- KiloVoltage. Technique 101: Getting Back to Basics
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- Leslie Hall
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1 Why do I need to know technique? Technique 101: Getting Back to Basics Presented by: Thomas G. Sandridge, M.S., M.Ed., R.T.(R) Program Director Northwestern Memorial Hospital School of Radiography Chicago, IL ARRT Standards of Ethics: Principle 7 The radiologic technologist uses equipment and accessories, employs techniques and procedures, performs services in accordance with an accepted standard of practice, and demonstrates expertise in minimizing radiation exposure to the patient, self, and other members of the healthcare team. An ethical obligation! X-Ray Production There are 3 ingredients necessary to generate x-rays: The X-Ray Tube 1. a source of electrons (ma) 2. rapid acceleration of the electrons (kvp) 3. rapid deceleration of the electrons (target) X-Ray Tube Two electrodes enclosed in a glass envelope (tube) Electrodes Cathode - KiloVoltage Anode + Why a glass tube? To maintain a vacuum environment: 1. Clear path for electrons to travel 2. No oxygen = no oxidation 3. No oxygen = no fire 1
2 Target Refers to the anode surface inside of the x-ray tube. The site of x-ray production The X-Ray Tube The cathode assembly Filaments (2): Thoriated Tungsten W (98%), Th (2%) Focusing cup: Nickel The Focusing Cup The Anode (Target) Molybdenum disk coated with: Tungsten rhenium alloy W (98%), Re (2%) Graphite backing Molybdenum stem Copper rotor Kilovoltage and Electron Velocity kvp continued Potential difference o Accelerates the electrons (rapid acceleration) o The strength of the electrode charges o As kvp, attraction, so velocity For 50 kvp Anode Cathode kvp Cathode MPH 80 MPH (Rapid deceleration) 2
3 Why Tungsten? (Wolfram) High Z-number (lots of electrons) o Densely-packed atoms High melting point: 3,422 C! Let s Review: X-Ray Tube Electrode Components Composition Function: Cathode (assembly) Anode (the target) Filament Thoriated Tungsten Source of electrons Focusing cup Ni Focus electrons Disk Molybdenum Base of anode Target surface Backing Tungsten- Rhenium alloy Graphite Site of x-ray production Conduct heat away from anode Stem Molybdenum Attached to disk Rotor Copper Turns anode ( 3,400 RPM) Primary Beam Formation (Tungsten Target) Bremsstrahlung Bremsstrahlung 90% of beam above 69.5 kvp 100% below 69.5 kvp Photoelectric Effect 10% above 69.5 kvp 0% below 69.5 kvp Cathode Anode Photoelectric Effect Cascade Effect 3
4 Isotropic Emission Primary / Useful Beam (composed of photons ) Primary Radiation Primary Beam Leakage Radiation Lead-Lined Housing Technical Factors The technologist s role in the image production process Technologists must select (and control):» Beam quality» Beam quantity Proper control is a form of radiation protection! Isotropic Emission milliamperage (ma) Electric Current ½ of mas mas controls the quantity of x-ray photons produced Directly proportional 1. Anode begins to spin 3,000 3,400 RPM Rotor 2 things happen: 2. ma is boosted to the filament Thermionic emission occurs A space charge is created Quantity directly proportional to ma Anode: Neutral Cathode: Neutral 4
5 Exposure 99% Thermal E. 1. kvp is applied to the tube electrodes: A potential difference is created Anode (+), Cathode (-) 3. Electrons undergo rapid deceleration: Energy conversion 100% kinetic energy 99% thermal energy 1% x-ray energy 2. Electrons undergo rapid acceleration: Travel toward the target e - e - e - e - e - e - e - e - e - e - e - e - e - e - e - e - e - e - e - e - e e - - e - ē - e - e - e - e - 1% X-Ray E. 100% Kinetic E. e - e - - e - e - e - e - mas mas Reciprocity The s in mas refers to time (seconds = unit of measurement) o Duration of the exposure (how long kvp is applied to the tube electrodes) PRIMARY FACTOR controlling Radiographic Density (analog systems only) o o Directly proportional to patient dose Digital Systems: Not mas dependent (prdetermined appearance) - impacts IR exposure Any combination of ma and time that equals a particular mas value will produce the same density (analog) and IR exposure (digital) sec. = 10 mas sec. = 10 mas sec. = 10 mas 10 mas = 10 mas = 10 mas.... So what s the difference??? mas Reciprocity (continued) ma Time 0.1 s 0.05 s s 0.02 s 0.01 s mas Small amount over a longer time. Advantage: sharper detail Disadvantage: more potential for motion blur Larger amount over a shorter time. Advantage: less motion Disadvantage: slight loss of detail sec. = 10 mas sec. = 10 mas 5
6 Calculating mas 1. If the mas is 30, and the time is 0.1 sec., what ma setting is required? mas = ma x time * ma = mas time * mas time * = mas ma ma time* or.... * ALWAYS seconds, not milliseconds 2. If the ma is set at 400, and the mas obtained is 80, what time setting is required? Whenever a beam interacts with tissue, 3 things happen: 1. Scatter 2. Absorption 3. Transmission Attenuated approximately 50% for every 4-5 cm of tissue. Beam/Tissue Interface * * * Image Receptor Automatic Exposure Controls (mas) Phototiming Radiographic Density (Analog Only) (Think density = darkness ) Digital: brightness (WL) Terminates at sufficient density (or IR exposure). Cells / chambers beneath table top, above the IR. o entrance type Increased (radiographic) density Decreased (radiographic) density Primary (controlling) Factor? Influencing (secondary) Factors? Altering density? minimum / drastic: mas kvp 6
7 kilovoltage peak (kvp) potential difference / beam strength (beam quality) The push behind the mas Penetrating ability (penetrability) (Radiographic) Contrast (Analog Systems Only) The visible (perceptible) difference between adjacent structures on a radiographic image. Digital term: Contrast Resolution Primary factor controlling: Radiographic Contrast (analog only) Radiographic Scales of Contrast kvp and Radiographic Contrast (Analog Systems Only) Short Scale: Few shades of gray between darkest and lightest areas of the image High overall contrast Very B & W image Long Scale: Numerous shades of gray Lower overall contrast Very gray image 125 kvp 106 kvp 90 kvp 77 kvp 65 kvp An Easy Way to Remember S H A L L kvp & Exposure Latitude (Analog Systems Only) Low kvp S h o r t H i g h A n d L o n g L o w High kvp /- 1 Mammo. Extremities +/- 4 (or 5)* 90 Abdomen, spine, hip, pelvis, etc +/- 8 (or more) Chest, Barium As kvp increases, so does exposure latitude (directly related) 7
8 More intense Less intense Photoelectric Effect (aka. Photoelectric Absorption) The Beam and the Body Absorption - Inner shell electron ejected o Characteristic radiation o Cascade effect Secondary radiation produced (in the patient) o Image contrast Compton Effect (aka. Modified Scattering) Outer-shell electron Scatter Varying degrees of photoelectric absorption Differential Absorption Without any photoelectric absorption X-ray photon + Scattered x-ray photon Divergence A gradual spreading out of the beam from its center as it travels. The amount is directly related to distance. Sourcto-Image Receptor Distance (SID) Distance from the anode (target site of x-ray production) Impacts beam intensity o distance (SID) = beam intensity o Also has an effect on image magnification / quality
9 Attenuation (Distance) Direct Square Law aka. Density Maintenance Formula (for analog systems) mr 3 mr Purpose: To maintain radiographic density (analog systems), or to maintain IR exposure (digital systems) when SID changes. This compensates for beam attenuation. o as SID, mas needs to o as SID, mas needs to More distance requires more mas Less distance requires less mas 80 mas 1 D 2 1 mas 2 = D If 10 mas with 75 kvp produces an acceptable exposure at 100 cm SID, what mas should be used at 180 cm? mas 1 mas used during the first image mas 2 new mas required at new distance D 1 original SID (for 1st exposure) D 2 new SID (for 2 nd exposure) Don t forget to square the distances 2. An acceptable exposure is obtained at an unknown SID using 25 mas at 90 kvp. If a similar exposure is obtained using 50 mas. What was the original SID? Attenuation Beam Intensity & Attenuation What influences beam intensity? S (Scatter) A (Absorption) D (Distance Inv. Sq. Law) 9
10 Inverse Square Law Inverse Square Law (continued) I 1 (D2) 2 I 2 = (D1) 2 Inverse (Invert) I 1 (D2) 2 I 2 = (D1) 2 Purpose: To calculate beam intensity or exposure / dose relative to changes in distance I 1 = Beam intensity (or dose) at the original position (D 1 ) I 2 = Beam Intensity (or dose) at the new position (D 2 ) D 1 = Original distance (where I 1 is measured)* D 2 = New distance (where I 2 is measured)* * Remember: Distances are always squared 1. The intensity of a beam is 100 mr at a distance of 1 meter. What is the intensity at 3 meters? 2. For a given technique, the x-ray intensity at 1 meter is 450 mr. What is the intensity at 2.5 meters? 3. A beam results in an intensity of 25 mr at 100cm. At what distance would the intensity measure 1 mr? Scatter & Grids 10
11 Scatter Impact of Scatter erroneous information to IR A very BAD thing! Primary Photon Patient / object significantly reduced energy Compton Effect No grid Grid Factors in Scatter Production More tissue = more scatter kvp (, ) Field Size (, ) Tissue / Pathology (, ) How can you minimize scatter production??? 1. COLLIMATE (as much as possible)! 2. Use the lowest appropriate kvp for the anatomy* * Although with digital, a higher kvp is recommended to reduce patient dose What is a radiographic grid? X-Ray Tube Collimator Primary / Useful Beam Primary / Useful Beam Patient Remnant / Exit Beam Grid Image Receptor X-Ray Table Grid AEC Detectors Image Receptor 11
12 Response (density) Response Radiopaque grid material: Scatter Control: Grids Radiolucent interspace material: Grid Purpose Cleans up scatter in order to: Improve (increase) radiographic contrast Increase visibility of small objects Between patient & I.R. No grid Grid IR Response to Exposure 0 Exposure 0 Exposure Analog Imaging Systems (Film / Screen) Digital Imaging Systems* No fog Fog: contrast, density Common Grid Types Non-Focused vs. Focused 1. Linear, non-focused 2. Linear, focused 12
13 Height of Pb strips Grid Ratio = Height (of Pb strips) Distance between strips (interspace) 1. What is the grid ratio if the height of the lead strips measure 1.2 mm and the distance between them is 0.1 mm? Higher GR = more clean-up (more contrast) But needs more mas Higher patient dose Less centering latitude Inverse relationship Lead strips Distance between (interspace thickness) 2. What is the ratio of a grid if the height of the lead strips measures 0.8 mm and the distance between them is 0.1 mm? 12:1 8:1 Greater lead content Need more mas to compensate Higher contrast images Lower lead content Need less mas to compensate Lower contrast images How much more (mas)??? Grid Conversion Factors* Grid Ratio GCF Non-grid 1 5:1 2 6:1 3 8:1 4 12:1 5 16:1 6 Converting from one grid ratio to another: (to maintain radiographic density or IR exposure) New GCF Old GCF x original mas = new mas (for new GR) * The ARRT does not recognize an official set of GCFs, so... make your life a little easier 13
14 1. An 8:1 grid is used with 10 mas and produces sufficient exposure. If the exposure is to be repeated using a 12:1, what mas is required? 2. A non-grid exposure is made using 70 kvp, 25 mas, and 40 SID. If the exposure were to be repeated with a 16:1 grid, what technique would be required? 3. A knee is obtained using a 16:1 ratio grid at 65 kvp and 12 mas. What mas would be used with a tabltop exposure? Just for the heck of it: The Anode Heel Effect Beam intensity is greatest on cathode side Thicker anatomy under the cathode Anode Weaker Cathode Stronger Fat Cat Technique Charts Fixed kvp, variable mas * Variable kvp, fixed mas Question: Why do we have or need them? Adjust mas by a factor of 2 for every 4-5 cm from base technique. For example: Base Technique AP Knee: mas Measure: 16 cm Your patient: 20 cm Use: mas Fixed kvp, Variable mas Charts Meas. kvp mas 8 cm cm cm cm cm Advantage: Constant contrast scale Disadvantage: Difficult to adjust 14
15 Adjust kvp by 2 for every 1 cm deviation from base technique For example: Base technique AP Knee: mas Measure: 16 cm Your patient: 20 cm Use: mas Variable kvp, Fixed mas Meas. kvp mas 10 cm cm cm cm cm cm cm Advantage: Easy to adjust Disadvantages: Variable contrast scale (analog systems), limited range of usefulness Additional Technique Considerations Type Inflatable air Fiberglass Wood or aluminum in the path of the beam Splints: Adjustment* None* None* mas by 30% or, 5 kvp* * May need to compensate for edema Casts Fiberglass: Usually, no adjustment needed Plaster (not standardized): Wet: kvp by 15% or mas x 2.5 or 3 Technique & Digital Equipment Dry: 6 8 kvp or mas x Signal-to-Noise Ratio (SNR) Relationship of useful information (signal) to erroneous information (noise) The higher the SNR, the higher (better) the spatial and contrast resolution Low IR Exposure Image Receptor Exposure Dose Creep High IR Exposure Increased exposure factors will increase SNR, however Patient dose Dose Creep SNR: Lower IR Exposure: Lower Target Range* SNR: Higher IR Exposure: Higher Pt. Dose: Lower Pt. Dose: Higher High SNR Low SNR (Quantum Mottle) 15
16 Conventional: Conventional (Analog) vs. Digital Systems mas and kvp had to be accurate. Image could not be manipulated so, if too dark or too light... REPEAT IT! Digital: Computer can compensate for some errors in technique however.... Still need to be conscious of patient dose! (dose creep) Exposure Numbers There are 3 major systems in digital imaging indicating IR exposure: 1. Carestream (Kodak): EI numbers (directly related) 2. Agfa: LgM (log mean) numbers (directly related) 3. Fuji (also Konica & Phillips): sensitivity (S-) numbers (inversely related) No matter the system, all numbers represent logarithms and exposure to the IR (not to the patient). System Number Exposure Numbers Relationship to Exposure Doubling IR Exposure IR Exposure Reduced to 1/2 Carestream EI Direct EI 300 EI 300 Agfa LgM Direct LgM 0.3 LgM 0.3 Fuji S # Inverse S# 100 S# 100 How to Double IR Exposure: With mas As mas, IR exposure To double IR exposure: Double the mas EI # increases by 300 LgM increases by 0.3 S # decreases by 100 How to Halve IR Exposure: With mas As mas, IR exposure To halve IR exposure: Reduce mas by ½ EI # decreases by 300 LgM decreases by 0.3 S # increases by 100 Technique and Exposure Indices Carestream: mas Exp. # Technique EI number mas mas 1800 Exp. # Technique EI number mas mas
17 Technique and Exposure Indices Technique and Exposure Indices Agfa: mas Exp. # Technique LgM mas LgM mas LgM 2.0 Exp. # Technique LgM mas LgM mas LgM 1.2 Fuji S- numbers: mas Exp. # Technique S number mas mas 100 Exp. # Technique S number mas mas 350 How to Double IR Exposure: With kvp As kvp, IR exposure To double IR exposure: Increase kvp by 15% EI # increases by 300 LgM increases by 0.3 S # decreased by 100 How to Halve IR Exposure: With kvp As kvp, IR exposure To Halve IR exposure: Decrease kvp by 15% EI # decreases by 300 LgM decreases by 0.3 S # increases by 100 Technique and Exposure Indices Carestream: kvp Exp. # Technique EI number mas mas 1800 Exp. # Technique EI number mas mas 1300 Technique and Exposure Indices Agfa: kvp Exp. # Technique LgM mas LgM mas LgM 2.0 Exp. # Technique LgM mas LgM mas LgM
18 Technique and Exposure Indices Just to Summarize... Fuji S- numbers: kvp Exp. # Technique S number mas mas 100 Exp. # Technique S number mas mas 350 To double IR exposure: mas x 2 or kvp by 15% EI #: LgM: S #: Got it? To halve IR exposure: mas x ½ or kvp by 15% EI #: LgM: S #: By the numbers... By the numbers... Action Analog EI number LgM S-number (Film) Carestream Agfa Fuji Double mas or kvp by 15% Density doubles by 300 by 0.3 by 100 Action Analog EI number LgM S-number (Film) Carestream Agfa Fuji mas x ½ or kvp by 15% Density by ½ by 300 by 0.3 by 100 For example Exposure #1: 25 mas at 70 kvp EI 1600 LgM 2.2 S200 Exposure #2: 50 mas at 70 kvp EI 1900 LgM 2.5 S100 For example Exposure #1: 25 mas at 70 kvp EI 1600 LgM 2.2 S 200 Exposure #2: 12.5 mas at 70 kvp EI 1300 LgM 1.9 S 300 Exposure #3: 25 mas at 70 kvp EI 1600 LgM 2.2 S200 Exposure #4: 25 mas at 81 kvp EI 1900 LgM 2.5 S100 Exposure #3: 25 mas at 70 kvp EI 1600 LgM 2.2 S 200 Exposure #3: 25 mas at 60 kvp EI 1300 LgM 1.9 S 300 Let s figure it out... EI number LgM S-number Carestream Agfa Fuji Target Number* EI LgM S 200 Exposure #1: mas EI LgM S 100 What would YOU do??? Let s figure it out... EI number LgM S-number Carestream Agfa Fuji Target Number* EI LgM S 200 Exposure #1: mas EI LgM S 300 * varies by vendor, exam, and facility source: Fauber, T. (2013). Radiographic Imaging & Exposure, 4 th ed., St. Louis: Elsevier. * varies by vendor, exam, and facility source: Fauber, T. (2013). Radiographic Imaging & Exposure, 4 th ed., St. Louis: Elsevier. 18
19 Important Rules of Thumb for Digital Systems Exposed field must cover at least 25 30% of the IR* Collimation evident on 3 (preferably 4) sides* Failure to collimate will adversely impact image quality (and patient dose) Exposure data recognition error (EDR) o Too light or too dark Exposure Data Recognition (EDR) Error Did not expose 25% or more of the image receptor. Masking is never a substitute for collimation! 1. In a modern rotating anode x-ray tube, which of the following will coat the anode disk? Let s See What You Remember... a. tungsten rhenium alloy b. thoriated tungsten c. tungsten copper alloy d. tungsten molybdenum alloy 2. Which of the following is responsible for a majority of scatter in diagnostic radiography? a. Photoelectric effect b. Bremsstrahlung c. Compton effect d. Photon absorption 3. Which of the following types of radiation can not be produced at tube potentials less than 70 kvp? a. Bremsstrahlung b. Characteristic c. Primary d. Secondary 19
20 4. Which of the following techniques will produce an analog radiograph with the highest overall contrast? a. 50 mas, 50 kvp b. 30 mas, 60 kvp c. 15 mas, 70 kvp d. 10 mas, 80 kvp 5. Low frequency x-ray photons will result in which of the following (analog systems)? a. short scale contrast b. medium scale contrast c. long scale contrast d. low scale contrast 6. Increasing the kvp: a. Decreases the energy of the x-ray photons b. Increases the quantity of x-ray photons c. Increases the penetrability of the x-ray photons d. None of the above 7. Which of the following groups of exposure factors will deliver the least exposure to the patient? a. 5 mas, 90 kv b. 10 mas, 80 kv c. 20 mas, 68 kv d. 40 mas, 66 kv 8. Which of the following techniques would produce the greatest radiographic density (analog systems) or IR exposure (digital systems)? a. 50 mas, 70 kvp, 40 b. 100 mas, 70 kvp, 40 c. 100 mas, 70 kvp, 80 d. 100 mas, 80 kvp, At 80 kvp, what percent of electron kinetic energy is converted into thermal energy? a. 1% b. 10% c. 90% d. 99% 20
21 10. Compared to a low ratio grid, a high ratio grid will do which of the following? a. absorb more primary radiation b. absorb more scatter radiation c. absorb less primary radiation d. absorb less scatter radiation 11. How will the use of radiographic grids impact image contrast? a. produce higher contrast b. produce lower contrast c. eliminate contrast d. have no effect on contrast 12. How much must the mas be increased when changing from no grid to an 8:1 grid? a. 2x b. 3x c. 4x d. 5x 13. If a technique of 110 kvp at 3.0 mas for an adult chest results in an EI number of 1400, which of the following would increase the EI to 1700? a. increase by 10 kvp b. increase mas 30% c. increase kvp to 125 d. increase mas to In order for the computer to accurately locate the appropriate anatomy, the part must be centered to the IR and at least sides of collimation detected. a. 1 b. 2 c. 3 d Which of the following would result in an image with the highest SNR and IR exposure? a. 1.7 LgM b. 2.0 LgM c. 2.3 LgM d. 2.6 LgM 21
22 16. Which of the following EI numbers would produce an image with the lowest SNR? a b c d Recommendations Make a formula sheet Add to it as you learn new ones ARRT Review: all formulas in one spot! Good luck future R.T.s! 22
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