Factors affecting contrast
kVp, mAs, Grid, Intensifying Screen, Beam
restrictors, Film processing
Types of Contrast
● Short and long-scale contrast
● High and low contrast
Technique conversion factors
● The 15% kVp rule
● kVp and mAs relationship
● kVp and Exposure Time relationship
● Technique change when using beam
restrictor
● Correction factor for varying
intensifying screen speeds
● Grid conversion factor
● Age correction factor
● Correction factor for orthopedic
radiography
Radiographic Density
Factors affecting radiographic density
● mAs as controlling factor of density
● Influencing factor for density
● Focal film distance
● kVp
● Pathology
● Film processing
● Intensifying screen
● Film emulsion
● Heel effect
Factors affecting detail and distortion
● Motion
● Focal spot size
● Object-film distance
● Intensifying screen speed
● Non-screen holder
● Film-screen contact
● Target-object-film alignment
Types of motion
● Voluntary
● Involuntary
● Limiting motion unsharpness
● Advantages of motion in radiography
Calculations for receptor
exposure
maintenance
● Reciprocity law
● 15 percent rule
● Grid factor/Bucky factor
● Speed class
● SID
Exposure Factor Formulation
Purpose
● Receptor exposure standardization
● Image consistency
Considerations
● Choice of technique system
● Patient thickness
● Image processing
Types
● Optimum kVp/variable mAs
● Variable kVp/fixed mAs
● Automated exposure
● Anatomically programmed
radiography
Kilovoltage Peak (kVp)
● The kVp affects the exposure to the
IR (Image Receptor)
● because it alters the amount and
penetrating ability of the
● x-ray beam.
● The area of interest must be
adequately penetrated before
● the mAs can be adjusted to produce
a quality radiographic
● image
● When adequate penetration is
achieved, increasing the kVp
● further results in more radiation
reaching the IR.
● In addition to affecting the amount of
radiation exposure to the IR, the kVp
also affects image contrast
The kilovoltage (kVp)
● is set by the radiographer and
applied
across the x-ray tube at the time the
exposure is initiated
determines the speed at which the electrons
in the tube
current move.
● The speed at which the electrons in
the tube current move
determines the quality or energy of the x-
rays that are
produced.
● The higher the energy of the x-ray
photon, the greater the
penetrability, or ease with which it moves
through the tissue
● Quality refers to the energy level of
the radiation.
Important Relationship
● Speed of Electrons and Quality of
X-rays
● The speed of electrons in the tube
current determines the quality or
energy of the x-rays that are produced. The
quality or energy of the
x-rays that are produced determines the
penetrability of the primary
beam
kVp and Beam Penetrabilty
● As kVp increases, beam penetrabilty
increases, as kVp decreases,
beam penetrability decreases.
Image Contrast –
● Differences in the brightness levels
(for
digital imaging) or densities ( for film-screen
imaging) to
differentiate among the anatomic tissues.
● The range of brightness levels or
densities is a result of tissues’
differential absorption of the x-ray
photons.
Radiographic Contrast –
● is the combined result of multiple
factors associated with the anatomic
structure, quality of the radiation,
capabilities of the image receptor,
and, in digital imaging computer
processing and display.
● Deals with radiographic imaging and
the production of quality
images/radiographs through proper
selection, computation, generalization
and application of various technique
factors and accessory devices.
Radiographic Contrast
● is the degree of difference between
adjacent densities.
●
● the ability to distinguish between
densities enables differences in
anatomic tissues to visualized
● An image that has sufficient density
but no differences in densities would
appear as a homogenous object.
● This appearance would indicate that
the absorption characteristics of an
object differ, the image presents with
varying densities.
● In tissues where the absorption
characteristic differ, recorded detail
is best visualized when contrast is
optimized for the area of interest.

Long-Scale and Short-Scale Contrast
Images
● A diagnostic image is produced
when the x-ray beam has sufficiently
penetrated the tissue.
● The penetrability of the primary x-ray
beam is controlled by kilovoltage,
therefore kVp is the controlling
factor for contrast on an image.
● When considering the amount of
contrast on an image, the
radiographer must determine if a
short or long scale of gray is most
appropriate for the anatomy to be
imaged.
● The number of densities from black
to white on a radiographic image is
an indication of the range of the
scale of contrast.
● The terms long-scale and short-
scale describe the number of
different densities between black and white
on the image.
● The choice of mAs or SID will not
affect radiographic contrast.
● a step wedge of graduated thickness
is used to illustrate how higher kVp
examinations penetrate greater
thickness and produce long-scale
contrast images.
● Low-kVp examination penetrate
fewer thicknesses and have only a
few steps between black and white,
and so produce short-scale contrast
images.
● When the primary beam penetrates
through tissue with adjacent
densities which have grater
differences in contrast, the image is
described as high contrast.
● The image will have few shades of
gray.
● A short-scale contrast image has
fewer steps between black and white
and is a high-contrast image.
● Low-kVp examinations produce
short-scale contrast images.
● This is the preferred scale of
contrast when imaging bone
anatomy as this demonstrates the
fine trabecular markings and
fractures the best.
● A zebra is a great example of high
contrast because it has black and
white stripes.
● Imaging the abdomen requires a
long scale of gray because
anatomy of the abdomen is comprised of
soft tissue and vital
organs with minor density differences.
● These images will have a few
differences in contrast because
the differences between adjacent densities
are small; this is referred to as a long-scale
contrast image which has many steps
between black and white and is a low-
contrast image.
● Using higher kVp will produce more
shades of gray which will allow for
better visualization of abdomen
anatomy.
● A herd of elephants is an excellent
example of a long gray scale; each
elephant will have a slightly different
color than other elephants; however,
they are all some shade of gray.
 ● Radiographic contrast is made up
of a total amount of contrast
acquired from both the subject
contrast and film contrast.
● Film contrast is the difference in OD
between different areas on the film.
● Subject contrast describes the
different amounts of exit radiation
through different parts of the body.
● kVp is the primary controlling factor
for radiographic contrast.
Film contrast is the range of densities the
film is capable
of recording.
● Film contrast is represented as the
slope of the characteristic curve.
● The four factors that affect film
contrast are intensifying screens,
film density, characteristic curve,
and processing.
● Intensifying screens create a higher
contrast image due to the exposure
of light to the film.
● Film density is changed when there
is a change in the film contrast.
● There is an optimum range of
densities for each film which allows
maximum visualization.
● Images which have too much or too
little density demonstrate a decrease
in contrast.
● When a film is exposed to the
correct exposure factors, the film
densities will fall within the
diagnostic range of densities in the
slope portion on the characteristic
curve.
●
● Densities which fall in the toe or
shoulder portion decrease the
contrast on the image.
● The slope of the characteristic curve
also affects contrast.
● As the slope becomes steeper, the
range of diagnostic densities
becomes compressed and the
contrast is increased.
● Various processing factors will affect
the amount of contrast on the film.
● Increasing the amount of time the
film is in the developer, the
developer temperature, or developer
replenishment rate will increase the
amount of chemical fog on the
image.
● Each of these changes will increase
the base fog and decrease contrast
of the image.
● Subject contrast depends on
differential absorption of the x-ray
beam.
● Differential absorption occurs
because different areas of the body
have different transmission and
attenuation effects on the x-ray
beam.
● Structures in the body that highly
attenuate x-ray photons, such as
bone, are called radiopaque
structures.
● The tissues that only partially
attenuate x-ray photons and allow a
majority of them to be transmitted,
such as lung, are called radiolucent.
 ● There are many factors that affect
differential absorption and subject
contrast: the thickness of the tissue,
the atomic number and type of the
tissue, the density of the tissue, the
kVp setting, contrast media, and
scatter radiation.
Tissue Thickness
● Thicker parts of the body attenuate
more x-rays.
● An increase of 4 cm in soft tissue
thickness decreases the exit
radiation by about a factor of 2.
● Two parts of the body with different
tissue thicknesses will produce a
different in subject contrast.
● This difference in absorption
between the two thicknesses will
influence the amount of subject
contrast.
● The two tissues will appear as two
different densities on the radiograph.
● As body part thickness increases,
the amount of attenuation also
increases, and when there is little
difference in the thickness of
adjacent body parts, the subject
contrast will be decreased.
Tissue Type and Atomic Number
● Tissues with higher atomic numbers
have greater attenuation values than
tissues with lower atomic numbers.
● Bone, soft tissue, and fat all have
different attenuation values.
● Bone has greater attenuation
because bone has a higher atomic
number than a fat or soft tissue.
● Bone will appear as a higher density
than soft tissue on the radiograph,
demonstrating a large difference in
subject contrast.
Tissue Density
● The density of the body part in
grams per cubic centimeter (g/cm3)
affects the amount of attenuation.
● Fat has lower density than soft
tissue, so 1 cm of soft tissue
attenuates more than an equal
thickness of fat.
● Bone is more dense and has a
higher atomic number than soft
tissue, so 1cm of bone has more
attenuation than 1 cm of soft tissue.
● Tissue density or mass density
should not be confused with OD.
● Mass density is the quantity of
matter per unit of volume.
● When mass density is doubled,
nearly twice as many x-ray photons
X-ray Energy
will be absorbed and scattered in
bone as in soft tissue.

● When the difference in density

between adjacent tissues is great,
• Higher-energy x-ray photons have
less differential absorption because
the subject contrast will be
they are more penetrating.
increased, and when the differences

•
in density are small, the subject
contrast is decreased. Higher-energy x-ray-photons also
produce more Compton scattering
● For example, bone tissue is denser than lower-energy x-rays because
than lung tissue, so it makes sense
Compton scattering predominates
that there is great subject contrast
at higher x-ray energies.
between bone and lung tissue.

● As you can see, the principles of • This combination of less differential

tissue type and density are alike in absorption and more scattering
how they affect contrast results in less subject contrast at
higher energies.

• Subject contrast depends on the

average energy of the x-ray beam.

• Increasing the average energy of

the x-ray beam by increasing the
kVp or the beam filtration lowers
the subject contrast.

• Lower kVp results in x-ray photons

with less energy and more
differential absorption will occur,
resulting in higher subject contrast.

• Mammography utilizes a lower kVp

to increase the subject contrast of
the breast tissue.
 • The increased attenuation makes
the structures containing the
contrast agent appear lighter than
the surrounding tissues and
increases subject contrast.

Contrast Agent
• The differences in subject contrast
between the soft tissue and the
• similar densities and are not easily
structure filled with the barium or
iodine allow us to visualized the
visualized on a radiographic image. outline of the vessel organ.

• To make these structures visible, a • Air is also used as a contrast agent.

substance with a higher density
must be used. • Air also increases differential

• Adding a higher atomic number

absorption because its lower
density increases transmission
contrast agent to vessels or organs through the air-filled structures.
in the body increases the
differential absorption and results
in body structures becoming more
• Air is a radiolucent contrast agent
which allows us to visualize lung
visible.
tissue as well as the ribs and

• Iodine and barium are commonly

mediastinum outline.

used as contrast agents because

they have high atomic numbers
• Air increases subject contrast and
provides a short scale of contrast
and high densities.
to better visualize structures.
• Introducing barium into the
• Scatter is a radiation that has
intestines and introducingiodine
undergone one or more Compton
into the kidneys are examples of
interactions in the body.
the use of contrast agents in
radiology.
• As kVp is increased, the percentage
• Barium and iodine are radiopaque of Compton interactions also
increases, and the result is an
substances which absorb the x-ray
increased amount of scatter
photons.
reaching the image receptor. (kVp=
 tcm x 2 +K) (Caliper) tcm = body
thickness in centimer ( 1 cm of
body thickness requires 2 kVp to
penetrate), K=constant of the
machine (that is the value that can
cause photosensitization in the film
after calibration of the machine)
• The presence of scatter reduces
radiographic contrast because the
scatter increases the film fog that
results in a long scale of gray.
• Grids are devices used to absorb
and reduce the scatter before it
reaches the film, thereby
increasing contrast.
• Grids are used when imaging with a
high kVp; low kVp imaging does not
produce the high percentage of
Compton interactions and does not
require a grid to absorb the scatter
before it reaches the film.
Influencing Factors Affecting
Contrast
• When imaging the body, a
sufficient amount of contrast
improves visibility of tissue within
the body.
• As previously discussed, kVp is the
controlling factor for contrast.
• Other factors that influence
contrast are mAs, SID, filtration,
beam, restriction, grids,
collimation, OID, anatomic part,
subject contrast and processing.
• Kvp –determines the voltage
applied across the tube ---- controls
energy of x-rays-----controls the
penetrability of x-rays -----controls
the quality of x-rays-----controls the
contrast
• mAs (milliAmpere-seconds)
changes the exposure to the image
receptor and density of the images,
thereby affecting contrast (density
differences) mAs = mA x time in
seconds. mA – current, time-
determine the length of time x-rays
are produce.
• When the exposure is changed
sufficiently enough to move the
film density out of the diagnostic
range, whether underexposed or
overexposed, the image contrast is
decreased.
• mAs – milliAmpere-seconds (mA x
time in seconds)
• mA- current
• Seconds – exposure time
SID – Source to Image receptor
Distance
• As the SID changes, the intensity of
the beam also changes.
• The inverse square law governs the
amount of change which will occur.
(The intensity of x-rays is inversely
proportional to the square of the
distance)
• Greater distances from the image
receptor will cause less density on
the image because the intensity of
the beam is diminished, resulting in
decreased contrast.
• Using shorter SID will increase
contrast.
• This occurs because the intensity of
the beam is greater when SID is
closer to the image receptor.
Filtration
• All types of filtration will alter the
image receptor exposure contrast.
( Beam Filtration(inherent and
added filter), Grid
• Filtration acts to absorb the weaker
x-ray photons that produce a more
energetic beam.
• The increased beam energy will
cause more Compton interactions
and scatter radiation, both of which
will decrease contrast.
Grids
• Radiographic grids affect contrast
as a result of their absorption of
the scatter radiation that exits the
patient.
• A grid is placed between the
patient and the image receptor.
• Much of the scatter radiation
exiting patient will not reach the
image receptor when absorbed by
a grid.
• The effect of less scatter, or
unwanted density (fog), on the
image is to increase the
radiographic contrast.
• The more efficient a grid is in
absorbing scatter, the greater its
effect on radiographic contrast.
Collimation – is limiting the size
of the field of x-ray exposure
only to the anatomy of interest
• Changes in the size of the x-ray
field affect the amount of the
tissue irradiated.
• A wider field size (decreased
collimation) irradiates more tissue
and causes more scatter radiation
to be produced.
• The increased amount of scatter
areas that produce less scatter.

radiation reaching the image

receptor results in less radiographic
• In addition, because increased OID
also decreases density, the change
contrast. in contrast may be difficult to

• A smaller field size (more

perceive.

collimation).

• The decreased amount of scatter

radiation reaching the image
receptor results in greater
radiographic contrast.
Object-to-Image Receptor
kVp
Distance
• When sufficient distance between
● A factor that must be considered

the object and image receptor is kilovoltage and how it affects

exists, an air gap is created, image density.
preventing the scatter radiation
reaching the image receptor is
reduced, the radiographic contrast
● Kilovoltage controls the energy of
the x-ray photons, and when the
is increased.
kVp is increased, the quality of the

• The exact amount of object-to-

image receptor distance (OID)
needed to increase contrast has
not been specified.
beam is increased and the x-ray
photons are able to penetrate the
tissue of interest.
● Increasing kVp also increases the

• The amount of OID required to

increase contrast depends, in part,
on the percentage of scatter
radiation exiting the patient.
amount of scatter radiation
reaching the image receptor,
thereby adding density to the
image.

• For anatomic areas that produce a ● An experienced radiographer

high percentage of scatter will be able to determine if the
radiation, less OID is needed to image requires a change in mAs
increase contrast than for anatomic
or kVp to produce optimum
 density.
●
● The general rule that is used is
the 15% rule.

● The 15% rule states that a 15%

decrease will halve the mAs on
the image.

● This rule can be used for the

following problem.

● 72 kvp @ 5mAs excessive density

● Repeat radiograph kVp 61 @ 5

mAs –optimum density

● When using kVp to add to the

image, one must be careful
because the additional kVp will
add density in the form of
scatter radiation.

● Scatter radiation will change the

contrast on the image, which
will increase the gray scale and
may be detrimental to the image.

● A skilled radiographer will be

able to distinguish the
appropriate factor to use to
make the desirable change in
exposure on an image while
maintaining density and gray
scale.