Projection radiography Flashcards

1
Q

How is traditional Xray film constructed?

A

Conventional film is layered he active component is an emulsion of radiation-sensitive crystals coated onto a transparent base material. Most film used in radiography has an emulsion layer on each side of the base - double-sided film - so that it can be used with two intensifying screens simultaneously

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2
Q

What is the emulsion in traditional film made from?

A

The emulsion is the active component in which the image is formed and consists of many small, irregularly-shaped silver halide crystals (grains) suspended in gelatin. The gelatin supports, separates, and protects the crystals. The typical emulsion is approximately 10 μm thick.

The silver halide typically used in medical imaging films is silver bromide.

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3
Q

How are traditional xray film images produced?

A

An image on film is created by converting silver ions into metallic silver, which causes each processed grain to become black. This requires two steps

First, the film is exposed to radiation, typically light from an intensifying screen, which activates the emulsion material but produces no visible change. The exposure creates a latent image - an invisible image that is present in the emulsion after exposure and before development

Second, the exposed film is processed in a series of chemical solutions that convert the invisible latent image into an image of developed silver halide crystals that is visible as different shades of grey. The darkness or density of the film increases as the exposure is increased and can be measured in terms of optical density

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4
Q

What happens on an atomic level in traditional film to turn it black?

A

Absorption of light photons by the bromide ions frees the extra electrons which move to and get trapped by the sensitive spot, causing it to become negatively charged. A positive silver ion is attracted to the spot and is neutralised, depositing an atom of black metallic silver. The process is repeated several times (depending on the number of photons that reach the grain) to give several metallic silver atoms – forming the latent image. The developer solution supplies electrons that migrate into the sensitised grains of silver bromide and converts the other silver ions into black metallic silver:

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5
Q

What are the 2 steps in traditional film after exposure?

A

Development
Fixing - Fixing is that part of the photographic process in which the unexposed and unreduced silver halide is removed to render the image stable in white light.

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6
Q

What in the process will effect image quality in traditional film process?

A

The strength and composition of the processing chemicals
The length of time that the film spends in the chemicals
The temperature of the chemicals

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7
Q

What is optical density?

A

The darkness of the film increases as the exposure is increased and this is measured as optical density. Optical density (D) measures film blackening, in terms of the transmission of light.

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8
Q

What is the traditional curve of optical density?

A

Low exposure (toe): It takes several silver atoms to make a crystal developable. At low exposures, is unlikely that crystals will have enough silver atoms, so small increases in exposure produce hardly any change in density (the toe of the curve), resulting in a white image with no contrast

Linear region: At higher exposures, where each crystal is likely to have some silver atoms produced, the probability of producing a developable crystal increases with exposure. This is the useful part of the characteristic curve and it is desirable to expose film within this region. This region has the highest contrast

High exposure (shoulder): At high exposures, nearly all the crystals can be developed, so the optical density reaches a maximum (the shoulder of the curve), resulting in a dark image with no contrast

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9
Q

Why does the characteristic optical density curve never reach zero?

A

Base plus fog
This is the density produced on an unexposed part of a developed film. This is partly due to the density of the film base itself, which is not completely transparent, and partly from the blackening caused by the emulsion.

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10
Q

WHat does film speed refer to?

A

One of the most important characteristics of film is its sensitivity, often referred to as film speed. The sensitivity of a particular film determines the amount of exposure required to produce an image. A film with a high sensitivity requires less exposure than a film with a lower sensitivity

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11
Q

What are the types of contrast on traditional film?

A

Radiation contrast - Also known as subject contrast this is the ratio of radiation intensities transmitted by different tissues or structures. (Change in x in the trad curve)

Radiographic contrast - When an image is produced on a film, the radiographic contrast depends on the subject contrast, and on any amplification introduced by the image production process. It is measured as the difference (not the ratio) between optical densities produced in areas of the film corresponding to different tissues. (change in y on the trad curve)

Gamma - The ratio between radiographic contrast and radiation contrast is called the film gamma (the slope of the curve)

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12
Q

what is the latitude of the plain film characteristic curve?

A

To obtain an image with an adequate range of contrasts, all the film densities must lie in the linear part of the characteristic curve. The latitude is a measure of how much room there is for variation in the exposure.

The film latitude measures the range of exposures that will result in a density within the useful range of film densities (0.25-2). The exposure latitude measures the range of exposure factors (kilovoltage (kV) and milliampere-second (mAs)) that will produce a radiograph with all the densities in the appropriate range

Film screen systems with a wide latitude have poor contrast (small gamma) and vice versa

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13
Q

How do you think the film speed and contrast are affected by the use of small or large grain sizes in the emulsion?

A

Large, uniform grain size results in:
Fast emulsion
Large gamma
Large grains also reduce the spatial resolution, though film unsharpness is rarely a limiting factor.

Variable grain size results in:
Small gamma

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14
Q

A film with a double emulsion:
A. Will have greater density for the same exposure than a single emulsion film
B. Will have improved resolution compared with a single emulsion film
C. Will have increased gamma compared with a single emulsion film
D. Will take longer to develop than a single emulsion film
E. Will have a total optical density of the sum of the individual emulsion densities

A

A. Correct. Both emulsions will be blackened, and their optical densities will add.

B. Incorrect. Resolution will be poorer because of crossover and parallax effects.

C. Correct. Imagine two areas of the film with densities of 0.7 and 0.8 - a difference of 0.1. When the densities of two superimposed emulsions are added they become 1.4 and 1.6 - a difference of 0.2.

D. Incorrect. The two emulsions develop together as the film passes through the processor: there will be no need for extra processing time, though more chemical replenishment may be needed.

E. Correct. Optical densities are superimposed in double-sided film.

It should be noted that this answer assumes that the emulsions on a double-sided film are the same as that on the single-sided one. Single emulsion films may be made with thicker emulsions, reducing the differences between the two types.

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15
Q

A film with a wide exposure latitude:
A. Will have a large gamma
B. Will be faster than one with smaller latitude
C. Will produce a satisfactory image for a wider range of exposure factors than one with smaller latitude
D. Requires automatic exposure control to produce a good image
E. Is particularly suited to high kV techniques

A

A. Incorrect. Latitude and gamma always oppose – a film with large gamma shows a large change in density for a small change in exposure.

B. Incorrect. Speed is independent of latitude – you can have a fast film with great or small latitude.

C. Correct. This is almost the definition of latitude.

D. Incorrect. With a wide latitude film, you are more likely to get a correct exposure, so while you might well use automatic exposure control (AEC), it is certainly not more important than with a high contrast film.

E. Incorrect. Using a high kV will reduce the radiation contrast, so that it is not necessary to have such a wide latitude film.

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16
Q

Base plus fog:
A. Is the optical density of the film base plus the unexposed emulsion
B. Is the optical density of an unprocessed film
C. Is increased at high kV
D. Is increased by storing film for long periods
E. Should be about 0.25

A

A. Correct. This is the definition of base plus fog.

B. Incorrect. Base plus fog is the density of unexposed, processed film.

C. Incorrect. Base plus fog is the density of unexposed film so the kV used for a subsequent exposure is irrelevant. However, it is true that film stored in a room where high kV procedures are taking place is at risk of being accidentally fogged by scattered radiation.

D. Correct. Fog tends to increase with the age of the film.

E. Incorrect. Base plus fog should not produce a density greater than 0.2 – so 0.25 is too high.

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17
Q

Radiographic contrast:
A. Is decreased at higher tube voltage (kV)
B. Is independent of the film exposure
C. Is improved at optical densities greater than 2
D. Is the reciprocal of gamma
E. Between two parts of an image is the ratio of their optical densities

A

A. Correct. Contrast is reduced at higher kV.

B. Incorrect. Contrast varies with the exposure and is described by the characteristic curve. Contrast is greatest in the linear portion of this curve.

C. Incorrect. Densities greater than 2 are towards the shoulder of the characteristic curve where the contrast is smaller.

D. Incorrect. Radiographic contrast is proportional to gamma.

E. Incorrect. The contrast is the difference between densities, not the ratio.

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18
Q

The quality of any image can be expressed using what six descriptors?

A

Contrast
Resolution
Noise
Magnification
Distortion
Artefacts

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19
Q

Define contrast.

A

Contrast is the difference in signal between different parts of an image.

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20
Q

What is subject contrast?

A

Subject contrast is the ratio of the radiation intensities in different parts of an image.

In film screen systems the optical density in the image varies with the log of the exposure. Many digital imaging systems also use a log scale to represent exposure.

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21
Q

if you ignore scatter does overlying tissue change the subject contrast?

A

ignoring scatter then no as the ratio transmitted will still be the same.

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22
Q

How does scatter effect contrast?

A

scatter reduces contrast as the scattered photons do not travel in their original directions, so they strike the image receptor in the wrong place to contribute useful information and apply a ‘fog’ over the whole image thus reducing the ratio between areas.

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23
Q

How does gamma effect image contrast in film screen systems?

A

Using a system with a larger gamma will result in a larger difference in optical densities for the same ratio of radiation intensities.

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24
Q

define noise.

A

The random variation in the signal is called the noise

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25
Q

What is the noise roughly equal to?

A

the square root of the actual number of photons

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26
Q

What is SNR equal to?

A

SNR = N/√N

SNR = √N

SNR will increase with the number of photons - in other words with dose.

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27
Q

Is it possible to reduce noise with amplification?

A

It is not possible to reduce noise by amplifying a signal. You would also amplify the noise so the percentage of noise remains the same

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28
Q

What is quantum mottle?

A

The variation in optical density, or image brightness, that is caused by the variation in the number of
x-ray photons detected, is called quantum mottle.

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29
Q

Does noise effect high or lose dose images more with low contrast?

A

Low dose
Noise reduces the ability to distinguish small levels of contrast.

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30
Q

Does changing the noise always improve image quality?

A

Reducing the noise in an image does not necessarily improve visibility, especially that of high contrast structures.

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31
Q

In order to reduce noise we must increase the number of photons used to form each element of the image. Listed here are a number of ways that this might be done.

A. Increasing the dose used to produce the image, so that more photons reach each part of the image
B. Make the image receptor from a material with a greater attenuation coefficient, so that more of the photons are captured
C. Make the image receptor thicker, so more of the photons are captured
D. Use an image receptor that gives a higher signal per absorbed x-ray photon
E. Use a narrower window when displaying the image, so that the contrast is more easily visualised
F. Use an image receptor that has larger detector elements

A

A. True. Signal to noise ratio depends on the square root of the number of photons forming each part of the image. Signal to noise ratio is increased at the expense of greater patient dose.

B. True. More photons are used, and this will increase the signal to noise ratio. There is no dose penalty.

C. True. More photons are used as above. However, in phosphor-based receptors the greater thickness will allow light to spread out more, increasing the unsharpness.

D. False. The noise will be amplified by the same amount as the signal and there will be no improvement in signal to noise ratio.

E. False. The narrower window will produce greater image contrast. However, changes in image brightness arising from noise will also increase and there will be no improvement in signal to noise ratio.

F. True. The number of photons per detector element will be higher, increasing the signal to noise ratio. However, the spatial resolution will decrease.

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32
Q

What are the main types of unsharpness?

A

Image receptor unsharpness
Geometric unsharpness
Movement unsharpness
Edge unsharpness

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33
Q

How can unsharpness be introduced by the intensifying screens?

A

When an x-ray is absorbed by an intensifying screen, the light produced can spread out before it reaches the film.

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34
Q

How does intensifying screen depth effect introduced unsharpness?

A

A thicker screen, which would make use of more of the x-rays, would allow more spreading of the light.

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35
Q

How might unsharpness be introduced in digital images without intensifying screens?

A

the detector element associated with a given pixel may lie on the border between a light and a dark area, so that the pixel will receive a signal that is an average of the two values.

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36
Q

What does geometric unsharpness introduce to edges in the image?

A

a penumbra - its size is a measure of the unsharpness.

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37
Q

What would happen to the size of the penumbra if the object were moved further away from the image receptor, increasing its magnification?

A

If the object is moved further away, the size of the penumbra is increased.

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38
Q

How large would the penumbra be if the object were placed in direct contact with the image receptor?

A

With the object in direct contact, there would be no penumbra.

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39
Q

what is motion blurring most often caused by?

A

movements such as breathing

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40
Q

Why does edge unsharpness occur?

A

An object might have a sharp edge, but have tapering thickness, so that the attenuation gradually decreases towards the edge. This will produce a gradual change in signal value in the image

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41
Q

What is resolution a measure of?

A

how far two objects must be apart before they can be seen as separate details in the image

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42
Q

How can resolution be measured?

A

It can be measured in line pairs per millimetre (lp/mm) where a line pair can be regarded as a black line and a white line. These line pairs/mm measure spatial frequency.

It can also be measured in units of distance (e.g. mm), the distance indicating how far two objects must be separated in order to be seen as separate. If two objects can be seen as separate, they are said to be resolved.

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43
Q

Does unsharpness effect resolution?

A

Unsharpness affects the resolution of an imaging system.

Each part of an imaging system will have some unsharpness associated with it. For example a film may be capable of showing 20 lp/mm, but intensifying screen unsharpness may reduce the overall resolution to 10 lp/mm, and geometric unsharpness will reduce this further. Even after the sources of unsharpness in the system have been accounted for, movement unsharpness may reduce the resolution in the final image even more.

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44
Q

How can you measure unsharpness mathematically?

A

by looking at how spread out the image of a sharp object becomes as a line spread function.

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45
Q

How is the ability of a system to reproduce spatial frequencies measured?

A

modulation transfer function (MTF)

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46
Q

What happens if there is a spatial frequency higher than the system capability?

A

The consequence is that the system is only able to use part of its range of greyscale or optical density. Although the pattern is seen at the correct spatial frequency, the contrast is much reduced.
If the spatial frequency of the pattern were increased further, the contrast in the image would be reduced further, until it became a uniform grey.

At some stage, the contrast would be too small for the pattern to be discernible.

If there were only small subject contrast in the object, the pattern would become indiscernible much earlier.

Resolution is ultimately limited by contrast. At low contrast, resolution is poorer.

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47
Q

What 2 sources of unsharpness only apply to digital detectors?

A

Detector aperture
The detector aperture is the size of the sensitive area of each detector element. The signal is averaged over this area. Therefore details that are much smaller than the detector aperture are not visible unless they have enough contrast to have a significant effect on the average signal.

Sampling pitch
Sampling pitch is the centre-to-centre distance between individual detector elements. It determines the highest spatial frequency that can be imaged. This is called the Nyquist frequency

48
Q

What is resolution in DR often limited by?

A

Resolution in digital radiography is often limited by the pixel size rather than other sources of unsharpness.

49
Q

What does magnification of an image depend on?

A

the relative distances between focus, image receptor and object

M= detector focus distance/object focus distance

50
Q

What effect does increased magnification have on image receptor unsharpness?

A

The increased magnification will spread the image over a greater area of the image receptor. This means that each detector element has to represent a smaller part of the image and the effect of receptor unsharpness is reduced. The increased geometric unsharpness is, however, usually much more significant than the reduced receptor unsharpness.

51
Q

How can distortion of an object happen?

A

If an object is inclined with respect to the image receptor, it will appear as a different shape

52
Q

What does the degree of x-ray attenuation depend on?

A

The density, atomic number and thickness of the various tissues intercepting each ray in the x-ray beam. Attenuation varies with the effective energy of the x-ray beam.

53
Q

define x-ray photon fluence?

A

X-ray photon fluence is equal to the number of photons per unit area in a defined plane.

54
Q

How is subject contrast defined?

A

Subject contrast is defined by the relative difference in x-ray photon fluence (or intensity) behind the detail, compared to that exiting the background tissue.

55
Q

When are contrasts needed in plain film?

A

he x-ray attenuation properties of certain important anatomical structures and organs are indistinguishable from those of surrounding body tissue. As a result, they do not possess the inherent subject x-ray contrast needed for radiographic imaging.

In this case it is necessary to administer a contrast agent (or contrast medium) to artificially create the necessary subject x-ray contrast.

56
Q

What is the Z and K edge of barium?

A

atomic number [Z = 56] and a k-absorption edge at 37 keV

57
Q

In a Ba meal examination the contrast agent is normally accompanied by a pill or drink which produces carbon dioxide gas. What is the purpose of this?

A

The gas serves to distend the stomach and enhance subject contrast formation.

The Ba contrast agent coats the mucosal lining of the GI tract enabling irregular features and interstices to be visualised in the x-ray image.

Alternatively, the Ba contrast medium can be introduced directly into the rectum, for example to image the colon (in a so-called Ba enema examination).

In a double-contrast Ba enema examination, air is introduced into bowel along with the barium, again to produce distension and to enhance subject contrast.

In a double-contrast medium study, it is the x-ray attenuation differences between Ba versus the carbon dioxide gas, rather than Ba versus soft-tissue which is relevant to subject contrast formation.

58
Q

Why is the maximum kV when using iodine contrast ~70kV?

A

Between 33 and 70 keV iodine is a relatively more powerful attenuator of x-rays than lead.

A peak tube voltage of 60 to 70 kV is often favoured in angiographic examinations to take advantage of the k-absorption edge of iodine.

59
Q

An angiographic contrast agent can enhance subject x-ray contrast via:
A. The k-edge emission effect
B. A relatively high atomic number
C. A relatively low density
D. The k-edge absorption effect

A

A. Incorrect.

B. Correct. Photoelectric absorption increases as the cube of atomic number.

C. Correct. The linear attenuation coefficient is proportional to density.

D. Correct. The attenuation coefficient of a material varies with photon energy and is relatively high at energies just above the k-edge.

60
Q

Which of the following are suitable as x-ray contrast agent for use in vascular imaging?

A. Iodine
B. Carbon monoxide
C. Gadolinium oxysulphide
D. Iodine-based compounds in solution

A

A. Incorrect. Elemental iodine is a solid.

B. Incorrect. Carbon monoxide is potentially toxic. Carbon dioxide may be used as an x-ray contrast agent.

C. Incorrect. Gadolinium oxysulphide is a phosphor used in intensifying screens. Gadolinium DTPA may be used as an x-ray contrast agent.

D. Correct.

61
Q

It has recently been suggested that a suspension of gold (Z = 79) nanoparticles might prove a suitable contrast agent for angiography.

Which of the following conditions apply to such a contrast agent?

A. Linear x-ray attenuation coefficient of gold is very much less than that of tissue
B. Linear x-ray attenuation coefficient of gold is very much greater than that of tissue
C. It would be a positive contrast agent
D. It would be a negative contrast agent

A

A. Incorrect.

B. Correct.

C. Correct.

D. Incorrect.

62
Q

Why is tomography sometimes needed over plain radiography?

A

to provide some information about the depth of objects

63
Q

How is movement blurring used in tomography?

A

Movement of the x-ray source, the film or the patient during the exposure will cause the image to be blurred. This blurring can be used to remove detail at all but a selected depth within a patient as only those structures at the centre of the rotation will not be blurred.

64
Q

Why is rotational tomography not the norm?

A

There is a practical problem to be overcome in moving the x-ray tube and film in that the x-ray beam has to be directed at the film throughout the exposure.

If the tube and film move in a circle, the movement is simple. However, the motion of the film cannot then be accommodated by a conventional x-ray table.

Since tomography examinations are relatively infrequent, tomographic capability is usually an attachment to a standard x-ray set-up.

65
Q

What is cut thickness in tomography?

A

In theory, the section that is not blurred is infinitely thin, but in practice there is a finite thickness over which the blurring is small enough to be tolerated in the image. This is called the cut thickness.

66
Q

How do you select cut height in tomography?

A

raise or lower the x-ray table until the appropriate part of the patient is at the pivot height. This means that you need to know the position of the tissue before you image it.

67
Q

How do you select cut thickness in tomography?

A

changing the angle through which the tube and the film move during the exposure. The greater the angle, the more motion blurring occurs, and the thinner the cut will be.

68
Q

What is the issue with overlying objects in tomography?

A

Although the image of objects far from the pivot is blurred out, these structures still absorb and scatter radiation, and this results in a reduction of contrast.

A grid cannot be used, particularly at the extremes of a linear tomogram, because the beam is directed obliquely towards the film. In order achieve good contrast it is necessary to use a lower tube potential (kV).

69
Q

Why can magnification be a problem in tomography?

A

In order to have sufficient movement of the film, a greater magnification is used than in conventional x-ray imaging.

70
Q

The use of lower kV, magnification and an oblique beam affects the dose received by the patient. How will each of them change the dose?

A

They ALL increase the dose:

The lower kV means that more absorption occurs in the patient, so less reaches the film. The mAs has to be increased to compensate and this increases the patient dose
Greater magnification is the result of an increased patient to film distance. This decreases the radiation dose to the film, so in order to maintain the optical density the mAs has to be increased. This increases the patient dose
The longer path that the x-rays take through the patient means that more absorption takes place. Again, the mAs has to be increased to maintain the optical density

71
Q

Regarding tomography:
A. Tomography requires a lower tube voltage (kV) than a conventional x-ray of the same anatomy
B. Tomography requires the use of a small tube current (mA) compared with a conventional x-ray
C. Tomography requires the use of an anti-scatter grid
D. The duration of the x-ray exposure must be matched to the duration of the tomographic movement

A

A. True. A large part of the exposure is done with an x-ray beam directed obliquely at the film. This means that an anti-scatter grid cannot be used, so a lower kV is used to give better contrast.

B. True. The x-ray exposure is long – a few seconds compared with a fraction of a second used in conventional radiography. Therefore to achieve a similar exposure (mAs), a smaller tube current is required.

C. False. An anti-scatter grid cannot be used as described above.

D. True. If the exposure stops before the movement is complete, the swing angle is reduced, and the cut thickness will be increased. The film may be underexposed. If the exposure continues after the movement stops, part of the exposure will have no motion blurring, and the structures that should be blurred will reappear. The film may be overexposed, and the patient will receive increased radiation dose.

72
Q

Regarding tomography:
A. Tomography requires an x-ray tube with a small focal spot
B. A large swing angle produces a thicker cut (i.e. more tissue in sharp focus)
C. The cut height can be changed by moving the patient couch up or down
D. The radiation dose received by the patient is greater than for conventional radiography of the same area

A

A. False. A small focal spot is used when it is necessary to minimise geometric unsharpness. In tomography, the main form of unsharpness is motion unsharpness, introduced deliberately as part of the imaging process. Use of a small focal spot would make no significant difference to the overall unsharpness in the image.

B. False. Large swing angles produce more motion blurring, and the region that is in sharp focus is reduced – the cut is thinner.

C. True. This is the most common way of achieving the correct cut height.

D. True. The use of lower kV, magnification and an oblique beam all increase the dose received by the patient.

73
Q

Why is the dose needed for film radiography much higher than for screen radiography?

A

The film emulsion is very thin, and nearly all the x-rays pass through it without interacting at all. Therefore most of the x-rays are not used to form the image. In order to get enough x-rays to interact with the film a large exposure is needed and, as a result, the dose to the patient is large.

74
Q

What is the intensification factor of a screen?

A

The exposure required to produce a given optical density without a screen, divided by the exposure needed with the screen

75
Q

What are the Advantages of screens over film alone?

A

the emulsion does not have to be thick to absorb light, so nearly all the light photons can be used. So if we can convert the x-ray photons into light, we have a different way of producing an image.

A screen can absorb 20-40 times more x-rays than film alone
A single x-ray photon can cause the emission of about 1500 light photons
The overall result is that when film is used with a screen, the same optical density can be achieved with smaller exposures than when film is used alone. The reduction factor is between 30 and 300.

76
Q

how does using an intensifying screen effect the gamma of the curve?

A

increases gamma (steeper curve)

77
Q

What properties will make a screen an efficient absorber of x-rays?

A

The screen must provide a large attenuation factor. This means it needs a combination of high linear attenuation coefficient (μ) and large thickness.

High linear attenuation coefficient requires:

High density
A high atomic number (Z)
A favourable K-edge

78
Q

What are the standard materials for intensifying screens?

A

gadolinium oxysulphide and lanthanum oxysulphide

79
Q

Why is lanthanum (Z=57) used over e.g. tungsten (z=74) for intensifier screens?

A

The K-edge for lanthanum is at 39 keV, and the sudden increase in attenuation at this point takes its mass attenuation coefficient above that of tungsten. This remains the case until we reach the K-edge of tungsten at 69 keV.

Although the range from 39 keV to 69 keV is relatively small, it represents a large proportion of the photon energies used in x-ray imaging.

80
Q

What is the conversion efficiency for gadolinium and lanthanum screens?

A

15% and 12%

81
Q

What is the disadvantage of a thicker intensifier screen?

A

When an x-ray is absorbed in the screen, the light it produces spreads out. The further away the source of light is from the film, the more it can spread before it reaches the film. So the increased absorption is at the expense of greater screen unsharpness
The screen does not transmit light perfectly, so light that has to travel a long way through the screen will undergo greater absorption and a smaller proportion will reach the film

82
Q

How can the disadvantages of thicker intensifier screens be overcome?

A

Double-sided film
Double screens- reduce film screen unsharpness compared with a thicker single screen, but they can introduce other problems:
Parallax
Crossover

83
Q

What is parallax?

A

with double sided film - Viewed from perpendicular, the two images line up. Viewed from an oblique angle the two images will not line up perfectly, and this will result in increased unsharpness.

This effect is known as parallax. The most common type of parallax error occurs when a pointer has to be read against a dial, as when reading the time from an analogue clock.

84
Q

What is crossover?

A

Crossover occurs when light produced in one screen is transmitted through the film base to produce an image in the opposite emulsion. The increased spread of the light means greater unsharpness.

85
Q

In order to use a film with a screen, we need to achieve the following:

A

Good contact between the film and screen, to minimise blurring
Exclude extraneous sources of light that will fog the film, while allowing the film and screen to be used in normal lighting conditions

86
Q

What is reciprocity?

A

The idea that The same exposure can be achieved using a large current and short exposure time or a small current and large exposure time.

87
Q

What is reciprocity failure?

A

at very small exposure rates (small tube current, long exposure time), the level of light in the film may be insufficient to produce a latent image. The process of image formation has time to reverse before it is complete. The optical density turns out to be lower than you would predict from the exposure.

88
Q

What is the principal reason for using image intensifier screens?

A

reduce the dose to the patient

The penalty paid for this dose reduction is a reduction in image quality.

Screens introduce additional unsharpness
When the intensification factor is increased this results in an increase in noise (if the conversion efficiency is increased) or poorer resolution (if the screen thickness is increased)

89
Q

Which of the following effects would result from using film with intensifying screens rather than film alone?

A. Reduced radiation dose to the patient
B. Reduced spatial resolution
C. Reduced magnification
D. Reduced contrast

A

A. Correct. Reducing patient dose is the main reason for using intensifying screens.

B. Correct. Intensifying screens introduce unsharpness because the light spreads out before reaching the film, and this reduces spatial resolution.

C. Incorrect. Intensifying screens have no effect on magnification.

D. Incorrect. Images formed using intensifying screens have somewhat higher contrast than those formed with film alone.

90
Q

What are anti-scatter grids made from?

A

The grid is constructed from lead strips, interspersed with a material transparent to x-rays.

91
Q

What are the 2 types of antiscatter grids?

A

parallel and focused

92
Q

What is grid ratio and how does this effect scatter?

A

ratio of the thickness of the grid to the distance between the lead strips

The larger the grid ratio, the smaller the angle of acceptance (θ) and the smaller the proportion of scatter that can pass through the grid.

93
Q

What is grid factor ?

A

The grid factor indicates the increase in exposure, and hence the increase in patient dose, required in order to keep the dose to the image receptor the same as without a grid.

94
Q

How are grid lines removed from the image?

A

In order to prevent visible grid lines, the grid is vibrated back and forth during the exposure, so that the lines are blurred out by the motion.

Such a moving grid was called a Potter-Bucky grid, after its inventors. Over the years, the device has come to be known as a Bucky. If a crossed grid is used, the motion needs to be more complex to avoid grid lines that would not be blurred out by a simple linear vibration.

95
Q

What is the difference between a linear and crossed grid?

A

lead in just one direction - a linear grid
Improved scatter reduction can be achieved by having strips in two directions at right angles - a crossed grid. However, this also removes more of the direct radiation, requiring a greater increase in exposure.

96
Q

What can be the problem with parallel grids?

A

In a parallel grid, all the strips are at right angles to the image receptor. Therefore, towards the edge of the x-ray field, the x-rays are travelling at an angle to the strips and some of the unscattered x-rays are absorbed. This can cause a reduction of optical density or pixel value towards the edge of the field.

97
Q

What can be the problem with a focused grid?

A

In a focused grid, the strips are arranged so they are parallel to the direction of the x-rays all the way across the image receptor.

this can only be achieved for a certain distance between the focal spot and the image receptor. Therefore a focused grid can only be used within quite a narrow range of focus-to-receptor distance (FRD).

98
Q

What are the disadvantages of using an antiscatter grid?

A

In order to maintain the image receptor dose at the level it would have been without the grid, an increased exposure is needed. This results in an increased dose to the patient. This increase can be as great as four times the dose with no grid.

At increased photon energies (higher kV), the proportion of scattered radiation is greater. Therefore, although it is even more necessary to remove scatter, the use of a grid results in a greater dose increase.

99
Q

When might you not want to use an antiscatter grid?

A

In situations where there is less tissue to produce scatter, or where lower tube potential (kV) is used, the effect of scatter may be small enough that the increased dose required by using a grid is not justified. This is often the case in paediatric radiology.

100
Q

How does an air gap between object and detector reduce scatter?

A

More scatter misses the detector

also According to the inverse square law the intensity of the direct radiation depends on the FRD. Scattered radiation originates in the patient so its intensity depends on the patient-to-receptor distance. If the receptor is moved further away, the patient-to-receptor distance increases by a much greater fraction than the FRD and so the intensity of scattered radiation intensity is reduced by a bigger factor.

101
Q

What quantity is measured to estimate dose?

A

The entrance surface dose (ESD) is an easily determined quantity that can be used to calculate other quantities, such as effective dose.

102
Q

What can cause error in converting ESD to effective dose?

A

The ratio of tissue dose to ESD will also depend upon the x-ray field size and on the focus-to-skin distance (FSD). The NRPB has used typical field sizes and focus-to-skin distances, and variations from these will be a source of error in the dose calculation.

Variation of the patient from the standard model is a further source of error.

103
Q

How might the ESD to a patient from an x-ray examination be estimated?

A. Placing a thermoluminescent dose meter (TLD) on the patient during the examination
B. Placing an ionisation chamber on the patient during the x-ray
C. Calculating it from the exposure factors (kV, mAs and FSD)
D. Using the reading from a dose area product (DAP) meter
E. Assuming that the dose is typical for that examination

A

A. Correct. Thermoluminescent dose meters will not normally show up on the image (except in mammography), so you could use one – but you would need to know in advance that you needed to measure the dose.

B. Incorrect. An ionisation chamber would normally interfere with the image, so it is not practicable to use one.

C. Correct. Calculating the dose is straightforward providing you know the x-ray output of the set. You could get this from the results of quality assurance tests or you could measure it retrospectively. Usually you have to guess the FSD from the focus-to-receptor distance (FRD).

D. Correct. The DAP can be used providing you also know the field size. You might be able to tell this from the image.

E. Correct. Sometimes, if no details of the exposure have been recorded, this is the best you can do. The question asked how the dose might be estimated, not calculated exactly.

104
Q

How is effective dose calculated?

A

allocated weighting factors which are used to calculate effective dose and use this multiplied by absorbed dose which is done for all tissues.

Some tissues do not have an allocated weighting factor, and are counted as part of the ‘remainder’. These receive an absorbed dose DR and have a weighting factor WR.

The effective dose from an x-ray exposure will be the sum of all the tissue doses, after each has been multiplied by its weighting factor.

105
Q

What factors determine the ESD?

A

Image receptor dose: the amount of radiation required by the image receptor - the film-screen cassette, the computed radiography (CR) image plate or a direct digital detector. For example, if the receptor requires a dose of 10 μGy, and 2% of the radiation is transmitted through the patient, you would need to deliver an ESD of 500 μGy (0.5 mGy).

Patient factors: the size and shape of the patient, and the projection chosen

Geometric factors: the FRD, FSD and magnification

Radiation quality: this is influenced by tube potential (kV), kV waveform and tube filtration

Absorption of the beam after the patient: the absorption of radiation by materials that are found between the patient and the image receptor - x-ray table tops, anti-scatter grids, image receptor covers

106
Q

T or F

A. For an antero-posterior (AP) abdomen x-ray, an obese patient needs a higher ESD than a slim patient
B. An AP lumbar spine x-ray needs a higher ESD than a lateral lumbar spine x-ray
C. A postero-anterior (PA) chest x-ray needs a higher ESD than an AP abdomen x-ray
D. An AP skull needs a higher ESD than a lateral skull Missed answer
E. An AP lumbar spine needs more ESD than an AP thoracic spine

A

A. True. The radiation will have to pass through more tissue in the obese patient.

B. False. The lower abdomen is bigger laterally than AP. Also, the x-rays for the lateral examination must pass through the pelvic bones.

C. False. The chest contains air in the lungs, so even though the thickness of the chest might be greater than the abdomen, it will absorb less radiation.

D. True. The skull is one part of the body that is bigger PA than laterally.

E. True. In the thoracic spine x-ray, the x-rays pass through the chest, whereas in the lumbar spine x-ray, they pass through the abdomen.

107
Q

How does FSD effect ESD?

A

inverse square law dictates that the beam intensity will fall with distance so increasing the FRD by moving the x-ray tube reduces the ESD.

If the longer FRD was achieved by moving the image receptor rather than the x-ray tube, the effect would simply be to increase the patient dose. For an increase in FRD from 1 m to 1.4 m, the dose would almost be doubled

108
Q

How does changing kV alter ESD?

A

Increasing the kV, maintaining the receptor dose - the radiation will be more penetrating so the ESD will be decreased

Increasing the kV, different receptor dose - If the same entrance dose is achieved by increasing the kV and adjusting the mAs, then the dose at any depth below the surface will be greater, and so will the receptor dose.

109
Q

What is the effect of filtration on ESD?

A

the effect of tube filtration is to modify the x-ray spectrum by preferentially absorbing lower energy x-rays. The effect is to reduce the radiation dose to the patient.

Many of the photons that are removed from the spectrum would not have reached the receptor. These photons would have given dose to the patient without playing a part in forming the image. Filtration reduces the dose to the patient with minimal effect on image quality.

Note that if excessively large values of filtration are used, there will be a reduction in x-ray output requiring an increase in exposure (mAs) and a decrease in contrast caused by the change in x-ray quality.

110
Q

how does absorption effect ESD?

A

The radiation which has been transmitted through the patient carries the signal that will produce the image. Some of this radiation is absorbed by items such as the table top, anti-scatter grid and image receptor cover and this means that the exposure must be increased to make up for this

111
Q

What factors affect the effective dose?

A

All the factors that influence the ESD will also influence the effective dose. However, there are also factors that influence effective dose without changing the ESD. These include:

The x-ray field size
The x-ray quality

Which tissues are irradiated:
Projection
Examination

112
Q

Does changing field size effect ESD?

A

When the x-ray field size is increased, more x-rays strike the patient, and a larger volume of the patient is irradiated. However, when we measure absorbed dose, we usually measure it at a single point, so a larger field size does not really change our estimate of the ESD. More tissue simply receives this dose.

113
Q

What is dose area product?

A

A quantity has been devised that takes into account the field size. This quantity is called dose area product (DAP). Dose area product is defined as the mean dose in air multiplied by the cross-sectional area of the x-ray field at the same point. It is measured in units of dose multiplied by area, most commonly Gy.cm2

Because the field area increases with the square of the distance from the x-ray source, and the dose decreases at the same rate, the DAP does not vary with distance from the x-ray tube. This is why a DAP meter, fitted on the aperture of the x-ray tube, can measure the DAP at the patient.

114
Q

How does a change in x-ray quality influence the effective dose?

A

If the radiation is more penetrating, deeper lying tissues will receive a dose that is a larger fraction of the ESD. However, for the same receptor dose, the dose at any depth will still be smaller.

At higher kV the effective dose will be reduced in comparison with lower kV x-rays
The change in effective dose will not be as great as the change in ESD

115
Q

How can projection effect effective dose?

A

Suppose a tissue, sensitive to radiation (having a large tissue weighting factor) lies close to the surface of the patient where the x-ray beam enters. That tissue would receive a relatively large dose. If the x-ray is taken using the opposite projection, say AP instead of PA, the dose to that tissue will be reduced.