@hotmail.com). choice of radiographic techniques, namely
x-ray tube voltage (kilovoltage) and output
2
Department of Radiology and Imaging, Georgia Regents (tube current–exposure time product) [3].
University, Augusta GA. The amount of blur, or unsharpness, af-
WEB
fects the appearance of both normal anat-
This is a web exclusive article. omy and pathologic abnormalities. Spatial
resolution is the technical term used to re-
AJR 2015; 204:W393–W397 fer to the amount of blur in an image. Spatial
resolution performance is an intrinsic prop-
0361–803X/15/2044–W393
erty of an imaging system that is generally
© American Roentgen Ray Society independent of the selected technique factors
AJR:204, April 2015 W393
(kilovoltage and tube current–exposure time
product). In this article, we describe the es-
sential characteristics of spatial resolution.
Factors that influence spatial resolution, as
well as performance of x-ray-based medical
imaging modalities, are described [4–7].
What Is Resolution?
Blur and Sharpness
Most radiologists have an intuitive sense
of what constitutes poor resolution and can
easily recognize a blurred image. Resolu-
tion, however, is sometimes taken to mean
the ability to see objects so that when lesions
are seen, then the resolution must be good.
Such statements are incorrect, as illustrated
by considering a single-cell molecule labeled
with a radionuclide and imaged with a PET
system. The activity will be seen, but the blur
associated with this point source will be sev-
eral millimeters, resulting in a blurry image
with poor resolution.
This example can be expanded to illus-
trate what imaging scientists mean regard-
ing spatial resolution performance. For two
nearby cells with radioactively labeled DNA
in their nuclei, a system that can resolve
these two entities would show two hot spots
as distinct entities (Fig. 1, upper panel). A
PET system would show only one very large
blurred object, and the activity in cell one
would not be resolved from the activity de-
picted in the nearby cell two (Fig. 1, lower
panel). A system with good resolution per-
mits the detection (and characterization) of
two small features, such as microcalcifica-
tions in mammograms, even when they are
physically close to each other.
There are several terms used to describe
spatial resolution in imaging. Blur and sharp-
ness are good descriptors that are universal-
ly understood, and they simply mean that
a sharp edge will also appear as sharp (not
blurred) in an image obtained with a system

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Fig. 1—Objects are depicted on left, and resultant
images are shown on right. Top panel shows that
two objects that are separated far apart result in
two (blurred) lesions in image. Bottom panel shows
that, when these two objects move closer together,
image shows one blurry object, and lesions are not
resolved. (Illustration by Abrahams RB)
that has good resolution performance. Oth-
er terms that may be used include resolution,
high-contrast resolution, unsharpness, and
detail visibility.
Measuring Resolution
Imaging scientists consider the spatial reso-
lution performance to be an intrinsic charac-
teristic property of an imaging system. In gen-
eral, resolution cannot be evaluated by looking
at line pair phantoms because the visibility
(detectability) in phantoms depends on the
amount of noise in the image. It is only when
noise is somehow made negligible that one is
left with the intrinsic blur associated with a
given imaging system. Two common ways of
assessing the intrinsic resolution properties of
an imaging system are the line spread function
and the modulation transfer function.
A line spread function is measured using
an image obtained of a narrow line, which is
simply a blurred version of the initial line (Fig.
W394 AJR:204, April 2015
Huda and Abrahams
2). The amount of blur can be measured as the
full width half maximum, which for a line is
the physical distance in millimeters between
the two points where the line intensity has
been reduce to half of the central (maximum)
value. Different measures of the spread in the
image are also possible, such as the full width
tenth maximum, where the value of full width
tenth maximum is obviously greater than the
full width half maximum (Fig. 2). The advan-
tage of these measures is that they are intuitive
and provide a quantitative sense of the amount
of blur in a given imaging system.
A modulation transfer function curve can
be estimated by looking at the images ob-
tained at differing spatial frequencies, as de-
picted in Figure 3. For low spatial frequen-
cies, corresponding to very large bars and
gaps, the region behind the lead will be pure
white and the region in the gap between the
bars will be pure black. The difference be-
tween the lead and gap regions is called mod-
ulation and is essentially close to 100% (black
vs white) at the lowest spatial frequencies.
This modulation is always reduced as spatial
frequencies increase because of the blurring
effects of an imaging system. At some high
Fig. 2—Illustration on
left depicts radiographic
image being generated
of narrow line of x-rays,
such as might result when
x-ray passes through long
narrow slit in sheet of lead.
Upper right panel shows
broadened (blurred) line
in radiographic image;
lower right panel shows
line profile through
radiographic image,
showing line spread
function (LSF) and
measured broadening as
full width half maximum
(FWHM) and full
width tenth maximum
(FWTM). (Illustration by
Abrahams RB)
spatial frequency, the image of the bars and
gaps blends into a uniform gray. At this point,
there is zero modulation in the image, and ad-
jacent bars cannot be differentiated (Fig. 3).
Line Pair Phantoms and Pixel Size
A line pair phantom contains strips of lead,
with gaps of the same size as the lead. When
the lead (and gap) are 0.5 mm, we can fit one
line pair into 1 mm and call this a spatial fre-
quency of one line pair per millimeter. High
spatial frequencies correspond to small ob-
jects and vice versa. When a line pair phan-
tom is imaged, the large objects are readily
resolved from each other because there is a
large gap between adjacent lines (Fig. 3). As
the spatial frequency increases, however, the
lines start to blur into each other and the lim-
iting spatial resolution occurs when distinct
lines are no longer visible (Fig. 3). When the
images are obtained at high exposures so that
noise is negligible, this spatial frequency is
known as the limiting spatial frequency and is
expressed in line pairs per millimeter.
The use of large pixels would clearly re-
duce the limiting spatial resolution perfor-
mance. In general, however, the use of small-
Fig. 3—On left is bar pattern that ranges from low
spatial frequencies (largest objects) to high spatial
frequencies (smallest objects), but all have 100%
modulation defined as difference in intensity (black
vs white). On right is resultant image showing how
image blur reduces modulation from close to 100% for
large objects to 0% modulation at spatial frequency
corresponding to limiting spatial resolution.
(Illustration by Abrahams RB)
 Resolution on Radiographs

er pixels is not expected to improve spatial Fig. 4—Relationship

resolution performance. The reason for this is between size of focal
spot and amount
that there are intrinsic sources of blur in the of blur in resultant
imaging chain, such as the size of the focal image in magnification
spot, that cannot be overcome by making pix- mammography. Use
of a large focal spot
els smaller. Vendors of imaging systems will
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(top) results in a much

make the pixels as small as they need to be,
and pixel size is not further reduced when in-
trinsic factors become the determinant factors
of achievable image sharpness.
What Affects Resolution?
Focal Spot
The size of the focal spot affects the
amount of focal spot blur in all radiologic
imaging, as depicted in Figure 4 [8–10]. In
radiography, fluoroscopy, and CT, the x-ray
tube normally has two focal spot sizes, with
nominal sizes of 0.6 and 1.2 mm. When the
large focal spot is used, the total power load-
ing that may be used is 100 kW, whereas the
small focal spot can only tolerate 25 kW. The
use of small focal spots will thus generally
result in longer exposures, which, in turn, in-
crease the likelihood of motion blur (see dis-
cussion later in this article).
In mammography, the x-ray tube normal-
ly also has two focal spot sizes, with nomi-
nal sizes of 0.1 and 0.3 mm. The maximum
tube current with the small focal spot is only
25 mA but can be four times higher with the
large focal spot. As with radiography, the use
of a small focal spot is generally associated
with much longer exposures and the associ-
ated problems of motion blur.
In mammography, geometric magnification
is used to investigate suspicious regions, which
is achieved by moving the compressed breast
closer to the x-ray tube (Fig. 4). In intervention-
al neuroradiology, the visibility of very small
blood vessels can be improved through the use
of geometric magnification. In both of these
cases, the use of geometric magnification will
always require the use of smaller focal spots to
minimize focal spot blur.
Motion
The amount of motion blur is directly re-
lated to the speed of any motion, which may
blurrier image than small
focal spot (bottom).
This is especially true
for magnified images
depicted in this graphic,
illustrating importance
of small focal spot when
geometric magnification
(twofold) is being
used. (Illustration by
Abrahams RB)
be voluntary or involuntary. Examples of in-
voluntary motion include cardiac motion and
peristalsis. The amount of motion blur is also
directly proportional to the exposure time of
any radiographic examination. Motion blur
can be estimated by multiplication of the speed
of any motion by the corresponding exposure
time. When increasing x-ray tube output, the
x-ray tube currents should be increased when
this is technically feasible, so that exposure
times are kept as short as possible.
Chest radiographic imaging has very short
exposure times, of the order of milliseconds,
which is easy to achieve as the chest is not dif-
ficult to penetrate and only low x-ray tube out-
puts (≈ 1 mAs) are used. In abdominal imag-
ing, exposure times must be increased to tens
of milliseconds to ensure that enough radia-
tion is incident on the image receptor, which is
achieved by use of much higher intensities (≈
20 mAs). The longest exposures are generally
encountered in mammography, where a typi-
cal exposure time is approximately 500 ms or
more and up to a factor of 3 higher when per-
forming magnification mammography [11].
There are a number of practical steps that
may be taken to minimize patient motion. Im-
mobilization devices include head supports
in CT and compression paddles in mam-
mography [12, 13]. Patients can be asked to
hold their breath and stay still. In cardiac CT,
β-blockers can be prescribed to reduce the
heart rate [14]. Sedation can be used when im-
aging newborns and young infants [15].
Receptor Size
Scintillators used in radiology include ce-
sium iodide used in flat-panel detectors and
image intensifiers and gadolinium oxysulfide
in mammographic screens. When x-rays are
absorbed by any scintillator, approximate-
ly 10% of the absorbed energy is converted
into light, which spreads out when traveling
to the light detector, as depicted in Figure 5
[16]. This spreading of light between the x-
ray interaction and the corresponding light
detector (film or a digital equivalent) may
result in significant image blur. Although a
columnlike structure can be used to reduce
diffusion of light, detector blur is nonethe-
less present in all scintillators. The amount
of blur is directly related to the scintillator
thickness as depicted in Figure 5.
In photoconductors, charge created after a
photoelectric or Compton interaction is collect-
ed directly by the application of an electric field
[17]. Because low-energy electrons do not trav-
el very far, there will be very little blur (Fig.
6). Consequently, photoconductors are expect-
ed to have excellent resolution performance
and are attractive for use in digital mammog-
raphy, where good resolution performance is

Fig. 5—For scintillators that absorb x-rays and produce light, amount of image
blur is directly related to thickness of scintillator (1 mm [left] vs 0.5 mm [right]).
Thickness of scintillator can be taken to be comparable to blur introduced into
resultant image. (Illustration by Abrahams RB)

AJR:204, April 2015 W395


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Fig. 6—Illustration of photoconductor shows
that charge (electrons) generated by incident
photons have minimal divergence when collected
by application of voltage across photoconductor.
(Illustration by Abrahams RB)
essential. By contrast, in computed radiogra-
phy, light beams are used to release the energy
stored in an exposed photostimulable phosphor.
As shown in Figure 7, there will be scattering of
the incident light, which will result in increased
image blur because of the release of light from
adjacent pixels. For this reason, there is a limit
to the thickness of any photostimulable phos-
phor. When thin detectors are used, this in-
creases patient doses because of the reduction
in x-ray absorption in thinner detectors.
In fluoroscopy, the number of television
lines determines the nominal width of each
line and thereby affects the achievable spa-
tial resolution performance. When the num-
ber of television lines increases from 500 to
1000, the limiting resolution performance
will also improve by a factor of 2. In CT, it is
the physical size of each detector (length and
width) that is directly related to the achiev-
able spatial resolution performance [18].
When corrected for image magnification, the
nominal detector dimension in both direc-
tions on a CT scanner may be taken to be a
nominal 0.5 mm or so.
Resolution Performance in
Radiographic Imaging
Radiography and Mammography
Digital radiographs generally have a ma-
trix size of 2000 × 2500. For a 35 × 43-cm
cassette, this digital matrix corresponds to a
pixel size of 175 μm and a limiting resolution
of three line pairs per millimeter. For a 20 ×
24-cm cassette, the pixel size would be 100
μm, and the limiting resolution would be five
line pairs per millimeter. Extremity radio-
graphs, where good resolution is important
for detecting hairline fractures, should there-
W396 AJR:204, April 2015
Huda and Abrahams
Fig. 7—Photostimulable phosphor shows scattering of incident read-out narrow light beam (left) and
emission of stimulated light from pixel of interest (right), as well as adjacent pixels, which increase image blur.
(Illustration by Abrahams RB)
fore be obtained using smaller cassettes. The
limiting resolution of a typical film-screen
system used for chest radiography was about
six line pairs per millimeter, or a factor of 2
better than a typical digital chest radiograph-
ic imaging system.
In digital mammography, the pixel size
typically ranges between 50 and 100 μm, so
that the corresponding limiting spatial reso-
lution ranges between 10 and five line pairs
per millimeter. A common pixel size of 70 μm
corresponds to a limiting resolution of close
to seven line pairs per millimeter. The total
number of pixels in a digital mammogram is
about 12 million, assuming a 3000 × 4000
matrix size. Most mammography worksta-
tions are capable of displaying up to 5 million
pixels, so that seeing all the available detail in
a digital mammogram will require the use of
image zoom capabilities [19].
Film-screen mammography typically
achieved a limiting spatial resolution of 15
line pairs per millimeter, which is a factor
of 2 better than digital mammography. This
example illustrates that the benefits of digi-
tal mammography relate to image processing
rather than any resolution issue per se. Mam-
mography film-screen systems are superior to
the capabilities of the human visual system,
which is about five line pairs per millimeter at
a 25-cm viewing distance [19]. This explains
why mammographers in the days of film al-
ways had a magnifying glass in their hands for
viewing mammograms on viewboxes.
Fluoroscopy and Digital Photospot
Fluoroscopy can be performed with image
intensifiers or flat-panel detectors and does
not generally require high-resolution perfor-
mance. With a standard 500-line television
system, the nominal limiting fluoroscopy
spatial resolution performance is about one
line pair per millimeter. Flat-panel detec-
tors with a pixel size of 175 μm can achieve
a limiting resolution of three line pairs per
millimeter. When these are used for per-
forming fluoroscopy, binning four pixels into
one large pixel is common for larger FOVs,
which results in a limiting resolution of 1.5
line pairs per millimeter.
Digital photospot images using an image
intensifier–based imaging chain are general-
ly obtained using a high-quality (1000 line)
television system. For a 25-cm FOV, the re-
sultant pixel size is 250 μm, and the corre-
sponding limiting resolution will be about
two line pairs per millimeter. Commercial
2000-line television systems are available,
but the benefits of providing improved spa-
tial resolution performance were not deemed
to be worthwhile. For flat-panel detectors,
spatial resolution for digital photospot im-
ages is identical to that for radiographs ob-
tained with these detectors—namely, three
line pairs per millimeter.
CT
In a head CT scan, the FOV is 250 mm,
the matrix size is 512 × 512 and the pixel
size is 0.5 mm. The best achievable resolu-
tion for this FOV and matrix size is thus one
line pair per millimeter. Increasing the FOV
to 500 mm for a large patient doubles the pix-
el size (1 mm) and halves the limiting spa-
tial resolution performance (i.e., 0.5 line pair
per millimeter). Spatial resolution in CT is
thus an order of magnitude worse than film-
screen combination and four times worse

TABLE 1: Representative Values of Limiting Resolution Performances for Digital Imaging Systems
Limiting Resolution,
Line Pairs per
Imaging System
CT
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Fluoroscopy
Digital subtraction angiography or photospot
Radiography
Mammography
than digital chest radiography. CT has ex-
cellent imaging characteristics and anatomic
localization compared with any type of pro-
jection imaging but also has inferior spatial
resolution performance.
In CT, the choice of the mathematic recon-
struction filter affects the amount of blur in the
resultant image [20]. Image reconstruction fil-
ters offer reduced image noise but at the ex-
pense of more image blur. Common names for
such high-resolution reconstruction filters in-
clude “bone,” “detail,” “high resolution,” and
“lung.” These filters are used to get excellent
detail for structures such as bone (vs air or tis-
sue) or lung (vs air), where the high intrinsic
contrast negates the importance of higher lev-
els of noise. Reconstruction filters with names
such as “standard” or “soft tissue” reduce im-
age noise at the price of inferior spatial reso-
lution performance and are used where the in-
trinsic lesion contrast is low.
CT spatial resolution can be improved by
up to a factor of about 2 by reducing the re-
construction FOV (zoom). This requires that
the original projection data are used to re-
construct a smaller anatomic region, which
thereby differs from simple magnification,
which uses reconstructed image data. Ob-
taining the best possible resolution may also
require the use of a reduced focal spot (0.6
vs 1.2 mm), which will also require a reduc-
tion of the focal spot power loading (25 vs
100 kW). However, when a small focal spot
is used with reduced power loading, the scan
time may need to be increased, which also
increases the likelihood of motion blur.
Conclusion
Resolution is the ability of an imaging
system to faithfully reproduce a sharp edge
AJR:204, April 2015 W397
Resolution on Radiographs
Millimeter
≈ 0.7 Improved by zoom reconstruction of the central region of acquired image
≈1 Improved by the use of electron magnification modes, as well as high-quality television
systems (1000 line)
≈2 Improved by the use of electronic magnification modes of image intensifiers (e.g.,
magnification 1 or 2)
≈3 Improved performance can be achieved by the use of smaller cassette sizes (5 line pairs
per millimeter for 20 × 25 cm)
≈7 Use of smaller (50 μm) pixels would improve resolution, whereas large pixels (100 μm)
would degrade resolution
that is present in the object. The key factors
that influence the sharpness of an image re-
late to the size of the source of x-rays (fo-
cal spot), the physical characteristics of the
x-ray detector system (area and thickness),
and the presence of any motion blur because
of the finite duration of all radiographic ex-
posures. Image processing, especially in CT
through the filtered back projection recon-
struction, can also affect spatial resolution
performance. The limiting resolution that is
routinely achieved in clinical practice ranges
from about 0.7 line pair per millimeter for
CT to about seven line pairs per millimeter
for digital mammography (Table 1). The val-
ues listed in Table 1 may be compared to the
human visual system, which can resolve up
to five line pairs per millimeter at a normal
viewing distance of 25 cm.
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