RADIOGRAPHIC TECHNIQUE

BY:JOYCE MARGARETH E. COSTALES

OBJECTIVES

 After the end of the discussion, the student should be able to:
 Define radiographic technique.
 Discuss milliampere second (mAs) and kilovolt peak (kVp) in relation to x-ray beam
quantity and quality.
 Describe characteristics of the imaging system that affect x-ray beam quantity and
quality.
 List the four patient factors and explain their effects on radiographic technique.
 Identify four image-quality factors and explain how they influence the characteristics of
a radiograph.
RADIOGRAPHIC TECHNIQUE

 Generally described as the combination of settings selected on the

control panel of the x-ray machine to produce a desired effect on
the radiograph. The geometry and position of the x-ray tube, the
patient, and the image receptor are included in this description.
 May be described by identifying three groups of factors. The first
group includes the exposure technique factors, the second group
include patient factors, and the third group consists of the image
quality factors.
EXPOSURE FACTORS(PRIME EXPOSURE FACTORS)

 Proper exposure of a patient to x-radiation is necessary to produce a diagnostic radiograph.

 The factors that influence and determine the quantity and quality of x-radiation to which the
patient is exposed.
 The four prime exposure factors are kilovolt peak (kVp), current (mA), exposure time (s),
and sourceto-image receptor distance (SID). Of these, the most important are kVp and mAs,
the factors principally responsible for x-ray quality and quantity. Focal-spot size, distance, and
filtration are secondary factors that may require manipulation for particular examinations.
 All of these factors, except those fixed by the design of the x-ray imaging system, are under
the control of the radiologic technologist. For example, focal-spot size is limited to two
selections. Sometimes the added x-ray beam filtration is fixed. The high-voltage generator
provides characteristic voltage ripple that cannot be changed.
KILOVOLT PEAK

 Has more effect than any other factor on image receptor exposure because it affects
beam quality and, to a lesser degree, influences beam quantity.
 With increasing kVp, more x-rays are emitted, and they have higher energy and
greater penetrability. Unfortunately, because they have higher energy, they also
interact more by Compton effect and produce more scatter radiation, which results
in reduced image contrast.
 The kVp selected helps to determines the number of x-rays in the image-forming
beam, and hence the resulting average optical density (OD).
 Finally, and perhaps most important, the kVp controls the scale of contrast on the
finished radiograph because as kVp increases, less differential absorption occurs.
Therefore, high kVp results in reduced image contrast.
MILLIAMPERES

 The mA selected determines the number of x-rays produced and therefore the
radiation quantity.
 As more electrons flow through the x-ray tube, more x-rays are produced.
 A change in mA does not change the kinetic energy of electrons flowing from
cathode to anode. It simply changes the number of electrons. Consequently, the
energy of the x-rays produced is not changed; only the number is changed.
 Often, x-ray imaging systems are identified by the maximum x-ray tube current
possible. Inexpensive radiographic imaging systems designed for private physicians’
offices normally have a maximum capacity of 600 mA. Interventional radiology
imaging systems may have a capacity of 1500 mA.
 EXPOSURE TIME

 Radiographic exposure times usually are kept as short as possible. The purpose is not to
minimize patient radiation dose but rather to minimize motion blur that can occur because
of patient motion.
 Producing a diagnostic image requires a certain radiation exposure of the image receptor.
Therefore, when exposure time is reduced, the mA must be increased proportionately to
provide the required x-ray intensity.
 An easy way to identify an x-ray imaging system as single phase, three phase, or high
frequency is to note the shortest exposure time possible. Single-phase imaging systems
cannot produce an exposure time less than 1/2 cycle or its equivalent 8 ms (10 ms on 50-Hz
generators). Three-phase and high-frequency generators normally can provide an exposure as
short as 1 ms. mA and exposure time (in seconds) are usually combined and used as mAs.
Indeed, many x-ray consoles do not allow the separate selection of mA and exposure time
and permit only mAs selection.
EXPOSURE TIME

 Although the radiologic technologist may be required to select an

exposure time, it is always selected with consideration of the mA station.
The important parameter is the product of the exposure time and tube
current.
 The mAs value determines the number of x-rays in the primary beam;
therefore, it principally controls radiation quantity in the same way that
mA and exposure time, taken separately, do; it does not influence
radiation quality. The mAs setting is the key factor in the control of OD
on the radiograph.
DISTANCE
 Affects exposure of the image receptor according to the inverse square law.
 The SID largely determines the intensity of the x-ray beam at the image receptor.
 When preparing to make a radiographic exposure, the radiologic technologist selects
specific settings for each of the factors described: kVp, mAs, and SID. The control
panel selections are based on an evaluation of the patient, the thickness of the
anatomical part, and the type of accessories used. Standard SIDs have been in use for
many years. For tabletop radiography, 100 cm is common, but dedicated chest
examination usually is conducted at 180 cm. Tabletop radiography at 120 cm and
chest radiography at 300 cm are now often used. The use of a longer SID results in
less magnification, less focal spot blur, and improved spatial resolution. However, more
mAs must be used because of the effects of the direct square law.
FOCAL-SPOT SIZE
 Most x-ray tubes are equipped with two focal-spot sizes. On the operating console, these usually are
identifiedassmallandlarge,0.5 mm/1.0 mm,0.6 mm/1.2 mm, or 1.0 mm/2.0 mm. X-ray tubes used in
interventional radiology procedures or magnification radiography may have 0.3 mm/1.0 mm focal
spots.
 Mammography x-ray tubes have 0.1 mm/0.3 mm focal spots. These are called microfocus tubes and are
designed specifically for imaging very small microcalcifications at relatively short SIDs.
 For general imaging, the large focal spot is used. This ensures that sufficient mAs can be used to image
thick or dense body parts. The large focal spot also provides for a shorter exposure time, which
minimizes motion blur. One difference between large and small focal spots is the capacity to produce
x-rays.
 Many more x-rays can be produced with the large focal spot because anode heat capacity is higher.
With the small focal spot, electron interaction occurs over a much smaller area of the anode, and the
resulting heat limits the capacity of x-ray production.
FOCAL-SPOT SIZE

 A small focal spot is reserved for fine-detail radiography, in which the

quantity of x-rays is relatively low.
 Small focal spots are always used for magnification radiography. These are
normally used during extremity radiography and in examination of other
thin body parts in which higher x-ray quantity is not necessary
FILTRATION
 Removal of low-energy x-rays from the useful beam with
aluminum or another metal.
 It results in increased beam quality and reduced
patient dose.
 Three types of x-ray filtration are used: inherent, added,
and compensating.
 All x-ray beams are affected by the inherent filtration
properties of the glass or metal envelope of the x-ray tube.
 For general-purpose tubes, the value of inherent filtration is
approximately 0.5 mm Al equivalent.
 FILTRATION

 The variable-aperture light-localizing

collimator usually provides an additional 1.0
mm Al equivalent. Most of this is attributable
to the reflective surface of the mirror of the
collimator.
 To meet the required total filtration of 2.5
mm Al, an additional 1-mm Al filter is inserted
between the x-ray tube housing and the
collimator. The radiologic technologist has no
control over these sources of filtration but
may control stages of added filtration.
 FILTRATION
 Some x-ray imaging systems have selectable added filtration.
 Usually, the imaging system is placed into service with the lowest allowable added filtration. Radiographic
technique charts usually are formulated at the lowest filtration position.
 If a higher filter position is used, a radiographic technique chart must be developed at that position.
 Under normal conditions, it is unnecessary to change the filtration.
 Some facilities may be set for higher filtration during examinations of tissue with high subject contrast,
such as the extremities, joints, and chest. When properly used, higher filtration for these examinations
results in lower patient radiation dose.
 When added filtration is changed, be sure to return it to its normal position before beginning the next
examination.
 As added filtration is increased, the result is increased x-ray beam quality and penetrability. The result on
the image is the same as that for increased kVp, that is, more scatter radiation and reduced image
contrast.
COMPENSATING FILTERS
 Are shapes of aluminum but plastic materials
also can be used that are mounted onto a
transparent panel that slides in grooves
beneath the collimator.
 These filters balance the intensity of the x-
ray beam so as to deliver a more uniform
exposure to the image receptor.
 They may be shaped like a wedge for
examination of the spine or like a trough or
bilateral wedge filter for chest examination.
COMPENSATING FILTERS
 Special “bow-tie”–shaped filters are used with computed tomography imaging systems to compensate
for the shape of the head or body.

 Conic filters, either concave or convex, find application in digital fluoroscopy, in which the image
receptor, the image intensifier tube, is round.
COMPENSATING FILTERS

 A step-wedge filter is an adaptation of the wedge

filter . It is used in some interventional radiology
procedures, usually when long sections of the
anatomy are imaged with the use of two or three
separate image receptors.
 A common application of a step-wedge filter
involves a three-step Al wedge and three 35 × 43-
cm (14 × 17-in) image receptors for translumbar
and femoral arteriography and venography. These
procedures call for careful selection of
radiographic technique.
COMPENSATING FILTERS
HIGH-VOLTAGE GENERATION

 The radiologic technologist cannot select the type of high-voltage generator to be used for a
given examination. That choice is fixed by the type of x-ray imaging system that is used. Still, it
is important to understand.
 How the various high-voltage generators affect radiographic technique and patient dose.
 Three basic types of high-voltage generators are available: single phase, three phase, and high
frequency.
 The radiation quantity and quality produced in the x-ray tube are influenced by the type of
high-voltage generator that is used.
 A half-wave–rectified generator has 100% voltage ripple. During exposure with a half-wave–
rectified generator, x-rays are produced and emitted only half the time. During each negative
half-cycle, no x-rays are emitted.
HIGH-VOLTAGE GENERATION

 A half-wave–rectified generator has 100% voltage ripple. During exposure with a half-
wave–rectified generator, x-rays are produced and emitted only half the time. During
each negative half-cycle, no x-rays are emitted.
 Half-wave rectification is used rarely today. Some mobile and dental x-ray imaging
systems are half-wave rectified. The voltage waveform for full-wave rectification is
identical to that for half-wave rectification except there is no dead time. During
exposure, x-rays are emitted continually as pulses. Consequently, the required
exposure time for full-wave rectification is only half that for half-wave rectification.
 Three-phase power comes in two principal forms: 6 pulse or 12 pulse. The difference
is determined by the manner in which the high-voltage step-up transformer is
engineered.
HIGH-VOLTAGE GENERATION

 The difference between the two forms is minor but does cause a detectable change
in x-ray quantity and quality. Three-phase power is more efficient than single-phase
power. More x-rays are produced for a given mAs setting, and the average energy of
those x-rays is higher. The x-radiation emitted is nearly constant rather than pulsed.
 High-frequency generators were developed in the early 1980s and are increasingly
used. The voltage waveform is nearly constant, with less than 1% ripple.
 At present, high-frequency generators are used increasingly with dedicated
mammography systems, computed tomography (CT) systems, and mobile x-ray
imaging systems. It is likely that most high-voltage generators of the future will be of
the high-frequency type regardless of the required power levels.
CHARACTERISTICS OF THE VARIOUS TYPES OF HIGH-VOLTAGE
GENERATORS

EQUIVALENT TECHNIQUE
(kVp/mAs)
Generator Type Percentage Ripple Relative Quantity Chest Abdomen
Half wave 100 100 120/20* 74/40*
Full wave 100 200 120/20 74/40
3 phase, 6 pulse 14 260 115/6 72/34
3 phase, 12 pulse 4 280 115/4 72/30
High frequency <1 300 112/3 70/24

*The milliampere second value equals that for a full-wave generator; exposure time is doubled. kVp, kilovolt peak;
mAs, milliampere seconds.
PATIENT FACTORS

 The patient’s size, shape, and physical condition greatly influence the required
radiographic technique.
 The general size and shape of a patient is called body habitus; four such states have
been described. Sthenic—meaning “strong, active”—patients are average patients.
Hyposthenic patients are thin but healthy appearing; these patients require less
radiographic technique. Hypersthenic patients are big in frame and usually
overweight. Asthenic patients are small, frail, sometimes emaciated, and often elderly.
 Recognition of body habitus is essential to radiographic technique selection. After this
has been established, the thickness and composition of the anatomy being examined
must be determined.
THICKNESS

 The thicker the patient, the more x-radiation is required to penetrate

the patient to expose the image receptor. For this reason, the radiologic
technologist must use calipers to measure the thickness of the anatomy
that is being irradiated.
 Depending on the type of radiographic technique practiced, the mAs
setting or the kVp will be altered as a function of the thickness of the
part.
FIXED KILOVOLT PEAK TECHNIQUE FOR AN ANTEROPOSTERIOR
ABDOMINAL EXAMINATION

kVp 80 80 80 80 80 80 80 80
Patient 16 18 20 22 24 26 28 30
thickness
(cm)
mAs 12 15 22 30 45 60 90 120
VARIABLE KILOVOLT PEAK TECHNIQUE FOR AN
ANTEROPOSTERIOR PELVIS EXAMINATION

mAs 100 100 100 100 100 100 100 100

Patient 15 16 17 18 19 20 21 22
thickness
(cm)
kVp 56 58 60 62 64 66 68 70
COMPOSITION
 Measurement of the thickness of the anatomical part does not release the radiologic technologist
from exercising some additional judgment when selecting a proper radiographic technique. The thorax
and the abdomen may have the same thickness, but the radiographic technique used for each will be
considerably different. The radiologic technologist must estimate the mass density of the anatomical
part and the range of mass densities involved.
 In general, when only soft tissue is being imaged, low kVp and high mAs are used. With an extremity,
however, which consists of soft tissue and bone, low kVp is used because the body part is thin.
 When imaging the chest, the radiologic technologist takes advantage of the high subject contrast. Lung
tissue has very low mass density, the bony structures have high mass density, and the mediastinal
structures have intermediate mass density. Consequently, high kVp and low mAs can be used to good
advantage. This results in an image with satisfactory contrast and low patient radiation dose.
 These various tissues often are described by their degree of radiolucency or radiopacity . Radiolucent
tissue attenuates few x-rays and appears black on the radiograph. Radiopaque tissue absorbs x-rays
and appears white on the radiograph.
RELATIVE DEGREES OF RADIOLUCENCY

Radiographic Body Habitus Tissue Type

Appearance
Radiolucent Black Asthenic Lung
Hyposthenic Fat
Sthenic Muscle
Radiopaque White Hypersthenic Bone
PATHOLOGY

 The type of pathology, its size, and its composition influence radiographic technique.
In this case, the patient examination request form and previous images may be of
some help. The radiologic technologist should not hesitate to seek more information
from the referring physician, the radiologist, or the patient regarding the suspected
pathology.
 Some pathology is destructive, causing the tissue to be more radiolucent. Other
pathology can constructively increase mass density or composition, causing the tissue
to be more radiopaque.
 These changes can have a direct influence on the attenuation of the x-ray beam by
the affected tissue, and ultimately the selection of the technical x-ray exposure
factors.
CLASSIFYING PATHOLOGY

Radiolucent (Destructive) Radiopaque (Constructive)

Active tuberculosis Aortic aneurysm
Atrophy Ascites
Bowel obstruction Atelectasis
Cancer Cirrhosis
Degenerative arthritis Hypertrophy
Emphysema Metastases
Osteoporosis Pleural effusion
Pneumothorax Pneumonia
Sclerosis
IMAGE-QUALITY FACTORS

 Refers to characteristics of the radiographic image; these

include OD, contrast, image detail, and distortion.
 These factors provide a means for the radiologic technologist
to produce, review, and evaluate radiographs. Image-quality
factors are considered the “language” of radiography; often, it is
difficult to separate one factor from another.
OPTICAL DENSITY
 Optical density is the degree of blackening of the finished radiograph. OD has a
numeric value and can be present in varying degrees, from completely black, in which
no light is transmitted through the radiograph, to almost clear.
 Whereas black is numerically equivalent to an OD of 3 or greater, clear is less than
0.2. At an OD of 2, only 1% of viewbox light passes through the film.
 In medical imaging, many problems involve an image being “too dark” or “too light.” A
radiograph that is too dark has a high OD caused by overexposure. This situation
results when too much x-radiation reaches the image receptor. A radiograph that is
too light has been exposed to too little x-radiation, resulting in underexposure and a
low OD.
 Overexposure and underexposure can result in unacceptable image quality, which
may require that the examination be repeated.
RELATIONSHIP OF THE OPTICAL DENSITY OF RADIOGRAPHIC FILM
TO LIGHT TRANSMISSION THROUGH THE FILM
Percent of Light Transmitted Fraction of Light Transmitted Optical Density (log Io/It)
(It/Io × 100) (It/Io)
100 1 0
50 1/2 0.3
32 8/25 0.5
25 1/4 0.6
12.5 1/8 0.9
10 1/10 1
5 1/20 1.3
3.2 4/25 1.5
2.5 1/30 1.6
1.25 1/80 1.9
1 1/100 2
RELATIONSHIP OF THE OPTICAL DENSITY OF RADIOGRAPHIC FILM
TO LIGHT TRANSMISSION THROUGH THE FILM
Percent of Light Transmitted Fraction of Light Transmitted Optical Density (log Io/It)
(It/Io × 100) (It/Io)
0.5 1/200 2.3
0.32 2/625 2.5
0.125 1/800 2.9
0.1 1/1000 3
0.05 1/2000 3.3
0.032 1/3125 3.5
0.01 1/10,000 4
OPTICAL DENSITY

The amount of light transmitted through

a radiograph is determined by the
optical density (OD) of a film. The step-
wedge radiograph shows a
representative range of OD.
OPTICAL DENSITY

A. Overexposed radiograph of the chest is too black to be diagnostic.

B. Likewise, an underexposed chest radiograph is unacceptable because
no detail to the lung fields is apparent. (Courtesy Richard Bayless,
University of Montana.)
CONTRAST

 The function of contrast in the image is to make anatomy more visible.

 Contrast is the difference in OD between adjacent anatomical
structures, or the variation in OD on a radiograph. Contrast, therefore, is
perhaps the most important factor in radiographic quality.
 Contrast on a radiograph is necessary for the outline or border of a
structure to be visible.
 Contrast is the result of differences in attenuation of the x-ray beam as it
passes through various tissues of the body.
DETAIL

 Detail describes the sharpness of appearance of small structures on the

radiograph.
 With adequate detail, even the smallest parts of the anatomy are visible,
and the radiologist can more readily detect tissue abnormalities.
 Sharpness of image detail refers to the structural lines or borders of
tissues in the image and the amount of blur of the image.
DISTORTION

 The fourth image-quality factor is distortion, the misrepresentation of object size and shape on the
radiograph.
 Because of the position of the x-ray tube, the anatomical part, and the image receptor, the final image
may misrepresent the object.
 Poor alignment of the image receptor or the x-ray tube can result in elongation of the image.
Elongation means that the anatomical part of interest appears bigger than normal.
 Poor alignment of the anatomical part may result in foreshortening of the image. Foreshortening
means that the anatomical part appears smaller than normal.
 Distortion can be minimized through proper alignment of the tube, the anatomical part, and the image
receptor. This alignment is fundamentally important for patient positioning.
REFERENCE:

 Bushong, Stewart C. (2012). Radiologic science for technologists : physics,

biology, and protection. St. Louis :Mosby,
 Ritenour, E. R.,Visconti, Paula J., and Sherer, Mary Alice S. (2011).
Radiation Protection in Medical Radiography. St. Louis :Mosby,