IMAGING WITH X RAYS

Sumeera Jadoon
Resident radiology
 OVERVIEW

Image quality
Attenuation of Xrays by patient
Scatter radiation
Radiation grids
 IMAGE QUALITY
It is the overall appearance of image & its fitness for
purpose

 Contrast
 Spatial Resolution
 Noise
 CONTRAST
 It is the difference in density between two areas on the
plain radiographic image. The differences can range from
clear white through shades of grey to black.

 It is the result of differences in attenuation of xray

photons in different tissues of body.
HIGH CONTRAST LOW CONTRAST
A high contrast image has a greater difference between the
grey shades displayed but a smaller range of greys. A low
contrast image has a smaller difference (i.e. it’s more difficult
to make out different areas) but a larger range of greys.
Image A (left) has high contrast  Image B (right) is a low contrast
image
 Subject Contrast
 It is the different amount of exit radiation through
different parts of body.

 The difference in x-ray penetration between different

tissues represents the contrast in the image.

 It occurs because different parts of body have different

attenuation and transmission effects on X-ray beam, a
phenomenon called differential attenuation.
The greatest contrast is found in areas of greatest
difference in density of adjacent structures 
Depends on

 Tissue thickness difference

 Tissue type and atomic number
 Tissue density
 Xray energy(kVP)
 Scatter radiation
 Difference in linear attenuation coefficients b/w tissues.
 Contrast media

 When two different thicknesses of the same material attenuate an x-ray

beam, the thicker part will attenuate more x-rays than the thinner part

A higher atomic number material will attenuate more x-rays than a lower
atomic number material
A higher density material will attenuate more x-rays than a
lower density material.

A higher kVp will make the x-ray beam more penetrating leading to
lower contrast.
 Scattered radiation will increase the image noise and decrease the
radiographic image's contrast.

Linear attenuation coefficient

 It is a constant that describes the fraction of attenuated incident photons

in a monoenergetic beam per unit thickness of a material.
 Higher the density and atomic number of a material, higher is its linear

attenuation coefficient. 
 FILM CONTRAST
Film contrast is inherent property of film. It determines
how the film will respond to different exposures

Depends on
characteristic curve shape
Intensifying screens
Processing
 CHARACTERISTIC CURVE
It is a graphical relationship between log of exposure
and density produced in the film.

Sensitometry is the study of relationship between intensity

of exposure and blackness of the film after processing.
It shows sensitivity of film towards radiation.
 REGION TO LEFT OF TOE
It show optical densities below 0.5 that occur before
exposure ,are not diagnostically useful. It is called basic fog

and show loss of contrast.

REGION BETWEEN TOE & SHOULDER

OD are in range of 0.5 to 2.5 exhibit contrast in diagnostic
range. Straight line of curve show contrast.
 REGION TO RIGHT OF SHOULDER

It has Dmax, at this point increase in exposure not give

increase in optical density but decrease called reversal.

LATTITUDE

Difference between max and min logE that produce useful

density. Lattitude is inversely proportional to contrast.
High contrast Low contrast
On the developed film Ag deposit is seen as black area which
has light stopping effect, degree of blackness varies with
amount of Ag present which in turn increase with increase
in exposure.

Greater blackening of the film shows less light to be

transmitted.
 INTENSIFYING SCREEN

It intensify x-ray photons by producing a larger number of light

photons.

Using intensifying screens results in lower radiation dose to patient but

cause slight blurring of the image.

An intensifying screen is a plastic sheet coated with fluorescent material

called phosphors. Phosphors are materials which convert photon energy to
light.
 FILM PROCESSING AND STORAGE
In conventional radiography film used is photosensitive so

any exposure to visible light produce fog on film. Likewise

film is stored in cool & dry place to avoid fogging.

Increasing film developer time, temperature or

increase chemical concentration increase fog and decrease
contrast.

In digital radiography contrast is enhanced by post

processing digital techniques
 CONTRAST MEDIA
There is low contrast b/w soft tissues so to increase contrast
a chemical substance is used with high atomic number &
density i-e barium(Z=56),iodine(Z=53) or low atomic
number or density such as air, CO2 and NO.

Photoelectric absorption occurs at high atomic number

Barium & iodine are radio-opaque substances which absorb

x ray photons, thus structures appear lighter than
surrounding tissues.

Air or gases are radiolucent contrast media, through which x ray

photons are less absorbes and thus structures appear darker than
surrounding tissues.
Barium is used as contrast agent in Ba swallow, Ba meal, Ba
follow through and Ba enema.

Iodine is used as contrast agent in CT, angiography and

venography, arthrogram and myelogram.

Air is used as contrast agent in double contrast ba enema&

Ct colonography.
SPATIAL RESOLUTION

It is the ability of imaging system to distinguish two closely

spaced objects. It is expressed in terms of spatial frequency
or size of the smallest visible detail

The number of line pairs per unit length is the spatial

frequency. Inverse of no of lines is the size of smallest visible
detail

The larger the spatial frequency, the smaller the objects are
resulting in higher spatial resolution.
The resolution of system is determined by no of bar patterns
that can be seen as separate.

Limiting resolution is the smallest set of line pairs to be

seen or smallest object that can be resolved by system.

 NOISE
It is called quantum mottle. It is a random process due
to fluctuations in the number of photons reaching the
detector from point to point. It occurs due to non uniform
xray photon production.

It represents fluctuations in density & occurs in fluoroscopy.

It is decreased by increasing mAs.

The images appear salt and peppery & grainy.  

Depends on
Quantum mottle: random interaction of xray photons with
image receptor. It is reduced by increasing no of primary
beam x rays.

Structure mottle: size/spacing of phosphors in screen

smaller the better.

Film graininess: depends on size/spacing of silver hyalide

crystals in film emulsion, smaller the better.
SCATTER RADIATION
These are produced when xray photons interact with
human body i-e compton and coherent scattering,
It produces fog on image, which increase density and
reduce the contrast and visibility of detail.

Factors contribute to increase in scatter

Increase thickness of tissue( photons travel more distance in body
resulting in more interactions)
Increase xray beam area
Increase kvp
Decrease air gap
Photoelectric interaction is the most desirable because the photons are traveling
in straight lines and they either stop in the body or continue to the detector.
While Compton scatter leads to a background haze in the detector.
Scatter measured on the detector depends on the distance between body and detector.
This distance is called Air Gap.
SCATTER REDUCTION
reducing beam area
compression of tissues to move overlying tissues
Kvp reduction
Increasing air gap
Grid devices

Beam restriction/ Collimation

It is x ray beam field size reduction to the anatomic region
of interest. It serves two purposes
limit patient exposure
reduce amount of scatter
It is done with beam restricting devices called collimators.
Collimators
xray field size & paient dose
contrast by reducing field size and scatter
An X-Ray Collimator is a device placed close to the X-Ray
Source to restrict the span of the X-Ray beam. It is often made
of lead shutters.


GRID

It is used to reduce scatter and improve image contrast.

It allows majority of primary x-rays to transmit & scattered

x-rays to be absorbed
Grid ratio increase result in increase scattered rays absorption . At high kvp high ratio
grids are used ie 16:1, usually used grids are b/w 8:1-12:1. Width of lead strip is0.06mm,
gap b/w strips is 0.25mm, 8:1 grids are used <90kvp, no of
Strips per cm is called grid frequency, usually in range of 30 to 80 per cm. Higher
frequency grids result in increase patient dose but no significant grid lines.
TYPES OF GRIDS
Stationary grids Moveable grids
unfocused/parallel Single stroke
focused Reciprocating
crossed Oscillating

Parallel grid Focused

grid
MOVING GRIDS
They start moving before exposure and continues to move
after exposure. Motion blurs grid strips.

GRID EFFICIENCY
The ability of grid to remove scatter and improve contrast.
It is measured by
selectivity
grid factor
contrast improvement factor
SELECTIVITY
It measures grid ability to remove scatter than primary radiation.
% of primary radiation transmitted
% of scatter radiation transmitted
Primary radiation transmitted depends on width of
interspace material and allignment. Scatter radiation
transmitted depends on grid ratio.
Heavy grids have high selectivity.

Grid factor is defined as

exposure necessary with grid
exposure necessary without grid
It will increase with increase grid ratio
CONTRAST IMPROVEMENT FACTOR
K = radiographic contrast with grid
radiographic contrast w/o grid
Higher ratio grids have high K value.
Heavy grids have high K value.
High frequency grids have low K value
Entrance Surface Dose
 It is the measure of the radiation dose that is absorbed
by the skin, measured in mGy.

Exit Dose is the radiation dose that emerge from the

patient, measured in microGy.

Absorbed dose is energy absorbed from ionizing radiation

per unit mass. SI unit is Gray(Gy). Conventional unit is rad  
Factors Affecting patient dose
kVp: Increasing kVp result in increase average energy of
beam and penetration result in decrease absorbed dose and
increase exit dose to produce image.

Filtration: Higher added filtration results in lowers skin

dose.

Focal Film Distance: Increase FFD reduces patient dose.

Collimation: reduces irradiated area and scatter radiation.

THANK YOU