Topic 3 Selection of kV High kV scattered radiation is energetic. Angle of rays is same as those of primary beam and is not deflected very much. Follows path of primary beam in forward direction adding to film density. Use of relatively high grid ratio, e.g. 12:1 or higher, improves image quality as scattered radiation in high kV techniques would be more efficiently absorbed.

Low kV results in high absorption of x rays. High kV results in less absorption of x rays. More x rays penetrate the tissue being examined and reach the film. This results in good visualization of structures required in pattern recognition.

Poor patient positioning Entire knee architecture not included. Lack of penetration of knee joint due to low kV selection.

Topic 4 Selection of mAs The higher mAs, the darker the image,the higher the patient dose.* Factors affecting mAs selection:  Focus film distance: For the same image density, if new FFD is equal to a factor multiplied by the old FFD, the new mAs equals the old mAs multiplied by a number equal to the square of this factor.**

Selection of mAs  Speed of film: Fast films need less mAs than slow films.  Size, thickness, and type of phosphors in intensifying screens: Fast screens require less mAs than slow ones. When changing from a 200 speed system to a 400 speed one, reduce original mAs by 50%. This reduces dose to patient.

Selection of mAs Intensification factor of intensifying screens determines selection of mAs. Large phosphors require less mAs than slow ones. Fast screens need less mAs than slow ones. Single intensifying screen requires more mAs than two screens in cassette.

Selection of mAs Slow screen systems produce good image detail, but more mAs needed for film blackening resulting in higher patient dose. Selection of specific film-screen combinations depends on information needed for pattern recognition.

Selection of mAs  Use of grid: mAs must be increased based on grid factor.  Degree of collimation: Reducing area of interest needs an increase in mAs. *  Output of generator/capability of unit.** Using a 3-phase generator instead of a single phase one requires mAs reduction.  Relationship to kV used.  Size of focus.

Very black film of distal femur due to high mAs. Patient subjected to unnecessary dose. Film retaken with reduced mAs.

Grossly over exposed radiograph AP pelvis of child. Too high mAs. Poor collimation – gonads in primary beam which means dose to reproductive organs. Repeat radiograph done.

Grossly overexposed skull radiograph Too high mAs. Poor radiographic technique – patient's skull rotated. No evidence of beam restriction – unnecessary dose to patient's eyes and thyroid.

Lecture 8 Radiographic Exposures (Module 6) Topic 1 Introduction Topic 2 Exposure Chart Topic 3 The step system Topic 4 Tasks 26 – 28

Topic 1 Introduction Objectives:  On completion of this module the student will Understand the effect each exposure factor has on the resultant radiograph. Be able to use this knowledge effectively. Be able to select the correct exposure factors required.

Topic 1 Introduction Understand and use the step system of exposure calculation. Be able to manipulate exposure factors using the step system. Be able to establish and maintain a reliable exposure chart. Be able to modify an existing exposure chart.

Topic 1 Introduction  Exposure: Refers to the quantity of radiation to which the patient is exposed. In radiography, the term "exposure" is used as the collective exposure factors kV, mA and time, which together produce the radiation exposure that will give the required penetration, density and contrast on the radiograph.

Topic 1 Introduction Other factors influence film quality but here we will only consider kV, mA, time and FFD (SID)  kV Controls largely the penetrating power (better described as beam quality), and to a lesser degree, the radiation intensity and threfore film density and patient dose.

Topic 1 Introduction Affects contrast. The higher the kV, the lower the contrast. The lower the kV, the higher the contrast.  mA: Controls radiation intensity and therefore film density and patient dose. The higher the mA, the higher the film density and patient dose.

Topic 1 Introduction  Time: Controls the length of time of radiation flow, and therefore film density and patient dose. The longer the exposure time, the higher the film density and patient dose.  mAs: The product of mA and time (in seconds). Many modern x-ray units use mAs rather than mA and time separately.

Topic 1 Introduction  FFD ( SID): The greater the distance an x-ray beam travels, the less effective it will be. The less the distance it travels, the more effective it will be. Exposure compensation is necessary with changes in FFD (SID).

Topic 1 Introduction  NOTE: It is important that the radiographer sets correct exposure factors required to produce a high quality radiograph which will give the maximum information yet minimises patient dose. Systems must be in place to help the radiographer select and manipulate exposure factors effectively.

Topic 2 Exposure chart Each x-ray unit should have a list of commonly used exposures for easy reference (see Appendix B, page 164).This can serve as a guide.  Methods of recording exposures: Written chart. Notebook. Computerised "chart" within the x-ray unit.

Topic 2 Exposure chart  Here we will deal with: Establishing and modifying an exposure chart. Manipulating exposure factors using the step system.

Topic 2 Exposure chart  Establishing an exposure chart Method: 1.Draw up a blank exposure chart (see Fig 6-1 and Appendix B page 168). 2.Fill in all anatomical areas to be covered, listing the views for each.

Topic 2 Exposure chart 3.Divide these into groups using the same set of conditions, e.g. all extremities using detail screens, no grid, 100cm FFD(SID). 4.Produce a well exposed set of radiographs of an extremity, e.g. hand. (This can be done in the course of a routine examination.)

Topic 2 Exposure chart 5.Record the exposures used against HAND on the chart. 6.Measure the thickness of the patient's hand in all projections used, e.g. PA, oblique, lateral 7.Measure thickness at the level of entry of central ray, for each hand position.

Topic 2 Exposure chart 8.Measure all other areas/positions in the same group (these can be obtained from a colleague or friend of a similar size rather than inconvenience the patient). 9.Calculate the exposures for all other areas/positions in the group, based on the following chart (patient thickness related to exposure change using the hand as your base level:

Topic 2 Exposure chart Patient thickness related to exposure change  1.5 cm increase in thickness requires a 25% increase in exposure (+1 step).  5.0 cm increase in thickness requires a 100% increase in exposure(+3 steps).

Topic 2 Exposure chart  5.0 cm decrease in thickness requires a 100% decrease in exposure (-3 steps).  1.5 cm decrease in thickness requires a 25% decrease in exposure (-1 step). NOTE: The reference to "+ or – steps" is explained in the next topic, the step system.

Topic 2 Exposure chart  Example PA HAND (2 cm thick) Exposure 50kV 6mAs. Calculate an exposure for a lateral WRIST (7cm thick). Thickness difference between the PA HAND and lateral WRIST is 5 cm.

Topic 2 Exposure chart For an increase of 5 cm the exposure is increased by 100% ( see previous discussion). Therefore the lateral WRIST exposure will be 50kV 12 mAs. The exposures for all other areas of the body can be calculated in this way.

Topic 3 The step system A simple standardised form of exposure factor manipulation, designed to remove some of the guess work and make exposure setting more accurate. Works on a series of step charts allowing use of standard step changes in exposure. Also related to patient thickness and medical condition (see Fig 6-5).

Topic 3 The step system  Note: Step changes can be applied to any one of the charts or split between the charts. The step system provides step charts for kV, mA, mAs, time and FFD(SID), (see Fig 6-2, Fig 6-3, Fig 6-4 & Fig 6-5). To use the step system for exposure changes, the term "step" is used.

Topic 3 The step system Each step on any of the charts will alter the exposure by approximately 25%. For a noticeable change in film density, the exposure must be altered by at least 25%. If a film is considered to be too light or too dark, change one of the exposure factors by at least 3 steps up or down.

Topic 3 The step system Any step change required to modify an exposure can be applied to any of the Step Charts, although other factors will influence this decision (contrast, penetration, patient dose, movement, limitations of the x-ray unit).

Topic 3 The step system Step changes need not be limited to one chart only. Necessary step changes can be split up between charts if necessary, providing that the overall number of required step changes is made.  Example Original Exposure: 60 kV 20 mAs New kV = 70 kV (an increase of 10 kV)

Topic 3 The step system An increase of 10 kV = three steps on the kV step chart. To retain the same density film, the mAs must be reduced by the same number of steps (three steps) on the mAs chart. New exposure = 70 kV 10 mAs  All Step Charts are from "Course Notes in Basic Radiography", Radiation Protection Branch, South Australian Health Commission.

Topic 5 Tasks The tasks are in the next four slides.