CHAPTER 16

IMAGE QUALITY

Image Quality  The less precise terms used instead of spatial

 The exactness of representation of the resolution & contrast resolution
patient’s anatomy on an image
Visibility of Detail
Three Major Categories of Radiographic Quality  The ability to visualize recorded detail when
 Film Factors, Geometric Factors & Subject image contrast & OD are optimized
Factors
Noise
DEFINITION  The random fluctuation in the OD of the
image
Radiographic/Image Quality  Grainy or uneven appearance of an image
 The fidelity with which the anatomical o Caused: insufficient number of
structure that is imaged on the radiograph primary x-rays
 High-Quality Radiograph: a radiograph that  Uniform signal produced by scattered x-rays
faithfully reproduces structures & tissues  Lower Noise: better radiographic image
 Most Important Characteristics: spatial o Rationale: improves contrast
resolution, contrast resolution, noise & resolution
artifacts  Four Components: film graininess, structure
mottle, quantum mottle & scatter radiation
Resolution
 The ability to image two separate objects & Film Graininess
virtually distinguish one from the other  The distribution in size & space of silver
halide grains in the emulsion
Spatial Resolution  Inherent in the image receptor
 The ability to image small objects that have  Contribute very little to radiographic noise
high subject contrast  Not under control of the RT
o e.g. bone-soft tissue interface, breast
calcification & calcified lung Structure Mottle
 Conventional Radiography: has excellent  The phosphor crystals in the radiographic
spatial resolution intensifying screen
 Inherent in the image receptor
Spatial resolution improves as screen blur  Contribute very little to radiographic noise
decreases, motion blur decreases & geometric  Not under control of the RT
blur decreases!
Quantum Mottle
Contrast Resolution
 The principal contributor to radiographic
 The ability to distinguish anatomical noise
structures of similar subject contrast
 The random nature by which x-rays interact
o e.g. liver-spleen & gray matter-white
with the image receptor
matter
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 Higher Quantum Mottle: if an image is

 Actual Size of Objects Imaged: smaller
produced with just a few x-rays
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under conditions of high contrast than low

o Appearance: mottled or blotchy
contrast
 Lower Quantum Mottle: if an image is
produced from a large number of x-rays
Detail & Recorded Detail
o Appearance: smooth
 The degree of sharpness of structural lines
 Under the control of RT
on a radiograph
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 16
IMAGE QUALITY

Heavily Exposed X-ray Film

The use of high-mAs, low-kVp settings & of  Appearance: black
slower image receptors reduces quantum
mottle! Sensitometry
 The study of the relationship between the
Speed intensity of exposure of film & the
 The sensitivity of x-rays to film blackness after processing
 It influences resolution & noise  Importance: essential for maintaining
adequate quality control
RADIOGRAPHIC QUALITY RULES  Two Principal Measurements:
Speed of Spatial Contrast o The exposure of film
Noise
IR Resolution Resolution o The percentage of light transmitted
Fast High Low Low through the processed film
Slow Low High High o Purpose: to describe the relationship
between OD & radiation exposure
Resolution, noise & speed are interrelated
characteristics of radiographic quality! Characteristic Curve
 Describe the relationship between OD &
radiation exposure
PRINCIPAL FACTORS THAT MAY AFFECT  Other Name: H & D curve (Hurter &
RADIOGRAPHIC QUALITY Driffield)
Geometric Subject  Portions: toe, shoulder & straight-line
Film Factors
Factors Factors  Apparatus Needed To Construct H & D
Characteristic -Distortion Contrast Curve: optical step wedge (sensitometer) &
curve -Magnification -Thickness densitometer
-Density -Blur -Density
-Contrast -Atomic Toe & Shoulder Portion
-Speed Number (Z)  At low & high exposure, large variation in
-Latitude exposure result in only a small change in
Motion OD
Processing
-Time Straight-Line Portion
-Temperature  At intermediate exposure levels, small
changes in exposure result in large changes
FILM FACTORS in OD
 The region in which a properly exposed
Unexposed, Processed X-ray Film radiograph appears
 Appearance: lucent
o Same with a frosted glass Sensitometer
 It easily transmits light but no  Optical step wedge
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images  Fabricated so that the relative intensity of

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light exposure to the film can be determined

Exposed, Processed X-ray Film
 Appearance: quite opaque Densitometer
 Instrument that measures the optical density
Properly Exposed X-ray Film of exposed film
 Appearance: various shades of gray
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 16
IMAGE QUALITY

 It has a light source focused through a o OD Range: 0.1-0.3

pinhole  OD of unexposed film is due
to base density & fog density
Penetrometer o Transmission: 79% (0.1) & 50%
 Aluminum step wedge (0.3)
 An alternative to the sensitometer  Very Low OD: too light to contain an image
 Very High OD: requires a hot light to view
Steps Involved in the Construction of Characteristic the image
Curve
1. First, the film under investigation is exposed Logarithms
– flashed – through the sensitometer  It allow a wide range of values to be
2. The film is processed expressed by small number
3. The processed film is analyzed by
densitometer Base Density
 Light Sensor: position opposite the  The OD that is inherent in the base of the
film film
 Radiographic Film: position o Caused By:
between pinhole & the light sensor  Composition of the base
4. The amount of light transmitted through  The tint (dye) added
each step of the radiographic image is  Value: approximately0.1
measured
5. The data are recorded, analyzed & plotted Fog Density
 Result: a characteristic curve  The development of the silver grains hat
contain no useful information
Log Relative Exposure (LRE) o Caused By:
 Change in optical density over each  Inadvertent exposure of film
exposure interval during storage
 Undesirable chemical
An increment in LRE of 0.3 results from contamination
doubling the radiation exposure!  Improper processing
 Value: not exceed 0.1
Optical Density
 A logarithmic function Higher fog density reduces the contrast of the
 Formula: OD = log10 (lo/li) radiographic image!
 Useful Range: 0.25-2.5 OD
o Highly Dependent On:
 Viewbox illumination Base plus fog OD has a range of
 Viewing conditions approximately 0.1 to 0.3!
 The shape of the
Reciprocity Law
80
characteristic curve
 Most Radiograph: 0.5-1.25 OD  It states that the OD on a radiograph is
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 Radiographic Film proportional only to the total energy

o OD Range: 0-4 (clear-black) imparted to the radiographic film
 High Quality Glass  It holds for direct exposure with x-rays
o OD: 0
 Unexposed & Processed Radiographic Film  It fails for screen-film exposure
o At Exposure Time: <10 ms or >2 s
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 16
IMAGE QUALITY

 Important: for special procedures that Average Gradient

require very short (angiointerventional  The most often used to numerically specify
radiography) or very long (mammography) image receptor contrast
exposure time  The slope of the line drawn between the
 Increasing mAs Setting: if the automatic points on the characteristic curve
exposure control does not compensate for  It corresponds to OD levels 0.25 & 2.-0
reciprocity law failure above base & fog densities
o Useful range of OD on most
Contrast radiographs
 Degree of differences between the light &  Image Receptor Contrast
dark areas of a radiograph o Formula: Average Gradient = (OD2
 High Contrast Radiograph: a radiograph – OD1)/(LRE2 – LRE1)
that has marked difference in OD  Most Range in IR: 2.5-3.5
 Low Contrast Radiograph: a radiograph that
has small & not distinct difference in OD Gradient
 Film-Screen Images: higher contrast than  It also may be identified image receptor
direct exposure images contrast
 The slope of the tangent at any point on the
Radiographic Contrast characteristic curve
 The product of image receptor contrast &
subject contrast Toe Gradient
 More important than average gradient for
Image Receptor Contrast general radiography
 Inherent in the screen-film combination o Rationale: many clinical ODs appear
 Influence By: in the toe region of the characteristic
o Range of ODs curve
o Film processing technique
 Contrast of 1: very low contrast Midgradient/Shoulder Gradient
 Contrast of >1: amplify the subject contrast  More important for mammography
during x-ray examination
 Contrast of 3: show large OD difference H & H Contrast Curve
over a small range of x-ray exposure  Another way to evaluate image receptor
contrast
Subject Contrast  Art Haus & Ed Hendrick
 Determined By:
o Size & shape of the anatomy being Speed
examined  The ability of an image receptor to respond a
o X-ray attenuating characteristics of low x-ray exposure
the anatomy being examined  A measure of film sensitivity
 Formula:
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o The energy (kVp) of the x-ray beam
1
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Film contrast is related to the slope of straight- Speed =

line portion of the characteristic curve! Exposure in roentgens to produce
an OD of 1.0 base + fog
 The reciprocal of the exposure, in Roentgen,
to produce an OD of 1.0 above base plus fog

STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO

 CHAPTER 16
IMAGE QUALITY

 Par Speed IR: 100  Relatively high speed

 High-Speed IR: >100  Low levels of fog
 Detail IR: <100
GEOMETRIC FACTORS
SPEED vs mAs
 Formula: Three Principal Geometric Factors
 Magnification
New IR speed Old mAs
=  Distortion
Old IR speed New mAs  Focal-spot blur
Latitude
 The range of exposure over which the image Magnification
receptor responds with ODs in the  Condition in which the images on the
diagnostically useful range radiograph are larger than the object they
 The margin of error in technical factors represent
 Wider Latitude:  Increased SID:
o mAs can vary more o Results:
o Long gray scale  Reduced magnification
o Low-contrast image  Improved spatial resolution
 Narrow Latitude:  Reduced patient dose
o mAs can vary less
o Short gray scale Magnification Factor
o High-contrast image  Formula:
Image size SID
Latitude and contrast are inversely MF = =
Object size SOD
proportional!
 MF at 100 SID: 1.1
Proper Film Processing  MF at 180 SID: 1.05
 It is required for optimal image contrast
Minimizing Magnification
Factors That May Affect the Finished Radiograph  Large SID: use as large SID distance as
 Concentration of processing chemicals possible
 Degree of chemistry agitation during  Small OID: place the object as close to the
development IR as possible
 Development time
 Development temperature Distortion
 Unequal magnification of different portions
Development Time & Temperature of the same object (shape distortion)
 It changes the shape & position of the  Depends on:
characteristic curve o Object thickness
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 Increased Time & Temperature: increases o Object position

speed & fog o Object shape
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o Result: decreases IR contrast  Thick Objects:

 Recommended Development Time & o Result:
Temperature By the Manufacturer:  Unequal magnification
o Results in:  Greater distortion
 Maximum contrast
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 16
IMAGE QUALITY

If the object plane and the image plane are not The focal-spot blur is small on the anode side
parallel, distortion occurs! and large on the cathode side of the image!

Foreshortening SUBJECT FACTORS

 Reduction in image size
 Increased Angle of Inclination: increases the Subject Factors
reduction in image size  Subject contrast
 Patient thickness
Elongation  Tissue mass density
 Image that is made to appear longer than it  Effective atomic number
really is  Object shape
 Caused: inclined object is not located on the  Kilovolt peak
central x-ray beam
Radiographic Contrast
Spatial Distortion  The contrast of a radiograph viewed on an
 The misinterpretation in the image of the illuminator
actual spatial relationships among objects  A function of IR contrast & subject contrast
 Caused: objects of the same size are  Formula: Radiographic Contrast = IR
positioned at different distances from the IR contrast x Subject Contrast

Focal-Spot Blur Subject Contrast

 Blurred region on the radiograph over which  Component of radiographic contrast
the radiologic technologist has little control  Determined by:
 Caused by: effective size of the focal spot o Size & shape of the subject
 The most important factor for determining o X-ray attenuating characteristics of
spatial resolution the subject
 Minimized: o Energy of the x-ray beam
o Use of small focal spot size
o Use of Short OID Patient Thickness
 Smaller OID: small focal-spot blur  Thick Body Section: attenuates a greater
 Formula: number of x-rays
OID  Thin Body Section: transmits a greater
Focal Spot blur = (Effective Focal Spot) number of x-rays
SOD
 The degree of subject contrast is directly
proportional to the relative number of x-rays
Focal-spot blur occurs because the focal spot leaving the sections of the body
is not a point!
Tissue Mass Density
83
Heel Effect  An important factor that affects subject
 Image toward the cathode side of a contrast
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radiograph have higher degree of blur &

poorer spatial resolution than those to the Effective Atomic Number
anode side  Compton interactions are independent of
 Smaller effective focal spot on the anode atomic number (Z)
and larger on the cathode side

STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO

 CHAPTER 16
IMAGE QUALITY

 Photoelectric interactions vary in proportion  Voluntary Motion: controlled by

to the cube of atomic number (Z3) immobilization
 Very High Subject Contrast: when the  Involuntary Motion: controlled by short
effective Z of adjacent tissue is very much exposure time
different  Low Ripple Power & High-Speed IR:
eliminate motion as a common clinical
Object Shape problem
 Maximum Subject Contrast: a structure that
has a form that coincides with the x-ray Procedures for Reducing Motion Blur
beam  Use the short possible exposure time
 Restrict patient motion by providing
Absorption Blur instruction or using a restraining device
 A characteristic of the subject that affects  Use a large SID
subject contrast  Use a small OID
 It reduces spatial resolution & contrast
resolution TOOLS FOR IMPROVED RADIOGRAPHIC
QUALITY
Kilovolt Peak
 The most important influence on subject Tools to Produced High-Quality Radiograph
contrast  Proper Patient Positioning
 Low kVp:  Selection of proper imaging devices
o High subject contrast  Proper radiographic technique
o Short gray scale contrast
o Black & white Patient Positioning
o Few shades of gray  Anatomical structure under investigation
o Narrow latitude should be placed as close to the IR
 High kVp:  Axis of the structure should lie parallel to
o Low subject contrast the plane of IR
o Long gray scale contrast  Central ray should be incident on the center
o More shades of gray of the structure
o Wide latitude  Patient must be immobilized effectively to
minimize motion blur
Two Major Disadvantages of Low-kVp Technique
 Multiple structures to be image must be
 The x-ray beam becomes less penetrating, positioned at the same distance from the IR
requiring a higher mAs to produce an
acceptable range of ODs Image Receptors
o Result: higher patient dose
 Fine-Detail Screen-Film Combination:
 Low subject contrast allows for wide extremity & soft tissue radiographs
latitude in exposure factors. Optimization of
84
radiographic technique by mAs selection is Principles To Be Considered When Planning A
not so critical when high kVp is used Particular Examination
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 Use of intensifying screen decreases patient

Motion Blur dose by a factor 20
 Blurring of an image that results from  Increased IR Speed:
movement of the patient or the x-ray tube o Increases radiographic noise
during exposure o Decreases spatial resolution
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 16
IMAGE QUALITY

 Low Contrast Imaging Procedure:  Reduced radiographic

o Wider latitude or margin of error in contrast
producing a radiograph  Rationale: H & D
curve has flattened
Selection of Technique Factors  Too High mAs
 Keep exposure time as short as possible o Results:
o Result: improved image quality  High OD
 Rationale: reduced motion  Reduced radiographic
blur contrast
 Generators: three-phase & high frequency
o Shorter exposure time is possible Filtration
 Increased Filtration
Kilovoltage Peak (kVp) o Results:
 The primary control of radiographic contrast  Reduced beam intensity
 Increased kVp  Enhanced beam quality
o Results:
 Enhanced quantity & quality Source-to-Image receptor Distance (SID)
 Increased relative Compton  Increased SID
interactions o Results:
 Results: less  Decreased OD
differential absorption  No change in contrast
& reduced subject
contrast
 Greater scatter radiation
 Result: higher
radiographic noise
o Principal Advantages:
 Reduced patient dose
 Wide exposure latitude
o Principal Disadvantage:
 Loss of contrast
 Low Radiographic Contrast
o Results:
 High latitude
 Increased margin of error

Milliampere-Second (mAs)
 The primary control of OD
 Increased mAs
o Results:
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 Increased radiation quantity

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 Higher OD
 Lower radiographic noise
 Higher patient dose
 Too Low mAs
o Results:
 Low OD
STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO
 CHAPTER 16
IMAGE QUALITY

PRINCIPAL FACTORS THAT MAY AFFECT THE MAKING OF A RADIOGRAPH

Focal
Patient Radiographic Motion Absorption Optical
Increase in Spot Contrast
Dose Magnification Blur Blur Density
Blur
Film Speed - 0 0 - 0 + 0
Screen Speed - 0 0 - 0 + 0
Grid Ratio + 0 0 0 0 - +
Processing
0 0 0 0 0 + -
Time/Temperature
Patient Thickness + + + + + - -
Field Size + 0 0 0 0 + -
Use of Contrast
0 0 0 0 0 - +
Media
Focal-Spot Size 0 0 + 0 0 0 0
SID - - - - 0 - 0
OID 0 + + + 0 0 +
Screen-Film
0 0 0 0 0 0 -
Contact
mAs + 0 0 0 0 + + or -
Time + 0 0 + 0 + + or -
Voltage + 0 0 0 0 + -
Voltage Ripple + 0 0 + 0 - +
Total Filtration - 0 0 0 0 - +

86
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STEWART C. BUSHONG SUMMARIZED BY: MEYNARD Y. CASTRO