RADIOGRAPHIC EXPOSURE FACTORS The X Ray quality film depends on various factors, as following: Kv / Kvp Potential difference between

film and anode The energy (you can consider this the penetrating power) of the x-ray beam is controlled by the voltage adjustment. This control usually is labelled in keV (thousand electron volts) and sometimes the level is referred to as kVp (kilovoltage potential). Do not be confused by the different terminology, just remember there is a control by which the difference in potential between the cathode and anode can be controlled. The higher the voltage setting, the more energetic will be the beam of x-ray. A more penetrating beam will result in a lower contrast radiograph than one made with an x-ray beam having less penetrating power. It is probably obvious that the more energetic the beam, the less effect different levels of tissue density will have in attenuating that beam. The generator waveform if is not constant potential (medium frequency etc) will affect the effective Kv. mA Tube Current The second control of the output of the x-ray tube is called the mA (milliamperage) control. This control determines how much current is allowed to flow through the filament which is the cathode side of the tube. If more current (and therefore more heating) is allowed to pass through the filament, more electrons will be available in the "space charge" for acceleration to the target and this will result in a greater flux of photons when the high voltage circuit is energized. The effect of the mA circuit is quite linear. If you want to double the number of "x" photons produced by the tube, you can do that by simply doubling the mA. Changing the number of photons produced will affect the blackness of the film but will not affect the film contrast. S Time The third control of the x-ray tube which is used for medical imaging is the exposure timer. This is usually denoted as an "S" (exposure time in seconds) and is combined with the mA control. The combined function is usually referred to as mAs or milliampere seconds so, if you wanted to give an exposure using 10 milliampere seconds you could use a 10 mA current with a 1.0 second exposure or a 20 mA current for a 0.5 second exposure or any combination of the two which would result in the number 10. Both of these factors and their combination affect the film in a linear way. That is, if you want to double film blackness you could just double the mAs. The X-Ray beam The x-ray beam has two main properties you need to understand. 1) Beam QUALITY is the ability of the beam to penetrate an object, its all about the penetrating power of the x-ray photons, this is controlled by the KV control. 2) Beam INTENSITY this is the number of x-ray photons in the beam and is principally controlled by the mAS But note as you increase the KV not only does the QUALITY harden (more penetrating) but you do actually get more photons so INTENSITY increases too. Putting it all together the exposure Any radiographic subject has a minimum Kv required for

the x-ray photons penetrate the most dense part of the subject, the most radiographicaly dense part of the subject will depend upon what the part is chemicaly composed of (Atomic number) and its thickness (remember linear attenuation coefficients and HVL!?) The thicker the subject the more absorption of x-rays so the thicker the part the more mAS you require. In theory the more Kv you use the less the contrast of the image will have. However in practice film screen / processing conditions affect contrast much more In practice it is not as simple as this as scatter is produced which is not image forming but adds density to the film and needs to be controlled, if you remember all those complex diagrams about interactions of x-rays with matter you will realise the amount and direction of scatter depends on the Kv and the material absorbing the x-rays. A few myths Changing the Kv by 2 or 3 makes almost no perceptable image change! Adding 10 Kv does not double the image density Exposure factors are an exact science ! (the image you produce must satisfy the radiologist who interprets the image - not all radiologists like the same penetration / density / contrast for the same body part) Image Contrast Here, we need to spend a little more time discussing the issue of radiographic contrast. This is an important concept because image contrast plays a critical part in the interpreter's ability to detect abnormalities which are only slightly different from the density of the surrounding material. It is not possible to say what is the optimal contrast (or the optimal radiographic technique) for all situations. Different body parts have different inherent tissue contrast. This can be illustrated by using the extreme examples of the chest and the breast. In the chest, there is good inherent tissue contrast with densities ranging all the way from bone at the high end to air at the low end. On the other hand, the breast is inherently very low in tissue contrast only containing structures which are water density (glandular material or tumor) or fat density. For the moment, we will disregard small calcifications which are really not normal structures. Because of this difference in inherent tissue contrast, we would be likely to use a very low contrast radiographic technique for the chest because we have good tissue contrast. Conversely we would be likely to use a very high contrast technique for the breast because the breast has minimal, inherent tissue contrast. Remember, image contrast is controlled by the energy of the "x" photon beam. Therefore, high kV techniques result in low contrast images (the assumption is always made that the image will have approximately the same average film density so if kV is increased, there must be a compensation in mAs to keep film density constant). To increase image contrast in situations where there is low tissue contrast, a low kV, high mAs technique should be used. This is obvious for mammography but you should also remember this possibility for other special situations such as looking for low-density foreign bodies embedded in soft tissue. To improve film contrast for mammograms we would need to use a very low energy x-ray beam.

Mammograms are frequently done with beams in the 25 keV range. For the chest x-ray, we would like to use a low contrast technique which requires a relatively high-energy beam. Chest x-rays are frequently done with beam energies above 100 keV. You should understand that for similar film densities, the high KV technique usually results in lower patient radiation exposure. Think about this long enough to clearly understand why less radiation is absorbed in the patient when a high-energy beam is used. The Kv is too low the femoral condyle is under pentrated you cannot see the bone trabecualr patterns. the contrast is too high to demonstrate all the soft tissues. Much better the all the subject is penetrated and all the soft tissues are visible Too much mAs Too Little mAs A good chest image the mediastinum is pentrated the image is exposed well demonstrating the bones and soft tissues. Under penetrated