PRINCIPLES OF IMAGING

The Radiographic Image

Overview

This course explains in detail the principle of image formation on any type of x-
ray receptor starting from the interaction between the x-ray and the object that
is radiographed.

This course will also explain the factors that affect the image quality such as the
kVp, mAs, spatial resolution, and contrast resolution and image sharpness.
Learning Objectives

Upon the completion of this course, the dental professional should be

able to:

Describe how the x-ray image is formed.

Explain the difference between contrast resolution and spatial resolution.

Describe the effect of the exposure settings on the image quality.

Describe the difference between magnification and distortion.

Introduction

On November 8, 1895, William C. Roentgen discovered the x-ray. About half a

month after the announcement of this discovery Friedrich Otto Walkhoff took
the first radiograph. It took him 25 minutes to get his own radiographic
image. Since then, technological advances have dramatically improved
radiographic image quality. However, the way the radiographic image quality is
affected by the X-ray beam quality, quantity and intensity, and by the
radiographic object, have not changed.

The purpose of this course is to explain the factors that are responsible of
forming the radiographic image and how they affect the image quality.
How is a Radiographic Image Formed?

When an x-ray passes through an absorber, it gets differentially absorbed by

what constitutes the absorber and the thickness of each component. When the
x-ray beam exits this absorber, it will have varying levels of intensities.

This variation will be recorded on a radiographic receptor as different densities

generating the radiographic contrast. The densities related to a thick absorber
(i.e., aluminum) will be brighter than the densities of the thin absorbers
(Figure 1).1-5
Figure 1. Illustration of a radiographic image formation.
To produce a radiographic image, x-ray photons must pass through tissue and
interact with an image receptor (IR) (a device that receives the radiation
leaving the patient), such as an imaging plate in computed radiography (CR).
Both the quantity and the quality of the primary x-ray beam affect its
interaction within the various tissues that make up the anatomic part.

In addition, the composition of the anatomic tissues affects the x-ray beam
interaction. The absorption characteristics of the anatomic part are determined
by its thickness, atomic number, and tissue density or compactness of the
cellular structures.
Finally, the radiation that exits the patient is composed of varying energies and
interacts with the image receptor to form the latent or invisible image and must
be processed.

A visible radiographic image is produced following processing of the latent or

invisible image. Depending on the type of imaging system, acquiring,
processing, and displaying of the image can vary significantly. However, the
attributes of a quality radiographic image are similar regardless of the type of
imaging system.
Differential Absorption
The process of image formation is a result of differential absorption of the x-ray
beam as it interacts with the anatomic tissue.

Differential absorption is a process whereby some of the x-ray beam is

absorbed in the tissue and some passes through (transmits) the anatomic part.
The term differential is used because varying anatomic parts do not absorb the
primary beam to the same degree. Anatomic parts composed of bone absorb
more x-ray photons than parts filled with air. Differential absorption of the
primary x-ray beam creates an image that structurally represents the anatomic
area of interest
As the primary x-ray beam interacts with the anatomic part, photons are absorbed, scattered,
and transmitted. The differences in the absorption characteristics of the anatomic part create
an image that structurally represents the anatomic part.
Radiographic Density

Radiographic density is reflected by radiographic image darkness. In

conventional film radiography, it is called "transmitted density" because it is a
measure of the light transmitted through the film. In digital imaging, it refers to
how much the overall histogram of the image is shifted towards the lower grey
levels.

There are common factors that affect the radiographic density of conventional
film and digital receptor or plate, and there are other factors that depend on
the nature of the receptor.
Change in mA and in Exposure Time

When the mA or exposure time increases, the number of x-ray photons

generated at the anode increases linearly without increasing beam energy.

This will result in a higher number of photons reaching the receptor and this
leads to an overall increase in the density of the radiographic image (Figure
2).
Change of image density related to change of mA and/or exposure time: Image A is used
as reference. Image B shows a brighter image due to decrease in mA and/or exposure
time. Image C shows a darker image due to increase in mA and/or exposure time.
Change in kVp

When the kVp increases, the number and energy of x-ray photons generated at
the anode increase.

This will result in a higher number of photons with higher energies reaching the
receptor, and this leads to an overall increase of density of the radiographic
image at a greater scale when increasing mA or exposure time (Figure 3).
 Change of image contrast related to change of kVp: Image A is used as reference. Image B
shows a higher contrast image due to decrease in kVp. Image C shows a lower contrast image
due to increase in kVp.
Change in Source to Object Distance

When the source to object distance increases, the intensity of the x-ray beam
decreases following the inverse square law.

This will result in decrease in the intensity of the beam reaching the object, and
this results in a decrease in image density (Figure 4).
Change of image density related to change of source to detector distance: Image A is used as
reference. Image B shows a brighter image due to increase of source to detector distance.
Thickness of the Absorber

When the thickness of the absorber increases, the number of photons absorbed
increases, leading to less photons reaching the receptor.

This will result in a decrease in the image density

Change of image density related to change of absorber thickness: Image A is used as
reference. Image B shows a brighter image due to increase of absorber thickness.
Radiographic Contrast
Contrast is the difference in density or difference in the degree of grayness
between areas of the radiographic image. The radiographic contrast depends on
the following three factors:

1. Subject Contrast
 Thickness difference
 Density difference
 Atomic number difference
 Radiation quality or kVp
2. Receptor Contrast
3. Factors that Affect Radiographic Contrast
1. Subject Contrast: it refers to the difference in the intensity transmitted through
the different parts of an object. For example, in an intraoral radiograph, enamel
will attenuate x-rays more than dentin. Subject contrast is affected by the
following factors:

Thickness difference: if the x-ray beam is attenuated by 2 different

thicknesses of the same material, the thicker part will attenuate more x
rays than the thinner part.
Density difference: this is also known as the mass per unit volume. It is the
most important factor contributing to subject contrast. A higher density
material will attenuate more x-rays than a lower density material.
Atomic number difference: A higher atomic number material will
attenuate more x-rays than a lower atomic number material.

Radiation quality or kVp: it has a great effect on subject contrast. A lower

kVp will make the x-ray beam less penetrating.
This will result in a greater difference in attenuation between the different
parts of the subject, leading to higher contrast. A higher kVp will make the x
-ray beam more penetrating
This will result in less difference in attenuation between the different parts
of the subject, leading to lower contrast.
2. Receptor Contrast: it refers to the ability of a receptor to show adequately the
information that the photons transmitted through the subject.
In conventional radiography, the contrast depends on the size of the grains, the
development time, the concentration and temperature of the developing
solution, and overall film density.
As conventional film use has been reduced, we will not discuss the details of
these factors
In digital imaging, contrast depends on the bit-depth of the receptor. Bit-depth
refers to the number of possible grey values that can be stored in an image.
The higher the bit-depth, the more gray values it can store. The simplest image,
a 1-bit image, can only show two colors, black and white. That is because 1-bit
can only store one of two values, 0 (white) and 1 (black). An 8-bit image can
store 256 possible gray values, while a 12-bit image can display 4096 gray
values.
3. Factors that Affect Radiographic Contrast: Scatter radiation will decrease the
contrast of the radiograph; however, collimation can counterbalance this effect.
Image Resolution

Image resolution is the details that an image can contain. The details depend on
the following factors:

1. Contrast Resolution

2. Spatial Resolution
Contrast Resolution
It is the ability of an imaging system to distinguish between multiple densities in
the radiographic image.

In the case of digital imaging, it depends on the bit depth of the system. As
noted earlier, an 8-bit system can show only 256 gray values as opposed to a
12-bit system, which shows 4096 gray values.

The 8-bit system shows less gray values and is a high contrast system than the
12-bit system that shows more gray values and is a low contrast system.

However, if the 12-bit-system can clearly show two near-by gray value
intensities, the system will have a high contrast resolution
 Comparison of 2 systems. In each rectangle, there is a square that has a grey value close to
the grey value of the rectangle. A has a low contrast resolution. B has a high contrast resolution.
Spatial Resolution

Spatial resolution in radiology refers to the ability of an imaging system to

differentiate between two near-by objects.

In digital imaging, it depends on the size of the pixel used. A large pixel size will
be unable to resolve two near-by structures as compared to a small pixel size.
Spatial resolution is measured in line-pairs per millimeters
Comparison of 2 systems: A has a low spatial resolution and B has a high spatial resolution.
Image Magnification

It refers to the proportional increase in the dimensions of a radiographed object

relative to the actual dimensions of that object and depends on the following
factors:

1. Increasing object to film distance only will result in an increase in

magnification of the radiographic image. Decreasing object to film
distance only will result in a decrease in magnification of the radiographic
image (Figure 8).
Comparison of magnification when the object to film distance changes. A short distance (A)
shows less magnification than a long distance (B).
2. Increasing source to object distance only will result in a decrease in
magnification of the radiographic image. Decreasing source to object
distance only will result in an increase in magnification of the radiographic image
(Figure 9).

Comparison of magnification when the source to object distance changes. A short distance (A) shows more magnification
than a long distance (B).
Image Distortion
It refers to the non-proportional increase in the dimensions of a radiographed
object relative to the actual dimensions of that object. It can be seen when
there is a change in the angle of the incidence x-ray beam or when the receptor
is not parallel to the object (Figure 10).

Figure 10. Distortion of the shape of the rectangle due to a change in the angle of incidence of an x-ray beam.
Image Sharpness

Sharpness is considered a major factor in determining image quality as it is the

factor that determines the amount of detail an imaging system can reproduce
(Figure 11).

Figure 11. Image A is sharpness when compared to B.

Image Sharpness
Sharpness is considered a major factor in determining image quality as it is the
factor that determines the amount of detail an imaging system can reproduce
(Figure 11).

11. Image A is sharpness when compared to B.

The sharpness of the image depends on multiple factors. We will consider one
variable at a time, keeping the other variables fixed:

The apparent focal spot size: The larger is the size of the apparent focal
spot, the larger is the penumbra, resulting in a less sharp image.
Source-to-object distance: The greater is the source-to-object distance,
the smaller is the penumbra, resulting in a sharper image.
Object-to-receptor distance: The greater is the object-to-receptor distance,
the larger is the penumbra, resulting in a less sharp image.
X-ray tube motion-related un-sharpness: If the tube moves when the x-ray
image is being taken, the apparent focal spot size will become larger resulting in
a larger penumbra and a less sharp image.
Conclusion

Radiographic image quality is a combination of the following: density, contrast,

spatial resolution, contrast resolution, magnification, distortion and sharpness.

The x-ray settings can affect many of those factors at the same time and it is
important to understand how these settings affect each of these variables.