Chapter 7

Radiographic Imaging
 Objectives (1 of 2)
Discuss primary, scatter, and
remnant radiation.
Describe the fundamentals of
image production.
Describe the two major categories
of image receptor systems used
today in radiography.
 Objectives (2 of 2)
Compare and contrast the latent
image formation process for
computed radiography systems, and
indirect and direct conversion digital
radiography.
Discuss image quality in terms of
image receptor exposure (signal
value), contrast (signal differences),
spatial resolution, and contrast
resolution.
Describe fluoroscopic imaging.
Image Production Process
X-rays were discovered in 1895.
November 8th.
X-ray beam energy is produced using
high-voltage electricity. KVP
X-rays pass through matter and strike
an image receptor (IR).
IR converts the energy of X-rays into an
electronic data set of signal values.
Computer processing converts signal
values into a viewable image.
X-Ray Production Requirements
X-ray tube with a vacuum inside.
Source of electrons.
Cathode filament (has temperature.)
Method to accelerate electrons to great
speed.
Voltage
Method to stop electrons and cause
energy transformation.
Target. X-ray is produced in the anode side.
Time allows this process to happen.
 Classes of Radiation
Primary
radiation
See Figure 7.1 in the
textbook for more
Scatter radiation information

Absorbed
radiation
Remnant
radiation
 Attenuation of Radiation
Attenuation is the loss of radiation energy
as a result of passing through an absorbing
material, such as the human body.
Different materials absorb radiation energy
differently based primarily upon density
and atomic number.
Differential absorption
The degree of attenuation can be high or
low.
High attenuation occurs in radiopaque(white)
matter.
Low attenuation occurs in radiolucent(black)
matter.
 Differential Attenuation
High attenuation
materials are
considered
See Figure 7.10 A in
radiopaque. the textbook for more
information
Low attenuation
materials are
considered
radiolucent.
 Technical Exposure Factors
Milliamperage (mA)(current) Sets the
temperature of the filament. (Less MA:
less heat, less electrons, less emission,
less amount.) and time (seconds)
mAs
Kilovoltage peak (kVp)
Source-to-image receptor distance (SID)
These factors are often referred to as the
prime factors of exposure technique.
 Image Receptor Systems
Computed radiography (CR):
Known by its technology
photostimulable phosphor (PSP) technology
storage phosphor technology
Direct Conversion DR.
Amorphous Selenium (aSe)
Indirect Conversion DR.
Amorphous Silicon (aSi)
These systems generally require no
modifications to standard radiographic
system.
Image Receptor Systems

See Figure 7.2 in the textbook for

more information

Each system produces an electronic data set of charge

values.
SIGNAL
Computed Radiography (CR)
Photostimulable storage phosphor (PSP)
technology.
Can be used with any X-ray system.
Enables an affordable transition from
film/screen to digital imaging.
System components:
CR cassette with imaging plate (IP)
Plate is reusable for thousands of exposures
CR Reader
Image Review Display Monitor
 Computed Radiography and
Exposure
Radiation exposure to
plate is stored in
barium fluorohalide
crystals that create
electron “traps.” See Figure 7.7 in
f-centers the textbook for
Requires the optimum more information
combination of mAs,
kVp, and SID for
optimum image quality.
Underexposure will
produce an image that
is “grainy” or noisy due
to quantum mottle.
 CR Technology
Exposed IP in cassette is
placed in a reader for
electronic processing of
the latent image into a
displayed manifest
image. See Figure 7.3 in the
IP scanned by laser textbook for more
information
beam to release energy
stored in f-centers.
Ultimately creates a
digital image through
computer software.
Multi-plate CR
reader
 Digital Radiography (DR)
Uses solid state electronics and thin-film
transistor (TFT) technology.
Detector permanently encased in rigid
cassette.
Referred to as “flat panel detector” (FPD)
Radiation exposure to detector creates an
electronic signal proportional to exposure.
No reader required.
Image display in seconds.
Two (2) classes of DR technology:
Indirect
Direct
DR Detector Operation (1 of 2)
Exposure to detector
element (DEL)
creates a stored
electronic charge.
See Figure 7.5
Charge values are in the
analog and directly textbook for
proportional to more
information
exposure.
Analog signal
converted to a
binary, digital value
for processing.
DR Detector Operation (2 of 2)
Digital signal
analyzed by
computer to create See Figure 7.6 in
a histogram. the textbook for
Histogram is more information

rescaled to
optimize
appearance.
Look-Up-Tables
apply correct
brightness and
contrast to image
 Indirect DR
Indirect DR systems use a scintillator
material to capture energy of the remnant
X-ray beam.
Scintillator emits light proportional to
exposure.
Light captured and converted to
electronic signal.
Two methods of signal capture:
Charge-Coupled Device (CCD)
Thin-Film Transistor (TFT)
Thin-film transistor(TFT) layer is
amorphous silicon (a-Si). Output is digital.
 Direct DR
Direct DR systems do
not have a
scintillating layer.
See Figure 7.4
Remnant X-ray beam in the
energy acts directly textbook for
with the TFT layer to more
create electronic information
charge.
TFT layer is
amorphous selenium
(a-Se).
Output from TFT layer
is in digital format.
Radiographic Image Quality

Image SIGNAL Optimum image

quality is a
function of x-ray
exposure and IR
characteristics.
Image
RESOLUTION
Primary Image Quality Factors

SIGNAL value is a
critical factor.
Image Signal See Figure 1.2
Factors: in the
textbook for
IR Exposure more
Contrast information

Image Resolution
Factors: Image Brightness and
Spatial Resolution Contrast Primarily
Controlled by Display
Contrast Resolution Monitor
Image Signal Value (1of 2)
Determined by total x-
ray exposure to IR.
Signal Value is directly
See Figure 7.7 in
proportional to x-ray the textbook for
exposure. more information
Optimum IR exposure
affects the visibility of
resolution (detail).
Sub-optimum exposure
creates quantum
mottle on images. Noisy image
Image noise/mottle impacts the
visibility of detail
 Signal Value Variables
Exposure
mAs
Beam Quality
kVp See Table 7.1
Beam filtration in the
Patient Characteristics textbook for
Tissue thickness more
Tissue composition information
Pathology
Distance
Inverse Square Law
Radiographic Grids
Grid ratio
X-ray Beam Modifications Good signal value is
Dimension the combination of
IR Characteristics these variables being
Fill factor and sensitivity optimized
Milliampere-Seconds (mAs) Is a Primary
Factor of Image Receptor Exposure

mAs represents the quantity of X-ray

production.
Direct relationship
Calculated by simple multiplication of
mA and time (s)

mA x Seconds =
mAs
 mAs
200 × 0.020 = 4 mAs
400 × 0.020 = 8 mAs
400 × 0.040 = 16 mAs
200 × 0.080 = 16 mAs
Regardless of the mA and time combinations,
the same mAs value will yield the same
exposure (mAs reciprocity law).
 Patient Factors
The patient and their tissue
characteristics can greatly affect signal
value.
Subject Density:
Tissue Thickness
Tissue Composition
Contrast material
Pathological Conditions

Signal value and subject density have

an inverse relationship
 Kilovoltage Peak (kVp)
Controls X-ray beam penetration.
Beam quality
Direct relationship to signal value.
Non-linear relationship
X-ray beam is or heterogeneous.
15% rule
Displayed as source-to-image receptor
distance (SID).
X-ray production is similar to a point-light
source.
Behaves according to the laws of light
and intensity as a function of distance.
SID and beam intensity have an inverse
relationship.
Inverse Square Law

I1/I2 = D22/D12
Exposure Maintenance Formula
mAs1/mAs2 = D12/D22

See Figure 7.11 in the textbook for

more information
 Beam Modification
The x-ray beam can be modified before
and after it enters the patient.
Primary beam modification
Scatter control
Beam alterations can improve image
quality and reduce patient dose.
Primary beam modification is of two
types.
Filtration
Beam limitation (collimation)
Modification of remnant radiation is a
scatter control process.
 Beam Filtration
Considered a primary beam modifier.
Filtration material is placed between x-
ray tube and patient.
Removes very low energy x-rays from
beam.
Filtration material may be aluminum or
copper.
Typically in millimeter thicknesses.
Filtration reduces patient absorbed skin
exposure without affecting useful beam
intensity.
 Half-Value Layer (HVL)
Used as a way to express X-ray beam
quality.
HVL takes into account the heterogeneous
makeup of an X-ray beam.
The amount of absorbing material that
will reduce the intensity of the X-ray
beam to half its original value.
Aluminum is most popular HVL filtration
material.
Typically expressed in millimeters of
aluminum equivalency.
mm Al/Eq
 Scatter Radiation
Scatter radiation is produced when x-rays
interact with matter.
Scatter radiation provides very little diagnostic
information to image.
Detracts from image quality if scatter is
excessive.
Reduction in scatter radiation yields a
decrease in IR exposure.
Common methods of scatter control:
Beam restriction
Radiographic grids
Beam filtration
 Radiographic Grids
Placed between patient and IR.
Used to reduce the amount of scatter
radiation reaching the IR.
Intercepts a portion of the remnant
radiation.
Improves image quality by reducing
useless “fog” radiation:
Increases image contrast in some cases
Grids described according to grid ratio
and frequency:
Constructed with lead strips and radiolucent interspace
material
 Radiographic Grids
Grids have specific characteristics:
Grid ratio
Grid frequency
Grid ratio is the relationship between
grid strip height and the distance
between grid strips:
Expressed as a ratio (6:1, 8:1, 10:1)
Grid frequency is the number of grid
strips per inch or centimeter:
85 lines/inch (lpi)
103 lpi
 IR Characteristics
IR’s detect the remnant
radiation from the patient
and convert it into an
electrical signal through
creation of electronic data See Figure 7.5
set. in the textbook
for more
Fill Factor
information
Higher % fill factor yields
increased sensitivity
Sensitivity
DR systems can be set
up to operate at different
system sensitivities
Set by vendor and
typically not adjustable
 IR Exposure Indicators
CR and DR Systems permit the
quantification of radiation exposure to
the IR.
Does NOT represent patient exposure.
Expressed as a numerical value.
Number can be used to assess image
quality in terms of image noise and IR
exposure.
Operator has responsibility to understand
what number means in terms of optimum
exposure and image quality.
 Exposure Indicators
See Table 7.2 in the textbook for
more information

DR system manufacturers calculate exposure

indicator values differently.
Currently no standardized method for
calculation
Exposure Index (EI#)
Increases linearly and proportionally with exposure
Sensitivity # (S#)
Decreases linearly and proportionally with exposure
 Deviation Index (DI#)
Established by
AAPM*
Used to account
for inconsistencies See Table 7.3 in
the textbook for
in exposure more information
indicator
calculation
between vendors.
Compares actual
exposure to
optimum Target
Exposure (EIT) *American Association of Physicists in
Medicine
IR Exposure Considerations
Exposure Latitude
Range of usable exposure levels
Digital receptors have wide range of sensitivities
Dynamic Range
Range of exposure levels IR can detect and use
Data Drop
Loss of detector signal value due to gross
overexposure
Detector Saturation
Loss of image features due to regional data drop of
detector values
Automatic Rescaling
Computer processing of data to account for
variations in exposure extremes to ensure acceptable
image quality
 Automatic Rescaling
Computer software optimizes image
quality by varying the brightness and
contrast of the image on the basis of
the exposure to the receptor.
Too little exposure results in noisy or
grainy images.
Too much exposure technique can
reduce image contrast.
Image Display Parameters
Digitally created images are viewed on
flat screen television monitors.
Images “windowed” to optimize
appearance
Display monitors have pixels with gray
scale depth.
Bit depth
Images can be adjusted in terms of
brightness and contrast.
Window level (WL) controls image
brightness.
Window width (WW) controls contrast.
 Image Contrast (1 of 2)
Due to differences in signal values on
IR.
Converted to varying shades of gray in
histogram.
Optimum contrast enhances visibility of
detail.
High Contrast
Short scale
Narrow window width
Low Contrast
Long scale
Image contrast
Wide windowis due to the shades of gray making up
width
an image.
 Image Contrast (2 of 2)
Subject Contrast
Contrast in data set signal values due to
tissue composition and kVp selection
Raw Image Contrast
Image data contrast prior to processing of
data by computer
Displayed Image Contrast
Difference in gray shades on displayed
image
Determined by adjustable window width
 Subject Contrast
The range of
differences in the
intensity of the x-ray
beam after it has
been attenuated by See Table 7.5
in the textbook
the subject. for more
Similar to raw image information
contrast.
Determined by
degree of differential
absorption.
Affected by several
factors.
 Spatial Resolution
Often referred to as recorded detail,
definition, sharpness.
Described as the sharpness with which
an object’s structural edges are shown
on an image.
Sharpness of detail is also a function of
the visibility of detail.
Affected by image noise and image contrast

Optimum image quality is a balance between spatial

resolution and the visibility of this resolution.
 Spatial Resolution

Controlled by several factors:

Temporal resolution
Exposure time
Dynamic motion of anatomy
Beam geometry
Focal spot size
Distances (SID, OID)
Distortion (shape, size)
Image receptor characteristics
Matrix size
DEL size
Del pitch
Sampling frequency
 Temporal Resolution (TR)
Image sharpness as a function of signal
acquisition time.
Greatly impacted by movement of
patient and/or anatomy during image
acquisition.
Motion distortion
Voluntary
Involuntary
Shorter exposure times generally
produce improved TR.
Radiography uses very short exposure times
in milli-seconds (mS) and provides excellent
temporal resolution
 Beam Geometry
Focal spot size of x-ray tube:
Selectable by operator
Typically two (2) focal spot size selections
Affects size of image penumbra
(loss of sharpness on edges of anatomy)
Distance
Source-Image-Receptor Distance (SID)
Object-Image-Receptor Distance (OID)
Distortion
Size distortion
Shape Distortion
 Focal Spot Size
Reduced by using
the smallest
dimension possible
based upon the X- See Figure 7.12 in the
textbook for more
ray tube information
manufacturer’s
specifications.
Smaller focal spot
yields better image
resolution. Note the smaller
penumbra with a smaller
focal spot
 Distortion
Any
misrepresentation of
the true size or See Figure 7.15
shape of the in the textbook
for more
patient’s anatomy as information
demonstrated on the
radiographic image.
Two types of
distortion:
Size distortion
magnification Magnification can be reduced
with increased SID and
Shape distortion decreased OID
 Shape Distortion
Any misrepresentation
of the true shape of
the patient’s anatomy.
Controlled by See Figure 7.15 in the
textbook for more
alignment of central information
ray, patient’s anatomy,
and IR.
May be deliberate to
deal with
superimposed
anatomical structures.
 Size Distortion
Inverse relationship
between resolution
and SID.
Increased SID See Figure 7.13
yields improved in the textbook
for more
image resolution. information
Increased SID also
lowers patient
entrance skin
exposure (ESE).
 Resolution and OID
Patient anatomy
should be
positioned as See Figure 7.14 in
close to the IR as the textbook for
more information
practical.
Decreased OID
improves spatial
resolution.
Best images
obtained with
small OID and
large SID.
IR Characteristics and Resolution

Digital receptors have inherent design

features that affect spatial resolution.
Determined by several specifications:
DEL size
DEL pitch
Distance between adjacent DELs in array
Sampling frequency
Out of the control of the radiographer.
 Fluoroscopy (1 of 2)
Use of X-rays to create real-time images
of patient anatomy and function.
Requires a radiographic/fluoroscopic
(R/F) X-ray system with fluoroscopic
imaging technology:
Image intensifier
Flat-panel detector (FPD)
Physicians can observe the body’s
physiologic actions and functionality.
 Fluoroscopy (2 of 2)
Images taken during
fluoroscopy are digital
images.
Exposures can be live, See Figure 8.19
in the textbook
fluoroscopic or static for more
spot images. information
Images can be played
back for review and
sent to an archival
system for long-term A digital radiographic/fluoroscopic system with
FPD. With this design, the FPD has replaced the
storage. conventional image intensifier.
 Conclusion
Radiologic and imaging sciences
professionals are responsible for using
the lowest exposure necessary to
achieve optimum image quality.
Various IR systems are used in
radiography and fluoroscopy.
Optimum image quality is obtained
using:
Correct exposure factors
Digital receptor technologies
Recommended X-ray beam geometry
Proper patient positioning