An Exposure Indicator For Digital Radiog

An exposure indicator for digital radiography:
AAPM Task Group 116 „Executive Summary…

S. Jeff Sheparda兲 and Jihong Wang
Imaging Physics Department #056, Division of Diagnostic Imaging, University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
Michael Flynn
Department of Radiology, Henry Ford Health System, Radiology Research 2F, 1 Ford Pl., Detroit,
Michigan 48202
Eric Gingold
Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia,
Pennsylvania 19107
Lee Goldman
Medical Physics Department, The Hartford Hospital, 80 Seymour Street, PO Box 5037, Hartford,
Connecticut 06102-5037
Kerry Krugh
Department of Radiology, Toledo Hospital, 2142 North Cove Blvd., Toledo, Ohio 43606
David L. Leong
Analogic Corporation, 8 Centennial Drive, Peabody, Massachusetts 01960
Eugene Mah
Radiology Department, Medical University of South Carolina, PO Box 250322, 169 Ashley Ave.,
Charleston, South Carolina 29425
Kent Ogden
Radiology Department, SUNY Upstate Medical University, 750 E Adams Street, Syracuse, New York 13210
Donald Peck
Radiology, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, Michigan 48202
Ehsan Samei
Radiology, Med Phys, Physics, and BME, Duke University, 2424 Erwin Road Suite 302, Duke University
Medical Center, Durham, North Carolina 27705
Jihong Wang
Imaging Physics Department #056, Division of Diagnostic Imaging, University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030
Charles E. Willis
Imaging Physics Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd.,
Unit 1352, Houston, Texas 77030-4009
共Received 21 November 2008; revised 9 March 2009; accepted for publication 30 March 2009;
published 9 June 2009兲
Digital radiographic imaging systems, such as those using photostimulable storage phosphor, amor-
phous selenium, amorphous silicon, CCD, and MOSFET technology, can produce adequate image
quality over a much broader range of exposure levels than that of screen/film imaging systems. In
screen/film imaging, the final image brightness and contrast are indicative of over- and underexpo-
sure. In digital imaging, brightness and contrast are often determined entirely by digital postpro-
cessing of the acquired image data. Overexposure and underexposures are not readily recognizable.
As a result, patient dose has a tendency to gradually increase over time after a department converts
from screen/film-based imaging to digital radiographic imaging. The purpose of this report is to
recommend a standard indicator which reflects the radiation exposure that is incident on a detector
after every exposure event and that reflects the noise levels present in the image data. The intent is
to facilitate the production of consistent, high quality digital radiographic images at acceptable
patient doses. This should be based not on image optical density or brightness but on feedback
regarding the detector exposure provided and actively monitored by the imaging system. A standard
beam calibration condition is recommended that is based on RQA5 but uses filtration materials that
are commonly available and simple to use. Recommendations on clinical implementation of the
indices to control image quality and patient dose are derived from historical tolerance limits and
presented as guidelines. © 2009 American Association of Physicists in Medicine.
关DOI: 10.1118/1.3121505兴
2898 Med. Phys. 36 „7…, July 2009 0094-2405/2009/36„7…/2898/17/$25.00 © 2009 Am. Assoc. Phys. Med. 2898
2899 Shepard et al.: Exposure indicator for DR: TG116 „Executive Summary… 2899
Key words: digital radiography, direct digital radiography, indirect digital radiography, computed
radiography, photostimulable storage phosphor, image quality, image noise, exposure index, quality
control, quality assurance, acceptance testing
I. INTRODUCTION of rules to produce consistent, high quality digital radio-

graphic imaging based not on image density but on feedback
The charge of TG116, as approved by the Science Council of regarding the detector exposure provided.
AAPM, was to identify a method of providing feedback, in Several manufacturers currently use an exposure indicator
the form of a standard index, to operators of digital radio- which parallels the concept of “speed” or “speed class” used
graphic 共DR兲 systems, which reflects the adequacy of the by film manufacturers. In addition, many manufacturers and
exposure that has reached the detector after every exposure users have become accustomed to characterizing their sys-
event. This report is the answer to that charge and will cover tems as functioning within a given speed class. This has
all digital radiographic image detector systems leaving digi- created some misunderstandings and scientific inaccuracies
tal fluorography or fluoroscopy 共radioscopy兲 for future con- which have been discussed in the literature.5
sideration. TG116 recommends avoiding the concept of speed class
Unlike screen-film imaging, image display in digital radi- when referring to DR system performance. The definition of
ography is independent of image acquisition. Inadequate or radiographic speed according to ISO 9236-1 is based on the
excessive exposure is manifested as higher or lower image radiation exposure required to achieve a net optical density
noise levels instead of as light or dark image. The final of 1.0 on the developed film.6 With digital radiography there
brightness of the image is controlled not by the exposure to is no fixed relationship between the radiation exposure and
the detector but by postprocessing applied to the acquired the resultant density in the image. With film-screen detectors
image data. Consequently overexposed images may not nec- a change in speed may also result in a change in the spatial
essarily be dark, and underexposed images may not appear resolution properties of the detector. This same relationship
light. This may be a new and confusing concept for operators does not hold true with digital detectors since sharpness is
of digital radiographic systems who are accustomed to independent of the amount of exposure used to acquire the
screen-film imaging. digital image.
For more than a decade, the phenomenon of “exposure The characterization of a digital radiographic system as
creep” in photostimulable storage phosphor imaging has being in a given speed class may give the false indication
been reported.1–3 This is attributed to the fact that digital that it should always be operated at a specific exposure level.
imaging systems can produce adequate image contrast over a It may also give the false impression that the resulting digital
much broader range of exposure levels than screen-film im- image will have the same noise and resolution characteristics
aging systems. This broad dynamic range is one of the ben- as those acquired with an equal speed class film/screen sys-
efits of digital detectors. However, if the detector is underex- tem. The digital system in reality can be operated over a
posed higher noise levels may obscure the presence of subtle broad range of sensitivity since the amount of radiation ex-
details in the image. Excessive detector exposures may pro- posure determines only the level of quantum mottle and not
duce high quality images with improved noise characteristics the brightness of the image. From this context the level of
but at the expense of increased patient dose. In extreme radiation exposure, and thus the speed class, should be de-
cases, excessive detector exposures may result in artifacts. pendent upon the imaging task and upon the observer’s tol-
As a result, most radiologists tend to complain about under- erance of image noise. As a general rule the ‘‘as low as
exposed images but remain silent when images are acquired reasonably achievable’’ 共ALARA兲 concept should prevail in
at higher dose levels unless apparent saturation has occurred. that the minimum amount of exposure, and hence, the maxi-
Technologists quickly learn that they can produce images of mum tolerable noise content, should be used to achieve the
better quality if they increase their exposure techniques, re- necessary diagnostic information.7 Using the speed class
sulting in less noisy images and avoiding radiologist com- characterization for given digital imaging systems may in-
plaints about noisy images. Average exposure levels tend to crease the possibility that ALARA is violated for some im-
creep up over time if a clear indicator of exposure is not aging tasks.
provided and routinely monitored. An index of detector exposure is appropriate because it is
Techniques required to achieve optimal radiographic im- reflective of the noise content, and thus the signal-to-noise
aging in DR may be different from those used for film/screen ratio 共SNR兲 in the image. For DR systems, the appropriate
imaging. In addition, different DR detectors may require dif- incident exposure is variable based on the desired signal-to-
ferent technique factors due to differences in the energy de- noise ratio rather than on the resulting optical density of a
pendence of the detector materials in use.4 共See Fig. 1.兲 radiograph. Different digital detectors may require more or
These technique differences between DR systems may cause less radiation exposure to achieve the same noise content
confusion and suboptimal image quality at sites where more depending upon the DQE of the detector technology in use.
than one type of system is in use. Operators need a clear set For a given system, the image noise content will track in-
Medical Physics, Vol. 36, No. 7, July 2009

versely with the detector exposure. As radiation exposure to applied on a pixel-by-pixel basis. After these corrections
the detector increases, image noise will decrease and SNR have been applied, the set of resulting pixel values are ready
will increase. to be processed by the system and are referred to as “for-
A standardized indicator of the exposure incident on a DR processing” pixel or Q values. The system then attempts to
detector that is consistent from manufacturer to manufacturer identify which of these pixels contain information that is of
and model to model is needed. This could be used to monitor interest to the user, typically those that contain information
differences in exposure between DR systems at a given in- relevant to the anatomy being examined. This process is
stitution, to compare techniques between institutions, or to called segmentation. It is from the segmented image values
estimate the quality of images from a given radiographic that TG116 proposes the exposure indicators be determined.
system. It could also provide quality control 共QC兲 data if The final image for display results from grayscale transfor-
software is provided to record and retrospectively analyze mations, broad area equalization, edge restoration, noise re-
exposure data from all systems. duction, or other image-related processes that are performed
A standard indicator which reflects the radiation exposure on the for-processing Q values resulting in “for-presentation”
that is incident on a detector after every exposure event is Q P values. Q P values are typically stored in a PACS and
appropriate. The detector exposure indicator is intended to transmitted to a printer or workstation for display. The re-
reflect the noise levels present in image data. An adequate mainder of this section defines the terms used in this docu-
exposure is one that results in an appropriate noise level in ment that relate to digital radiography processes just de-
the image as determined by the clinic where the system is in scribed.
use. This report does not make recommendations on expo-
sure adequacy, nor does the indicator represent exposure to • DR: Radiographic imaging technology producing digi-
the patient. tal projection images such as those using photostimu-
The task group considers the recommendations in this re- lable storage phosphor 关computed radiography 共CR兲兴,
port to be achievable and important. It recognizes that a par- amorphous selenium, amorphous silicon, CCD, or
allel standard was recently completed within the Interna- MOSFET technology.
tional Electrotechnical Commission 共IEC兲, designated IEC • Standardized radiation exposure 共KSTD兲: The air kerma
62494-1 Ed.1: Medical electrical equipment—Exposure in- at the detector of a DR system produced by a uniform
dex of digital x-ray imaging systems—Part 1: Definitions field radiation exposure using a nominal radiographic
and requirements for general radiography. This IEC standard kVP and specific added filtration resulting in a specific
specifies the definitions and calibration conditions for the beam half layer value 共HVL兲共see Sec. IV兲.
detector exposure indices of digital radiography systems. The • For-processing pixel values 共Q兲: For-processing pixel
leadership of Task Group 116 participated in this IEC effort values are the image pixel values produced by a DR
since its inception and served as U.S. National Committee system after necessary corrections have been applied to
experts in IEC Working Group 43. The concepts and calibra- the initially recorded raw data to compensate for these
tion conditions in the IEC working draft are consistent with types of effects 共see IEC62220-1 Ed.1 for a complete
those in this report. While the terminology and definitions in description of appropriate correction methods兲.7 The
the IEC standard may differ in scale and nomenclature from following corrections may be applied:
those in this report, the IEC standard is completely consistent
共1兲 Defective pixels may be replaced by appropri-
with this report. Absolute adherence to the nomenclature,
symbols, and multiplicative factors of scale in this report are ate data.
inconsequential to achieving the ultimate benefit of these 共2兲 Flat-field correction.
recommendations as long as all manufacturers adhere to the 共3兲 Correction for the gain and offset of single pix-
IEC standard definitions. Users should be able to rely on a els.
manufacturer’s claim of conformance to the IEC standard to 共4兲 Geometric distortion.
identify equipment offering a standard exposure index as de- The relationship between Q and KSTD may vary for dif-
scribed in this report. ferent DR systems. Manufacturers are expected to pro-
vide access to Q data and to provide information on this
relationship as a part of normal system documentation.
II. DEFINITION OF TERMS USED Images with Q values would typically be processed by
Digital radiography systems utilize a series of computa- the DR system in order to produce images for
tional processes to transform the raw data of the detector into presentation.
an image intended for presentation. These processes include
those used to assess the average response of the detector and • Normalized for-processing pixel values 共QK兲: Normal-
its relation to the incident x-ray exposure. ized for-processing pixel values QK are for-processing
The image formation process begins with the extraction of pixel values Q which have been converted to have a
raw data from the detector immediately following an expo- specific relation to a standardized radiation exposure
sure event. Those data must be corrected for imperfections in 共KSTD兲. Q values are converted to QK using the DR
the detector array such as the presence of bad pixel elements, system’s relationship between Q and KSTD. After con-
dark current corrections, and gain corrections that may be version of Q to QK, the relationship between air kerma

at the input surface of the detector and the QK value is detector response for a specific image, KIND, agrees
with KTGT共b , v兲. Relative exposure indices are to be re-
QK = 1000 log10 冋册
KSTD
, 共1兲
ported as
K0
where KSTD is in microgray units, K0 = 0.001 ␮Gy,

DI = 10 log10冋 KIND
册
KTGT共b,v兲
, 共2兲
and KSTD ⱖ K0. with one significant decimal of precision 共i.e., 0.0, .6,
• For-presentation image values 共Q P兲: For-processing −1.3, . . .兲. DI is intended as an indicator for radiogra-
pixel values 共Q兲 are typically modified by image pro- phers and radiologists for whether or not the tech-
cessing to produce an image with values suitable for nique used to acquire a radiograph was correct. This
display 共Q P兲. This processing generally determines the definition results in a DI of 0.0 when the reported
useful values for display and applies a grayscale trans- KIND equals KTGT 共a perfect exposure兲. The index
formation. The processing may also provide broad area changes by ⫾1.0 for each +25% / −20% change of the
equalization, edge restoration, or noise reduction. reported KIND.
• Indicated equivalent air kerma 共KIND兲: An indicator of
the quantity of radiation that was incident on regions of
the detector for each exposure made. The value reported III. RECOMMENDATIONS
may be computed from the median for-processing pixel
This report makes the following specific recommenda-
values in defined regions of an image that correlate with
tions regarding the indicator of exposure for digital radiog-
an exposure to the detector. The median value is then
raphy systems:
converted to the air kerma KSTD from a standardized
radiation exposure that would produce the same detec- • It is recommended that all DR systems 共regardless of
tor response, i.e., result in the same median for- detector design兲 provide an indicator of the x-ray beam
processing signal value Q in a predefined ROI. The re- air kerma 共expressed in ␮Gy兲 that is incident on the
gions from which the median is determined may be digital detector and used to create the radiographic im-
defined in different ways 共see Sec. V兲. The value should age. This indicator shall be called the indicated equiva-
be reported in microgray units with three significant fig- lent air kerma 共KIND兲. It is further recommended that
ures of precision. the DICOM Standard incorporates a new element for
• Image values of interest 共VOIs兲: Pixel values in the digital radiography that is specifically defined as the
original image 共Q兲 that correspond to the region in the indicated equivalent air kerma. The indicator value shall
recorded image area for a particular body part and ana- be included in the DICOM header of every image as a
tomical view. KIND may be calculated from a subset of floating point value with three significant figures.
pixels within the VOI. Not all pixel values in an image • In addition to the indicated equivalent air kerma, it is
are associated with objects that are of interest to the recommended that the relative deviation from the value
viewer for the purposes of diagnosis. Those that are of targeted by the system for a particular body part and
interest are referred to as the VOIs. The pixels that are view be reported. This index, the DI, should be promi-
associated with the VOI are typically identified based nently displayed to the operator of the digital radiogra-
on their physical location and their relative signal phy system immediately after every exposure and im-
strength characteristics. This identification process is re- mediately after any modification of the detected image
ferred to as segmentation. Specification of a standard values of interest. It is further recommended that the
method to be used for segmentation is not within the DICOM Standard incorporate a new element for digital
charge of this task group. Further, to recommend one radiography that is specifically defined as the deviation
standard method above all others may impede the de- index. This indicator value shall be included in the DI-
velopment of more sophisticated methods that yield COM header of every image as a signed decimal string
more stable results in the future. Detector values suit- value between ⫺9.9 and +9.9 with one significant digit
able for presentation 共Q P兲 are typically sent to display after the decimal.
devices 共printers or workstations兲 or image archives. • The indicated equivalent air kerma and the deviation
DICOM standards, including DICOM PS3.14, define index are determined from the segmentation image pix-
these as presentation values, or P values.8 els 共see Sec. V兲. It is recommended that systems pro-
• Target equivalent air kerma value 共KTGT兲: The optimum vide display functions to optionally delineate the seg-
KIND value that should result from any image when the mented image pixels as an overlay on the recorded
detector is properly exposed. KTGT values will typically image that is otherwise normally presented for approval
be established by the user and/or DR system manufac- by the operator. Additionally, this overlay region can be
turer and stored as a table within the DR system. The incorporated in any images exported for archive or
table is referred to in this document as KTGT共b , v兲 where viewing using DICOM services. DICOM Segmentation
b and v are table indices for specific body parts and Storage SOP Class 共Supplement 111兲 forms the basis
views. for achieving this functionality.9 Alternatively, this
• Deviation index 共DI兲: An indicator as to whether the could be accomplished with overlay and annotations

that are part of Gray Scale Presentation State Storage scientific grade 共also called ultrapure aluminum兲 and is avail-
objects described in DICOM Supplement 33.10 able only through specialty metal companies for a high price
• Vendors should provide appropriate analytical tools 共see and in small quantities and limited form. Alloy 1100 is a
Sec. XI兲 and allow for-processing image data 共Q val- 99.0% pure Al alloy that is widely available on the market.
ues兲, or exposure values normalized to the standard The use of copper as a component of the added filtration
beam conditions 共QK兲, to be displayed and analyzed on is recommended in order to reduce the overall thickness of
the system console. It is also important that the vendor added material. In prior publications, 0.5 mm of Cu was
allows these data to be exported in DICOM format for found to minimize the variability in the response of a CR
off-line analysis. To accomplish this, all DR systems system as kVP was varied within 80 kVP ⫾ 10%.14,15 The
should provide access to images containing for- addition of Al material allows a HVL near the desired nomi-
processing pixel values Q. This can be provided by sup- nal to be achieved while keeping the copper thickness at a
port for DICOM export services of DX for-processing value that is readily available from metal foil suppliers. The
images containing normalized for-processing values added Al material should be on the beam exit surface of the
QK. Alternatively, images of either QK or Q can be Cu so that any Cu characteristic radiation is absorbed in the
made available in DICOM PS3.10 format on a media aluminum.
storage device.11 Typically, clinical tubes in use at modern facilities contain
• The relationship between QK values and the standard- enough inherent+ added filtration to exceed the IEC open
ized radiation exposure incident to the DR detector is beam HVL specification of 2.5 mm Al at 70 kVP 共RQR5兲. If
required for tests of system performance. It is recom- this is the case, the filtration to be added to the beam should
mended that this relationship be provided by the system be reduced to satisfy RQA5 by removal of all or part of the
manufacturer over the full range of radiation exposures aluminum. If the open beam HVL falls below the specifica-
that the system is capable of recording. tion of 2.5 mm Al at 70 kVP, the filtration to be added to the
• For tests of system performance, it is useful to view and beam should be increased to satisfy RQA5 by addition of up
analyze the for-processing image values of acquired test to 4 mm of aluminum. If the unfiltered beam is generated
radiographs. It is recommended that systems provide using exotic added filtration, it is recommended that added
functions to display images without image processing filtration be replaced with enough aluminum to meet the re-
共i.e., Q values兲 and to report the mean, median, mode, quirements of RQR5. The kVP may also be adjusted, if nec-
standard deviation, and pixel count of values within essary.
graphically defined regions. Interactively drawn circular Added filtration with 0.5 mm of copper plus 3–4 mm of
or rectangular regions are appropriate for this purpose. aluminum is suitable for x-ray tubes with modest intrinsic
• For testing of systems, it is recommended that manufac- filtration. For an unfiltered x-ray tube spectra with HVL of
turers provide methods to remove the antiscatter grid 2.58 mm Al at 70 kVP 共RQR5兲, computational simulations
without otherwise changing the detector response or 共see Appendixes A and B兲 indicate that a similar beam qual-
provide grid attenuation factors to be used in ity with HVL= 6.8 mm Al is obtained using added filtration
calibration. of either 21 mm of pure aluminum as specified for RQA5,
0.5 mm Cu plus 3 mm Al 共type 1100兲, or 24 cm of muscle.
IV. STANDARD RADIATION EXPOSURE The following types of brass 共30%–50% zinc with traces
CONDITIONS of tin兲 are also considered acceptable to be used in place of
the copper: Admiralty brass 共30% zinc and 1% tin兲, alpha
IV.A. Standard beam spectrum
A uniform field radiation exposure made to the detector of
a DR system is used to assess the relation between for-
processing image values recorded by the detector 共Q兲 and the
quantity of radiation incident on the detector 共KSTD兲. The
radiographic technique used to make the exposure is in-
tended to provide a beam quality typical of that for most
examinations for which the system is used. This is done by
using additional filtration to emulate the beam hardening of a
patient. This section recommends standardized radiation con-
ditions to be used for this purpose and addresses only general
radiographic systems.
The IEC and ISO have previously made recommendations
for standard radiation conditions for use in testing medical
diagnostic x-ray systems.6,12,13 A variety of conditions with
different beam qualities are recommended and labeled with
“RQA” prefixes. However, these conditions require thick fil-
ters composed of 99.9% aluminum which is impractical for
field measurements. Alloy 1190 falls into the category of FIG. 1. Energy dependence of common detector materials 共Ref. 4兲.

TABLE I. Standard beam radiographic conditions.
Added Nominal IEC

kVP filtration HVL surrogate
0.5 mm Cu+ 共0 – 4兲 mm Ala

66–74 or 21 mm pure Al 6.8 mm Ala RQA-5
a
Type 1100.
brass 共less than 35% zinc兲, alpha-beta brass or duplex brass

共35%–45% zinc兲, arsenical brass or DZR brass, beta brass
共45%–50% zinc兲, cartridge brass 共30% zinc兲, common brass
or rivet brass 共37% zinc兲, high brass 共35% zinc兲, low brass
共20% zinc兲, naval brass 共40% zinc brass and 1% tin兲, red
brass 共gunmetal兲, or yellow brass 共33% zinc兲. Use of leaded
brass, aluminum brass, white brass, or gilding metal is not
recommended.
For the first edition of IEC 61267, kVP was to be adjusted
to achieve a desired beam HVL.11 For the second edition,
more stringent constraints were placed on the beam quality
before added filtration rather than allowing kVP adjustments.
As a consequence, the conditions recommended in the sec-
ond edition are applicable only to laboratory facilities. It has
also been reported that CR system response varies by ap-
proximately 10% over a limited a range of kV.14 Measure-
ments made by TG members on a variety of clinical systems
共both CR and DR兲 indicate that system response is very con-
sistent within the recommended ranges of HVL, kV, and
added filtration 共see Appendix B兲. System response in terms FIG. 2. Standard beam geometry.
of for-processing signal per unit exposure varied by less than
or equal to 6% with kVP/filter combinations as low as
67 kVP with 0 mm Al 共5.93 mm Al HVL兲 to 73 kVP with 8 source has acceptable exposure reproducibility 共co-
mm Al 共8.62 mm Al HVL兲. Similar results have been found efficient of variation ⬍0.03兲 and kV accuracy
by others and reported in the literature 共see Fig. 1兲.4 For this 共⫾3%兲 at the standardized condition. During any
limited range of kV, 5% tolerance seems reasonable. exposure for which an image is not acquired, the
While use of the RQA5 beam is acceptable for calibra- image receptor should be protected from exposure
tion, TG116 recommends standard beam conditions using to the primary beam.
copper foil and highly available type 1100 aluminum with a 共2兲 The detector should be placed as far from the x-ray
specified kVP range whose accuracy has been independently source as is practical, at least 100 cm.
verified to be within 3% of the indicated value 共see Table I兲. 共a兲 If the detector is a CR plate the cassette should be
The target HVL is intended to be reasonably close to RQA5 separated from any surface that may increase
共6.8⫾ 0.25 mm Al兲. Minor adjustments in indicated kVP backscatter from that surface entering the cassette
and added filtration are permitted to achieve the target beam 共see Fig. 2兲, as recommended in AAPM Report
quality. While not required, it is acceptable to vary the kVP 93.15
by up to ⫾5% and the amount of added aluminum within the 共b兲 If present, and if possible, remove the antiscatter
listed range to achieve a beam quality that is as close as grid and any other system components present be-
possible to the listed target HVL. The generator used for the tween the ion chamber and the image detector
standard beam must be capable of maintaining a constant kV without otherwise modifying the response of the
throughout the entire exposure. detector. If any components cannot be removed,
obtain the attenuation factors from the DR system
IV.B. Standard beam geometry and calibration or component vendor.
verification procedure 共c兲 If the detector is not square, the long axis of the
This section describes the measurement geometry to be detector should be perpendicular to the x-ray tube
used to determine KSTD under the standard radiation expo- anode-cathode axis.
sure conditions shown in Fig. 2. The steps to use when mak-
共3兲 Place a calibrated ion chamber at the center of the
ing these measurements are summarized below.
beam approximately midway between the source
共1兲 Prior to any measurements verify that the x-ray and detector 共see position A in Fig. 2兲. The dis-

tances should be measured to the center of the

chamber and to the surface to the detector. The dis-
tance from the x-ray source, to the center of the ion
chamber, and to the surface of the detector must be
known. If the distance from the detector housing
surface to the detector is not labeled consult the
manufacturer for this measurement.
共4兲 Collimate the x-ray beam to only cover the ion
chamber with no more than 1 in. margins.
共5兲 Add 0.5 mm copper filtration at the face of the col-
limator. FIG. 3. Example of a method to determine KIND from an analysis of the
共6兲 Cover the detector with a lead attenuator or similar image histogram. 共Courtesy of Agfa Medical Imaging.兲
barrier to preclude exposure to the detector. Mea-
sure the HVL of the filtered beam and adjust the
kVP and/or aluminum filtration within the limits 共Q兲 and standardized radiation exposure 共KSTD兲, i.e., Q as a
specified in Table I to obtain a HVL as close as function of KSTD. This relationship should be specified over
possible to 6.8 mm Al. the full range of exposures for which the system is designed
共7兲 Make an exposure and determine the air kerma at to respond. If individual systems vary in response, informa-
the detector 共KSTD兲 using an inverse square correction provided with the system should include the acceptable
tion and applying the grid attenuation factor, if ap- variation specific to a particular system. As a part of accep-
propriate. Repeat the exposure at a new mAs setting tance testing, physicists may wish to verify this relationship
that will deliver the desired air kerma to the detec- by recording images of a uniform field obtained using stan-
tor. In general, the desired air kerma will produce a dard beam exposures made with an appropriate set of mAs
value of KSTD that is in the middle of the detector values.
response range. For validating Q as a function of KSTD, the incident air
共8兲 Move the ion chamber perpendicular to the tube kerma should be measured using the methods described in
axis such that it is outside the detector field of view Sec. IV B for which KSTD reflects the radiation incident to
共see position B in Fig. 2兲. the central region of the detector. For each image recorded,
共9兲 Remove the filtration and open the collimator so the either the for-processing image pixel values Q or the normal-
x-ray beam will cover the entire detector and in- ized for-processing image pixel values QK should be ana-
cludes a margin large enough to cover the ion cham- lyzed to determine the median value from a central region of
ber. If the system does not allow the collimator to interest 共具Q典 and 具QK典兲.
be opened beyond the detector size, open the colli- For determining the indicated equivalent air kerma from
mator as large as possible and place the ion chamber an individual clinical image, KIND is computed as the KSTD
as close to the edge of the x-ray beam as possible corresponding to the 具Q典 value in a defined region of a re-
within the field of view of the detector. Ensure that corded image 共see Fig. 3兲. The median of image values is
the entire ion chamber is in the radiation beam and computed and transformed using the known relationship be-
is not shadowed by a collimator blade. Replace the tween for-processing image pixel values 共Q兲 and exposure.
filtration. The median is recommended rather than the mean or mode
共10兲 Remove the protective lead apron and make an ex- because it is less affected by data extremes and outliers.
posure using the mAs found in step 共7兲 above. De- Rectangular or circular regions having an area greater than or
termine the ratio of the air kerma at position A to equal to about 4% of the active detector area should be used.
that at position B. The median value can be determined using vendor-supplied
analysis tools designed specifically for evaluating the test
When making standardized radiation exposures using this image or by exporting the test image as a DICOM object to
geometry, the air kerma recorded by the ion chamber is con- an external workstation for evaluation. The median Q value
verted to KSTD for each exposure using the KA / KB ratio de- and the median KSTD value are thus the same as long as the
termined and the inverse square correction. Some manufac- transformation is monotonic. Additionally, the median value
turers have specified other requirements in addition to beam can be determined from the histogram of values within the
quality, such as readout time delay after exposure with CR defined region.
systems. These requirements should be adhered to as long as The region used to compute KIND should be defined such
the standard beam conditions specified in this part are not that the indicated equivalent air kerma reflects the median
affected. exposure within the segmentation image pixels in the re-
corded image. The segmentation image pixels will vary de-
V. ASSESSMENT OF INDICATED EQUIVALENT AIR pending on the purpose of the radiograph. For example, the
KERMA „KIND… primary anatomic region of interest in a chest radiograph is
It is expected that manufacturers of DR systems will es- the lung parenchyma whereas the mediastinal and subdia-
tablish the relationship between for-processing image values phragmatic portions of the image would be secondary re-

est interest to be rendered with maximum contrast. The value

of KIND is computed from pixels in the for-processing image
that correspond to this range. Regardless of the method used
to define the region that is used to compute KIND, its value
should reflect any changes to the segmentation image pixels
that are made by the operator.
This report does not make recommendations as to how the
segmentation image pixels are to be defined. Rather, the
scope of recommendations is restricted to recommendations
directed at standardizing the terminology and beam condi-
tions associated with reporting indices of exposure. It is ex-
pected that conformance in these areas can be achieved in the
near future. The TG recognizes that the defined region from
which KIND is computed has strong influence on the result. A
completely satisfactory solution for this difficult engineering
FIG. 4. Example of a method to determine KIND from Q P of a processed problem remains unidentified. In light of this, the consensus
image 共Ref. 16兲. of the TG is that it would be inappropriate to limit further
development of more robust segmentation algorithms by es-
tablishing a standard method for defining segmentation pix-
gions. However, the mediastinum would be a primary region els at this time.
for a thoracic spine radiograph. Hence the segmentation im- The indicated equivalent air kerma KIND is an indicator of
age pixels for the PA chest exam and for the PA T spine, even the detector response in regions where anatomically impor-
if collimated identically, would not comprise the same set of tant tissues have been recorded by a DR detector. KIND is not
image pixels. equal to the incident exposure for the radiograph recorded.
For some existing systems the segmentation image pixels Rather, it is associated with the incident exposure from a
are defined by the portions of the image for which body standard reference beam that would have produced the same
tissue has attenuated the beam. Unattenuated regions of di- detector response. For this reason, it is referred to as an
rect exposure are excluded along with regions outside of the “equivalent” air kerma. For the general radiography standard
collimated primary beam that receive only scattered and off- beam conditions, the incident exposure required for the same
focus radiation. Other systems have used geometric regions receptor response in a typical DR detector varies modestly
共circles, rectangles, etc.兲 positioned in the general area of the for peak tube potential values in the range from 55 to
primary anatomic region. These can be systematically placed 90 kVP.4 In general, the actual incident exposure required to
in the field such as for the position of a central automatic produce the same detector response will change with varying
exposure control 共AEC兲 cell. tube potential for radiographs of a specific object.
More robust scene recognition algorithms may be used to
identify the segmentation image pixels. Robust region defi-
nition methods typically require advanced image segmenta- VI. REPORTING DEVIATION INDEX
tion algorithms that have generally not been fully disclosed For radiographs of different body parts and/or views, the
by manufacturers. In most cases, these methods occasionally value of KIND required to obtain acceptable image quality
fail under certain clinical conditions. To aid users in identi- may vary. Additionally, the purpose and clinical diagnostic
fying recordings for which the segmentation may have indications expected for a particular procedure may influence
failed, it is recommended that systems provide functions to what is considered acceptable. For this reason, it is recom-
display an overlay of the segmentation image pixels. If pro- mended that manufacturers automatically reference the ap-
vided, this overlay should be accurately registered to the im- propriate standard beam condition 共based on body part and
age pixels. Additionally, methods to modify the selection of anatomical view兲 when determining KIND and deduce the re-
segmentation of the image pixels after the automated seg- corded relative exposure from the appropriate KIND in rela-
mentation algorithm is performed should be provided. tion to that targeted for the body part and view of the radio-
For many systems, region definition is used to identify graph.
that portion of the image that should be rendered in the mid- The DI is intended to indicate the acceptability of SNR
portion of the grayscale transformation. In recent reports, it conditions in the segmentation image 共as compared to high
has been suggested that the for-presentation image pixel val- or low兲 to persons performing or interpreting radiographic
ues 共Q P兲 be used to define the region for computation of examinations. How this index is calculated and the informa-
KIND.16 In this work, pixels of the for-presentation image tion displayed to these groups have an influence on how it is
共Q P兲 within a fixed range of presentation values are used to interpreted. Several options were considered by the TG for
define the region for computation of KIND 共see Fig. 4兲. For the nature of this index. Some were of the opinion that an
example, presentation values from 45% to 55% of the full index that varies linearly with KIND / KTGT共b , v兲 would be
range of values are in the midgray regions of the image, more understandable to both radiologists and technologists.
which normally correspond to the anatomic regions of high- However, this approach suffers from the fact that such an

index would asymptotically approach 0 as exposures de- tion may be diagnostically unacceptable to the radiologist
creased to 0, thus minimizing the apparent impact that un- reading on a display calibrated to DICOM PS3.14. The de-
derexposure has on image quality. Another consideration is viation index can be used clinically to ensure that the amount
the fact that image noise is logarithmically related to expo- of radiation delivered to the detector and, hence, the noise
sure. For underexposed images, use of a linear indicator content in the image, is appropriate for a given imaging task.
would not reflect the magnitude of the change necessary to The reader should be cautioned that possible system er-
bring about a corresponding improvement in noise. It was rors in the segmentation may cause the DI to incorrectly
decided that a logarithmic scale in base 10 would provide reflect the adequacy of the exposure. Causes of errors in
appropriate information in terms of both direction 共overex- segmentation will vary by vendor—some examples include
posure or underexposure indicated by a positive or negative the presence of prostheses or gonadal shielding, failure in
value, respectively兲 and magnitude 共+1 is approximately identification of collimated area due to scatter or off-focus
125% of the intended exposure, ⫺1 is 80% of the intended radiation, and unexpected positioning of a body part in the
exposure兲 on needed technique corrections. An exposure re- field of view. Poorly defined collimation may lower the DI,
sulting in a DI value of +1 would require an adjustment of depending on the exam and projection. Undercollimation
⫺1 step on the density or mAs control of a properly cali- that causes unusually large amounts of the image to be un-
brated modern radiographic system. attenuated by the patient may increase the DI. Both of these
Tables of targeted values may be provided by manufactur- interferences can result in a false DI. If any of these is the
ers with values reflecting typically acceptable KIND values case and the reported DI is out of the acceptable range, a
for the detector technology being used. Typically, these will repeated exposure may not be necessary. The technologist
be lower for detector technology that has higher detective should closely scrutinize every image for noise content, us-
quantum efficiency. Provisions must be available for imaging ing zoom and pan utilities if available. DI values should be
centers to adjust the KTGT values based on an individual fa- treated more like a guide instead of an absolute measure of
cility’s criterion for image quality. Systems should provide a image quality. Until segmentation becomes more robust, the
mechanism to export and import tables in a consistent format technologist should judge image quality on noise content and
so that tables could be shared between imaging facilities us- not depend solely on the exposure index value.
ing the same DR system. A process for updating the tables of
all systems within a facility that is managed via a network
would be extremely valuable so that changes in KTGT values VIII. EXPOSURE INDICATOR AND RADIOGRAPHIC
can be readily disseminated to distributed systems. DR sys- TECHNIQUES
tems should also provide the means to automatically save the The KIND indicator serves as a means of establishing ap-
associated KTGT共b , v兲 for any body part and view as the de- propriate radiographic techniques which might otherwise
fault target value when invoked by an appropriately privi- drift widely from desired levels. Adhering to target ranges
leged operator. for the particular deviation index values can be a valuable
tool for standardization and stabilization of manual tech-
niques. For departments involved in clinical aspects of radio-
VII. CLINICAL USE OF THE DEVIATION INDEX logic technology training programs DI can also be used as an
The clinical use of the deviation index is essentially the aid to instruct students in proper manual technique selection
same as that of film optical density: It serves as an indicator and for evaluation of trainee performance in this regard.
of proper radiographic exposure. For film/screen images, the DI values are determined for each body part and anatomi-
optical density of the image itself is used to indicate proper cal view being imaged on an exposure by exposure basis by
exposure according to the clinical preferences of the facility. comparing the KIND value for a given exposure to the target
By delinking image appearance 共in terms of brightness or KTGT共b , v兲 values stored on the system. These KTGT共b , v兲
contrast兲 from the amount of radiation exposure used to pro- values are the optimal exposure values determined either by
duce it, digital imaging alleviates the dynamic range limita- the vendor or by the site system administrator for each body
tion suffered by film. The drawback is that the direct visual part and anatomical view being imaged. The KTGT共b , v兲 val-
feedback as to proper exposure is also severed. As has been ues should be set according to clinical preferences and spe-
noted before, the result can be widely varying clinical tech- cific exam needs. This approach is consistent with maintain-
niques, with consequences to both image quality and patient ing exposures in a range that is ALARA. The KTGT共b , v兲
radiation exposure. The primary concern with DR image values associated with each body part and view, if present,
quality as it relates to detector exposure is with image noise should automatically be invoked when the body part and
共quantum mottle兲. DR postprocessing and “QC” worksta- view for postprocessing are selected by the operator at the
tions generally utilize displays of lower resolution 共1024 processing system console.
⫻ 1024 or less兲 and lower brightness and capable of render- Once KTGT共b , v兲 levels are set, it is useful to identify sev-
ing fewer gray levels than those to be used for primary di- eral types of “control limits” on DI: A target range, a “man-
agnostic interpretation. These “secondary”17 workstations are agement trigger” range, or a “repeat” range 共see Table II兲.
also rarely calibrated to DICOM PS3.14. As result, it is often The reason for this is that unlike filmed images, in which
the case that image noise is not well appreciated on such inadequate or excessive image optical density is a determi-
displays. What might appear acceptable on the QC worksta- nant of when a repeated film is needed, the reason for repeat-

TABLE II. Exposure indicator DI control limits for clinical images. on DI may be difficult to achieve in practice due to variations
and drifts in CR reader calibration 共especially with multiple
DI Range Action
readers兲, variations between detectors, as well as traditional
Excessive patient radiation exposure: Repeat only if differences between x-ray rooms 共generator design, calibra-
relevant anatomy is “burned out,” require immediate tion, and tube filtration兲.
⬎+3.0 management follow-up
Overexposure: Repeat only if relevant anatomy is burned
+1.0 to +3.0 out
⫺0.5 to +0.5 Target range IX. KIND AND AUTOMATIC EXPOSURE CONTROL
Less than ⫺1.0 Underexposed: Consult radiologist for repeat SYSTEMS
Less than ⫺3.0 Repeat
In regard to maintaining appropriate image quality and
patient exposures, it is clear that AEC systems are just as
important to digital imaging as for film/screen imaging de-
ing a digital image is primarily noise related. What would be spite the wide dynamic range of DR. Regardless of detector
an underexposed film image may be of adequate diagnostic type, AEC systems are designed to 共and must be appropri-
value in digital form. Similarly, it is never appropriate to ately calibrated to兲 terminate an x-ray exposure once a pre-
repeat overexposed digital images unless analog-to-digital determined radiation exposure is recorded at the detector.
converter saturation has occurred which may cause relevant Like film/screen systems, digital detectors have energy de-
parts of the image to be “burned out” or “clipped” 共that is, all pendence, which in general differs from that of the AEC
pixels in the affected region are forced to the maximum digi- sensors 共see Fig. 1兲.4 Depending on design and calibration of
tal value and thus containing no information兲 or contrast to the AEC, the result can be digital image levels that vary from
be affected in excessively exposed regions of the image. the desired level.
Since this judgment depends upon the diagnostic task, it is A well-designed AEC should be capable of modifying re-
appropriate to seek consultation with a radiologist for certain quired detector exposures based on exposure conditions
ranges of DI-indicated underexposure and overexposure 共typically selected kVP and mA兲 to compensate for energy
prior to repeating. dependence and exposure rate and thereby maintain a con-
A properly functioning AEC system will produce optical sistent image signal-to-noise ratio.19 Assuming that AEC per-
densities of ⫾0.15 OD under varying combinations of kVP formance is evaluated under clinically relevant conditions
and phantom thickness 共adjusting mA to result in exposure which can be simulated by various thicknesses of acrylic and
times greater than 10 ms兲.18 For a film/screen combination, kVP ranging from 60 to 120,19 the KIND can serve as the
optical density in the straight-line portion of the H&D curve indicator of image signal level for this purpose, just as opti-
is related to detector exposure 共or KIND兲 as follows: cal density did for film. Adequate AEC performance with
冉冊
film/screen is considered to be a density variation of ⫾0.15
KIND2
⌬OD = ␥ log10 . 共3兲 OD on a system using film with a gamma of 2.5. For equiva-
KIND1 lent performance on a DR system using AEC, one would
expect KIND to remain constant with varying thickness and
Combining Eqs. 共2兲 and 共3兲, the range of deviation indices kVP 共adjusting mA to result in exposure times greater than
corresponding to a given OD range would be 10 ms兲 within ⫾7%.
⌬DI = 冉冊
10
␥
⫻ ⌬OD. 共4兲
In using KIND during AEC performance evaluation, sev-
eral caveats must be noted. First, the KIND may be associated
with a different image region from that used by AEC sensors;
For a film/screen combination with a gamma of 2.85 共a fairly second, the size of the area used by KIND determination may
common gamma in clinical use兲, the acceptable DI range introduce different field sizes and energy-related effects from
would be those affecting the AEC; and third, many of the conventional
⌬DI = 冉冊
10
2.85
⫻ 0.3 = 1.05 or ⫾ 0.5.
radiographic systems used with DR were designed to com-
pensate for film/screen energy dependencies and may not be
capable of providing constant response for DR.
The TG recommends the action levels shown in Table II. Many radiographic systems in use today incorporate AEC
To be effective, care must be taken to assure that appro- systems designed for use with film/screen systems and may
priate targets and limits are posted and the radiographers are allow for energy compensation appropriate for film/screen.
educated and periodically re-educated as to their meaning. A Such compensation may be hard-wired and unalterable or
substantial deviation from the established target range should may have insufficient ability to compensate appropriately for
require management oversight to determine the cause for the DR. In particular, it is often the case that KIND tends to be
deviation and implement appropriate corrective action such higher for AEC-based exposures at lower kVP because the
as retraining, recalibration of the equipment, or reassessment AEC compensation intended for rare-earth film/screen sys-
of the target value. Operators should be instructed that high tems overcorrects for lower kVP.20 If this is the case,
DI values are associated with excessive radiation dose but KTGT共b , v兲 values for DI may need to be adjusted upward to
have good image quality with respect to noise. Tighter limits appropriately reflect this energy dependence.

Appropriate KTGT共b , v兲 ranges for AEC performance using the same DR system. A process for updating the tables
evaluation must therefore take into account the age and pedi- of all systems within a facility that is managed via a network
gree of the radiographic system. Derived KTGT共b , v兲 limits would be extremely valuable so that changes in KTGT values
for AEC testing are equivalent to those that are used for film can be readily disseminated to distributed systems.
共for example, ⫾0.15 optical density units兲.21 Certainly, the For each clinical mode of operation other than general
much narrower latitude of film/screen calls for fairly tight radiography for which a system is designed, the calibration
AEC performance limits for reliable clinical results. Al- conditions should be specified by the manufacturer 共see Sec.
though desirable for DR as well, this may not be achievable XII兲. The manufacturer should also provide the following:
in practice at this time.
• Filter共s兲 to be utilized for establishing KSTD for general
radiography as well as for other modes of operation and
X. INAPPROPRIATE CLINICAL USE OF DI should specify which body parts and views are associ-
A final note regarding DIs and clinical techniques: Even if ated with each filter 共see Sec. XII兲.
images being produced clinically have corresponding DIs • A means to readily mount/dismount the filter共s兲 on an
well with the target range, the clinical techniques used may x-ray collimator.
still not be appropriate. One can just as readily achieve an • mA, time/mAs, SID, grid or no grid, and system proto-
acceptable DI for an AP L-spine view with 65 kVP as with col settings for calibration conditions.
85 kVP; evidence of underpenetration and concomitant ex- • The grid transmission factor associated with each beam
cess patient exposure with the lower kVP may be clear from condition 共if present兲.
the contrast and underexposure of the spine regions but may • Exact specification of how to configure the system to
be windowed/and leveled out in a digital image. Similarly, obtain the for-processing image data.
poor collimation, unusual patient body habitus, the presence • Written, step-by-step calibration protocol and recom-
of prosthetic devices, or the presence of gonadal shielding in mended frequency of calibration.
the image may raise or lower DIs 共depending on the exam • Full disclosure of the KTGT values associated with each
and projection兲 and perhaps hide an inappropriate body part and view.
technique.22–25 It is essential that all aspects of good clinical • Specification of the accuracy and reproducibility of the
technique be adhered to and an appropriate DI value should KSTD for the standard beam condition and the expected
not be interpreted as proof of good work. change in KIND for other beam conditions.
The task group strongly recommends implementation of all
XI. RECOMMENDED OPTIONAL FEATURES of these ideas and anticipates the creation of many more once
the efforts of the equipment manufacturing community are
In addition to implementation of this standardized expo-
brought to bear on these issues.
sure indicator, there are opportunities for other useful tools to
facilitate presentation of image processing-related informa-
tion and improve the overall quality of the imaging opera-
tion. For instance, Sec. III calls for an overlay that graphi- XII. APPLICATION TO DEDICATED CHEST,
cally illustrates the pixels in a given image which have been MAMMOGRAPHY, VETERINARY, AND DENTAL
used to calculate QK. This is intended to provide a very quick RADIOGRAPHY
method of determining that the automated segmentation soft- KIND is intended to be used as a measure of image quality
ware performed correctly for any image. A similar feature with respect to image noise. For low energy x rays, more
would be to create a pop-up display of the Q histogram with incident radiation is required to create the same detector re-
the locations of the segmentation image pixels minimum and sponse as for high energy x rays. The variation in detector
maximum overlaid on it showing the minimum and maxi- response for kVP values between 55 and 90 is sufficiently
mum Q values used for QK determination. Finally, there are small to make KIND an effective indicator of image quality
many clever ways to indicate the DI for every image using a with respect to the recorded noise in the image.4 For higher
sliding bar or color coded tool with position and or color energies, this may not be the case. To maintain a consistent
linked to the magnitude of DI. relationship between image noise and the indicator, it is pos-
Other highly desirable features are logs of the DI values sible that two standard beam conditions could be defined,
and logs of the reasons for rejected and repeated images one for imaging of the chest at tube potential settings above
stored on the system. The anatomical view selection and 100 kVP and one for all other radiographic images. This
technique factor information for every rejected image as well higher energy standard beam should be reasonably close to
as the images themselves should also be stored on the sys- RQA9 共see Table III兲.
tem. Software to analyze these logs to assist with process For a tube with HVL of 5.00 at 120 kVP 共RQR9兲, similar
improvement by identifying potential problematic exams, beam quality with HVL= 11.6 mm is obtained with 40 mm
problems with equipment, and technologists in need of con- of pure aluminum as specified for RQA9 or with 1.0 mm Cu
tinuing education is also invaluable to the user community. plus 4 mm of Al 共type 1100兲. If 11.6 mm Al HVL cannot be
As already mentioned in Sec. III, systems should provide achieved at 120 kVP with the recommended filtration, the
a mechanism to export and import tables in a consistent for- additional aluminum filtration may be reduced and the kVP
mat so that tables could be shared between imaging facilities adjusted to achieve the required HVL.

TABLE III. A standard beam condition for dedicated chest imaging systems.
Application kVP Added filtration Target HVL IEC surrogate

a a
Dedicated chest 114–126 1.0 mm Cu+ 共0 – 4.0兲 mm Al or 40 mm pure Al 11.6+ 0.3 mm Al RQA-9
a
Type 1110.
Digital mammography, veterinary, and dental radiography 共C兲 24.5 cm muscle 关National Bureau of Standards 共NBS兲
can all potentially benefit from a universal exposure indica- muscle composition兴.26
tor for the same reasons discussed in this report. Digital ra-
diography in these fields suffers the same problems with Added filtration A is based on the RQA5 standard and
manufacturer specific exposure indices from which DR suf- filtration B on the TG116 standard. For filtration B, the alu-
fers. Application to these areas would require modification of minum thickness is specified as 2.8 mm based on results
the calibration beam conditions to reflect the differences in indicating that the HVL matches at the same kVP. The added
typical beam attenuation and beam energies in clinical use. aluminum was iteratively changed to determine this value.
The conditions for general radiographic systems differ Additionally, the relation between added aluminum and the
substantially from those for mammography systems. Devel- kVP needed to obtain a HVL of 6.8 was determined. Simi-
oping a universal exposure indicator for mammography larly, 24.5 cm of muscle is chosen to match the HVL at the
would be useful for providing technologists feedback about same kVP.
exposure adequacy, especially for institutions with digital The results are summarized as follows:
mammography units from different manufacturers. • The three added filtration conditions produce nearly
identical spectra at the same kVP when the kVP is ad-
APPENDIX A: RQA-5 VS TG116 STANDARD BEAM justed to obtain a HVL of 6.8 共see Figs. 5 and 6兲.
CONDITIONS, XSPECT 3.5B COMPUTATION • The HVL increases/decreases by about 0.1 for a 1 kVP
SIMULATION change 共see Fig. 7兲.
1. Simulation of standard beam conditions • The kVP for which a HVL of 6.8 is produced is related
to the HVL of the source with a slope of ⫺2.5 kV/mm
Computational simulations using the XSPECT toolkit were 共73.6 kVP at 2.58, 72.6 at 3.02, 70.1 at 4.00 mm兲. See
used to simulate Fig. 8.
• the x-ray spectrum emitted by typical x-ray tube and • The detected signal and SNR in relation to kVP is
collimator assemblies, nearly identical for added filtrations A and B above 共see
• the attenuation of the spectrum by various amounts of Figs. 9 and 10兲.
added filtration,
• the half value of the x-ray spectrum,
• incident on the added filtration and
• incident on a detector;
• and the signal and noise of a digital radiography
detector.
For x-ray source conditions, three x-ray sources were con-
sidered based on their HVL at 70 kVP:
共A兲 IEC RQR5 共2.58 mm Al, 70 kVP, Al intrinsic filtra-
tion兲.
共B兲 Henry Ford Health System 共HFHS兲 Rm 3 共3.02 mm Al,
70 kVP, Al/Cu intrinsic filtration兲.
共C兲 HVL 4 共4.00 mm Al, 70 kVP, Al/Cu intrinsic
filtration兲.
Source A is a lightly filtered source based on the IEC

RQR5 specifications. Source B is based on a clinical system
at HFHS for which the HVL has been experimentally mea-
sured. Source C is a hypothetical system with relatively
heavy intrinsic filtration. FIG. 5. Using a source with HVL= 3.02 mm Al, kV= 72.59, the spectra for
alternative additive filtrations are shown. The spectrum with added filtration
For added filtration, three added filtration configurations 21 mm of aluminum 共Type 1090, 99.9%兲 is shown as a solid line. The
were considered: spectrum with added filtration of 0.5 mm of copper plus 2.8 mm of alumi-
num 共Type 1100兲 is shown as points. The points have been reduced by a
共A兲 21 mm aluminum 共99.9%, RQA5兲. factor of 0.514 to produce the same exposure 共mR兲 as the line. Both spectra
共B兲 0.5 mm copper and 2.8 mm aluminum 共99.0% Al兲. have HVL⫽6.80.

3. X-ray emission spectrum „SPECT_GEN…

X-ray emission spectra in units of photons/共keV sr mA s兲
are obtained from the SPECT_GEN module. In generating a
spectrum, the user defines the kVP, atomic number, tube
angle, voltage waveform, and spectral increment. The pro-
gram then generates a spectrum of bremsstrahlung and char-
acteristic radiations and corrects them for self-absorption.
The spectral calculations are based on equations from
Storm27,28 and contain empirical corrections for tube angle
and voltage ripple. The results from XSPECT have been cross-
checked for molybdenum and tungsten tubes against Fewell
and Shuping’s data published by the FDA though the Bureau
of Radiological Health.29
4. Primary beam attenuation „ATTEN…

Attenuation of the emission spectrum by various layers of
FIG. 6. Same solid line as Fig. 5. Again, the spectrum with added filtration
materials is done using the program ATTEN that applies
21 mm of aluminum 共Type 1090, 99.9%兲 is shown as a solid line. The
spectrum with added filtration of 24.5 cm of muscle 共NBS兲 is shown as Beer’s law to the primary beam based on the material com-
points. These values have been increased by a factor of 43.7 to normalize position of the layer. Material compositions are stored in
the exposure. material files having a standardized format and maintained in
a material library. Photoelectric cross sections for the ele-
ments were obtained from the work of Biggs and Lighthill.30
2. XSPECT computational tools The coherent and incoherent cross sections were taken from
the work of McMaster et al.31 For aluminum materials, type
HVL 共aluminum兲 were computed using the XSPECT toolkit 1100 was used for 99.0% purity material and type 1090 for
for modeling x-ray transmission imaging. This toolkit con- 99.9% purity material. Typical impurities were taken from
tains programs for generating and modifying x-ray spectra matweb 共www.matweb.com兲
stored in a common format. Utility programs modify the
spectra to account for primary beam attenuation, unit conver- 5. Entrance exposure „mR…
sion, and distance effects. Other programs compute the ex-
posure in mR, the HVL of the x-ray spectrum, and the re- After the beam is attenuated, a simple inverse square law
sponse of a detector in terms of the recorded signal and noise is applied to yield the spectrum at the entrance point to the
in units of electrons. The toolkit is presently being used in a patient. The MR program then computes the exposure at this
graduate laboratory course on radiation imaging 共NERS 580, point. The computation of exposure involved summing the
University of Michigan, www.engin.umich.edu/class/ product of energy fluence 共ergs/ cm2 / keV兲 and the air energy
ners580兲. absorption coefficient over the range of spectral energies.31 A
conversion factor of 87.643 共ergs/gm兲/R is used along with
the air ionization factor of 33.97 J/C.
6. Detector response „DETECT…

The DETECT routine is used to compute detector signal by
a weighted numeric integral of the x-ray energy spectrum
incident on the detector assembly, ␾d共E兲
共photons/keV cm2 mA s兲:
S = Ap 冕 0
kVP
␩s共E兲E␾d共E兲dE,
␴2s = A p 冕 kVP
0
共␩␴共E兲兲2E2␾d共E兲dE,
where A p is the pixel area in cm2 and S has units of

electrons/共pixel mA s兲. The signal transfer efficiency, ␩s共E兲
共electrons/keV兲, represents the average number of electrons
FIG. 7. Same solid line as Fig. 5. The points are for 0.5 mm Cu plus 2.8 mm
produced in the detector by an incident x-ray with energy E.
Al 共1100兲 added filtration. The HVL of both is 6.8 at a kV of 72.59. For
both, the slope of the relation with kV is 0.094 mm/kV. As a rule of thumb, If ␩s共E兲 equals 1.0 for all energies, the signal computed is
a 1 kV increase will produce a 0.1 increase in HVL. that for an ideal energy integrating detector, Si.

FIG. 8. Same source as in Fig. 5. The solid line shows the dependence of FIG. 10. Similar conditions as for Fig. 9, the detected signal 共electrons兲 per
HVL on kV for 21 mm Al 共1090兲. The points are for 24.5 cm muscle 共NBS兲 incident mR 共scatter free兲 as a function of kV is shown.
added filtration. The sensitivity of HVL in relation to kV is slightly more
compared with that for 21 mm Al added filtration.
The detector tables for a 500 ␮m thick selenium direct digi-
tal radiography detector were used in this comparison.
The noise variance of the detector signal was computed
using a similar integration 共see equation above兲. The noise APPENDIX B: COMPARISON OF PURE ALUMINUM
variance ␴2s has units has units of electrons2 / 共pixel mA s兲. VERSUS COMMERCIALLY AVAILABLE TYPE
The noise transfer efficiency, 共␩s共E兲兲2 共electrons2 / keV兲2, 1100 AND 1190 ALUMINUM AND A
represents the average contribution to the signal variance of a COPPER/ALUMINUM ALTERNATIVE FOR RQA5
pixel by an incident x-ray with energy E. The noise com- 1. Introduction
puted for an ideal detector is similarly obtained by setting
␩s共E兲 = 1. The signal-to-noise ratio, S / ␴s, is seen to be pro- Task Group 116 has recommended 0.5 mm copper 共Cu兲
portional to A1/2 with 0–4 mm of alloy 1100 aluminum 共Al兲 as an alternative
p as expected
The accuracy of the signal and noise estimate computed x-ray beam hardener to obtain the same RQA5 spectrum as
by the DETECT routine depends on an accurate knowledge of specified in IEC 61267:2005.12 IEC 61267 requires the use
the transfer efficiencies ␩s共E兲 and ␴2s . For this work, both 99.9% pure aluminum for the RQA5 radiation qualities.
were determined by using a Monte Carlo analysis to estimate Alloy 1190 is a 99.9% pure Al alloy that meets the re-
the detector’s signal probability distribution function, quirements of IEC 61267. In attempts to purchase alloy
p共q , E兲dq, that describes the probability of collecting q elec- 1190, the authors were unsuccessful in finding an off-the-
trons when an x-ray of energy E is incident on the detector. shelf source; alternatively alloy 1100 is a 99.0% pure Al
alloy that is widely available on the market. Alloy 1190 is
FIG. 9. Same source as Fig. 5. The detected NEQ 共i.e. SNR2兲 for alternative
additive filtrations are shown in relation to kV. The response for 21 mm
added aluminum 共Type 1090, 99.9%兲 is shown as a solid curve. The points FIG. 11. Simulated beam spectrum comparison of 21 mm 100% Al and the
are for 0.5 mm Cu plus 2.8 mm Al 共1100兲 added filtration. mean of 21 mm alloy 1100 at 70 kVP.

FIG. 12. Simulated beam spectrum comparison of 21 mm 100% Al and the FIG. 14. Simulated beam spectrum comparison of 0.5 mm Cu and 2.0 mm
mean of 21 mm alloy 1100 at 70 kVP normalized to the 100% Al spectrum alloy 1100 and 21 mm 100% Al at 70 kVP normalized to the 100% Al
to allow for better visualization of the differences. spectrum to allow for better visualization of the differences.
registered with 99.9% purity, which is higher than what is simulate all the possible combinations of elements in a spe-
considered the highest purity commercial grade Al with cific batch, mixture modeling theory was used to select a
99.45%.32 Alloy 1190 falls into the category of scientific reasonable set of mixtures as input to the simulation model
grade 共also called ultrapure aluminum兲 and is available only to produce a prediction formula.
through specialty metals companies for a high price and in To perform the mixture modeling, the custom design plat-
small quantities and limited form. form in JMP 6 software 共SAS Institute, Cary, NC兲 was used.
What is currently unknown is the impact of using the A total of 1395 mixtures for each alloy using 30 elements
widely available alloy 1100 compared with the specified al- were made in order to develop an accurate prediction for-
loy 1190. mula.
Once the mixtures were selected in JMP, radiation quality
2. Materials and methods simulation was performed using IDL 6.4 共IIT Visual Solution,
Boulder, CO兲. The initial beam spectrum was calculated us-
Since aluminum composition will vary from batch to ing the method developed by Boone and Seibert,33 and to
batch and from the source of the raw materials, the first goal this beam different filters were applied depending on the re-
using simulation is to determine mixture compositions that sults desired. As the filters were applied, the attenuation was
reflect the maximum, minimum, and median attenuation pos- calculated with 1 keV interval from 1 to 70 keV.
sible for alloys 1100 and 1190. Since it is not possible to
FIG. 15. Simulated beam spectrum comparison of 0.5 mm Cu and 3.0 mm

FIG. 13. Simulated beam spectrum comparison of 0.5 mm Cu and 2.0 mm alloy 1100 and 21 mm 100% Al at 70 kVP normalized to the 100% Al
alloy 1100 and 21 mm 100% Al at 70 kVP. spectrum to allow for better visualization of the differences.

The mass attenuation coefficients used in the simulation

were taken from Cullen et al.34 with the exception of vana-
dium which was from the NIST mass attenuation coefficient
data set.35 For a composite material such as alloy 1100, the
linear attenuation coefficient ␮ was calculated according to
the weight fraction of each element.
To determine the HVL for each Al Alloy mixture model,
the initial x-ray spectrum was hardened to RQR5 with pure
Al to achieve a HVL of 2.58 mm Al. Then the composition
filter was added and a new beam spectrum calculated. Last FIG. 16. Initial X-ray system HVL on 25 tested units at 70 kVP.
the HVL was determined for the new beam using 100% pure
Al. For the calculation of copper/aluminum filters, pure cop-
per was used first and then the 1100 alloy. Figure 13 compares the spectrum for 21 mm pure Al to
Once simulated values were determined for each mixture, that for Cu/Al combination; there is a large difference in the
JMP 7 software 共SAS Institute, Cary, NC兲 was used to de-
height of the beam spectra. Using the 0.5 mm Cu and 2 mm
velop a HVL prediction formula. Next the HVL for 5000 Al filter combination there are over two times more photons.
simulated batches of each alloy was generated using the Figures 14 and 15 show the spectra for different Cu/Al filters
HVL prediction formula. normalized to the output of pure Al. It can be seen that there
is a left shift with 2 mm Al and with 3 mm Al the spectra are
3. Results and discussion nearly identical. The HVL values in Table IV show that 2.5
mm Al with 0.5 mm Cu would have essentially the same
The numeric details of the distribution of the 5000 simu- HVL as 21 mm pure Al.
lated samples of both alloys 1100 and 1190 are listed in In addition to the investigation by the authors, several
Table IV. It is important to note that the standard deviation of Task Group 116 members performed testing of x-ray systems
alloy 1100 is 22.5 times greater than that of alloy 1190, but at their institutions to determine if the target HVL of 6.8 mm
the ⫾3 standard deviation is still only ⫾0.0425 mm Al. The Al can be achieved using 0.5 mm Cu filter in combination
last line in the table shows the deviation of the mean from with an Al filter ranging in thickness from 0 to 4 mm. A total
the RQA5 target of 6.8 mm Al. of 25 systems were tested. The initial filtration was measured
From the simulation results, we see that the HVL using for all 25 systems and the results are plotted in Fig. 16. It is
pure Al is slightly lower than the target of 6.8, but the round- important to note that out of the 25 systems only 6 had initial
ing to one decimal point is 6.8. Out of all alloys tested, 1190 HVL of less than the maximum of 2.58 mm Al specified in
provides a HVL that is the closest to the target with a mean IEC 61267.
difference of just 0.01 mm Al. The standard deviation is Since it is usually difficult to remove filtration in a clinical
negligible so it can be expected that any batch of alloy 1190 setting, it is much more practical to adjust the added filtration
would produce a HVL value rounded to 6.79 mm Al. HVL to reach the target HVL of 6.8 mm Al. The AAPM recom-
for alloy 1100 had a noticeable shift from the target of 6.8, mendation of varying the amount of Al in the Cu/Al filter
which may be attributed to the addition of Cu and iron 共Fe兲 combination is an appropriate method. Figure 17 plots the
to the alloy. With a range of 6.8803⫾0.0283 mm Al covering amount of additional Al needed to achieve the target HVL of
95% of all batches, we have a range of 6.8525–6.9081 mm 6.8 mm for different initial HVL values.
Al. The 0.1 mm Al error margin is acceptable for clinical use
and well within the ⫾0.25 mm Al proposed by Task Group
4. Conclusion
116.
Figure 11 shows the comparison between the mean beam We conclude that the IEC 61267 requirement to use
spectrum for alloy 1100 and that of pure Al. Alloy 1100 99.9% pure Al is unrealistic and is unnecessary. While the
absorbs slightly less radiation, and the beam quality is use of 21 mm of alloy 1100 Al is a close substitute, a slightly
shifted slightly harder. This can also be seen in Table IV with thinner filter would be appropriate to achieve the target HVL
the mean having a difference of 0.1165 mm Al. A normalized of 6.8 mm Al.
plot of the two spectra 共Fig. 12兲 makes it easier to see the The use of a Cu/Al combination filter is an adequate al-
difference in beam hardness. ternative. Our simulation results show that 0.5 mm Cu and
TABLE IV. Simulated HVL results from the various alloy batches.
Pure Al Alloy 1190 Alloy 1100 0.5Cu/1Al 0.5Cu/2Al 0.5Cu/3Al
Mean 6.7638 6.788 5 6.880 3 6.656 7 6.753 9 6.846 0

Std. Dev. – 0.000 629 3 0.014 166 4 0.000 760 4 0.001 442 4 0.002 056 2
Mean target ⫺0.0362 ⫺0.011 5 0.080 3 ⫺0.143 3 ⫺0.046 1 0.046

“Performance evaluation of computed radiography systems,” Med. Phys.

28, 361–371 共2001兲.
15
J. A. Seibert, T. Bogucki, T. Ciona, W. Huda, A. Karellas, J. Mercier, E.
Samei, S. J. Shepard, B. Stewart, K. Strauss, O. Suleiman, D. Tucker, R.
Uzenoff, J. Weiser, and C. Willis, AAPM Report No. 93, American As-
sociation of Physicists in Medicine, College Park, MD 共2006兲.
16
R. Van Metter and J. Yorkston, “Toward a universal definition of speed
for digitally acquired projection images,” Proc. SPIE 5745, 442–457
共2005兲.
17
E. Samei et al., AAPM Report No. OR-3, American Association of Physi-
cists in Medicine, College Park, MD 共2005兲.
18
W. R. Hendee and R. P. Rossi, Quality assurance for radiographic x-ray
units and associated equipment, DHEW Publication 共OSTI ID 5545617兲,
Bureau of Radiological Health, Rockville, MD, Colorado Univ. Medical
Center, Denver, CO, FDA-79-8094 共1979兲.
FIG. 17. Approximate Al to add to 0.5 mm Cu for RQA5@70 kVP. Aver- 19
E. G. Christodoulou, M. M. Goodsitt, H. P. Chan, and T. W. Hepburn,
aged from 25 systems tested.
“Phototimer setup for CR imaging,” Med. Phys. 27, 2652–2658 共2000兲.
20
L. W. Goldman, “Speed values, AEC performance evaluation and quality
control with digital receptors,” in Specifications, Performance Evalua-
3.0 mm Al provide the same HVL as 21 mm of pure Al. A tions, and Quality Assurance for Radiographic and Fluoroscopic Equip-
side benefit of using Cu/Al combination is that it requires ment in the Digital Era, AAPM Medical Physics Monograph No. 30
half of the exposure to achieve the same exposure as a 21 edited by L. W. Goldman and M. V. Yester, Medical Physics Publishing,
Madison, WI 共2004兲.
mm pure Al filter. 21
L. E. Wilkinson and J. C. P. Heggie, “Determination of Correct AEC
a兲
Function with Computed Radiography Cassettes,” Australas. Phys. Eng.
Electronic mail: [email protected] Sci. Med. 20, 186–191 共1997兲.
1
M. Freedman, E. Pe, S. K. Mun, S. C. B. Lo, and M. Nelson, “The 22
C. E. Willis, J. C. Weiser, R. G. Leckie, J. Romlein, and G. Norton,
potential for unnecessary patient exposure from the use of storage phos- “Optimization and quality control of computed radiography,” Proc. SPIE
phor imaging systems,” Proc. SPIE 1897, 472–479 共1993兲. 2164, 178–185 共1994兲.
2
D. Gur, C. R. Fuhman, J. H. Feist, R. Slifko, and B. Peace, “Natural 23
C. E. Willis, R. G. Leckie, J. Carter, M. P. Williamson, S. D. Scotti, and
migration to a higher dose in CR imaging,” Proceedings of the Eighth G. Norton, “Objective measures of quality assurance in a computed
European Congress of Radiology 共ISBN: 0938-7994兲, Vienna, Italy, radiography-based radiology department,” Proc. SPIE 2432, 588–599
12–17 September 1993, p. 154. 共1995兲.
3
J. A. Seibert, D. K. Shelton, and E. H. Moore, “Computed radiography 24
H. G. Chotas and C. E. Ravin, “Digital radiography with photostimulable
x-ray exposure trends,” Acad. Radiol. 3共4兲, 313–318 共1996兲. storage phosphors: Control of detector latitude in chest imaging,” Invest.
4
R. Van Metter and J. Yorkston, “Applying a proposed definition for re-
Radiol. 27, 822–828 共1992兲.
ceptor dose to digital projection images,” Proc. SPIE 6142, 426–444 25
M. Arreola and L. Rill, “Management of pediatric radiation dose using
共2006.
5 Canon digital radiography,” Pediatr. Radiol. 34, S221–S226 共2004兲.
W. Huda, “The current concept of speed should not be used to describe 26
J. H. Hubbell, NBS Report No. 29, 1969 共unpublished兲.
digital imaging systems,” Radiology 234, 345–346 共2005兲. 27
6 E. Storm, “Calculated bremsstrahlung spectra from thick tungsten tar-
International Organization for Standardization 9236-1:2004, 2004.
7 gets,” Phys. Rev. A 5共6兲, pp. 2328–2338 共1978兲.
C. E. Willis and T. L. Slovis, “The ALARA concept in pediatric CR and 28
E. Storm, “Emission of characteristic L and K radiation from thick tung-
DR: Dose reduction in pediatric radiographic exams—A white paper con-
ference executive summary,” Pediatr. Radiol. 34,S162–S164 共2004兲. sten targets,” J. Appl. Phys. 43共6兲, 2790–2796 共1972兲.
29
8
Digital Imaging Communications in Medicine 共DICOM兲 3.0, Perfor- T. R. Fewell and R. E. Shuping, “Handbook of mammography spectra,”
mance Standard 共PS兲 3.14, Grayscale Standard Display Function, Na- DHEW Publication, FDA 79-8071, Bureau of Radiological Health, Rock-
tional Electrical Manufacturers Association, 1300 N. 17th Street Rosslyn, ville, MD 共1978兲.
30
VAa 22209, 2007. F. Biggs and R. Lighthill, Analytical Approximations for X-Ray Cross
9
Digital Imaging Communications in Medicine 共DICOM兲 3.0, Supplement Sections II, SC-RR-71-0507, Weapons Effects Research Department,
111: Segmentation Storage SOP Class, National Electrical Manufacturers Sandia Laboratories, Albuquerque, New Mexico 共1971兲.
31
Association, 1300 N. 17th Street Rosslyn, VA 22209, 2007. W. H. McMaster, N. Kerr Del Grande, J. H. Mallett, and J. H. Hubbell,
10
Digital Imaging Communications in Medicine 共DICOM兲 3.0, Supplement Compilation of x-ray cross sections UCRL-50174, sections I, II revision
33: Grayscale Softcopy Presentation State Storage, National Electrical 1, III, IV, Atomic Data and Nuclear Data Tables, Volume 8, Issues 4–6,
Manufacturers Association, 1300 N. 17th Street Rosslyn, VA 22209, US Atomic Energy Commission 共1970兲.
32
2007. Bureau of Mines, Mineral Facts and Problems 共1985 edition兲, Bulletin
11
Digital Imaging Communications in Medicine 共DICOM兲 3.0, Perfor- #675, US Department of the Interior, Washington, DC 共1986兲.
33
mance Standard 共PS兲 3.10, Media Storage and File Format for Media J. M. Boone and J. A. Seibert, “An accurate method for computer-
Interchange, National Electrical Manufacturers Association, 1300 N. 17th generating tungsten anode x-ray spectra from 30 to 140 kV,” Med. Phys.
Street Rosslyn, VA 22209, 2007. 24, 1661–1670 共1997兲.
12 34
IEC 61267 共ed. 2.0兲, Medical diagnostic X-ray equipment - Radiation D. E. Cullen, M. H. Chen, J. H. Hubbell, S. T. Perkins, E. F. Plechaty, R.
conditions for use in the determination of characteristics, International J. A., and J. H. Scofield, Lawrence Livermore National Laboratory Report
Electrotechnical Commission 共2005兲. No. UCRL-50400, 1989 共unpublished兲.
13 35
IEC 62220-1 共ed. 1.0兲, Medical electrical equipment - characteristics of J. H. Hubbell and S. M. Seltzer, Tables of X-Ray Mass Attenuation Co-
digital X-ray imaging devices - Part 1: Determination of the detective efficients and Mass Energy-Absorption Coefficients 共Version 1.4兲, Na-
quantum efficiency, International Electrotechnical Commission 共2003兲. tional Institute of Standards and Technology, Gaithersburg, MD 共2004兲
14
E. Samei, J. A. Seibert, C. Willis, M. Flynn, E. Mah, and K. Junck, 共http://physics.nist.gov/xaamdi兲.

An Exposure Indicator For Digital Radiog

Uploaded by

Copyright:

Available Formats

An Exposure Indicator For Digital Radiog

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

An Exposure Indicator For Digital Radiog

Uploaded by

Copyright:

Available Formats

An exposure indicator for digital radiography:

AAPM Task Group 116 „Executive Summary…

I. INTRODUCTION of rules to produce consistent, high quality digital radio-

Medical Physics, Vol. 36, No. 7, July 2009

Medical Physics, Vol. 36, No. 7, July 2009

where KSTD is in microgray units, K0 = 0.001 ␮Gy,

Medical Physics, Vol. 36, No. 7, July 2009

Medical Physics, Vol. 36, No. 7, July 2009

TABLE I. Standard beam radiographic conditions.

Added Nominal IEC

0.5 mm Cu+ 共0 – 4兲 mm Ala

brass 共less than 35% zinc兲, alpha-beta brass or duplex brass

Medical Physics, Vol. 36, No. 7, July 2009

tances should be measured to the center of the

Medical Physics, Vol. 36, No. 7, July 2009

est interest to be rendered with maximum contrast. The value

Medical Physics, Vol. 36, No. 7, July 2009

Medical Physics, Vol. 36, No. 7, July 2009

Medical Physics, Vol. 36, No. 7, July 2009

Medical Physics, Vol. 36, No. 7, July 2009

Application kVP Added filtration Target HVL IEC surrogate

Source A is a lightly filtered source based on the IEC

Medical Physics, Vol. 36, No. 7, July 2009

3. X-ray emission spectrum „SPECT_GEN…

4. Primary beam attenuation „ATTEN…

6. Detector response „DETECT…

where A p is the pixel area in cm2 and S has units of

Medical Physics, Vol. 36, No. 7, July 2009

Medical Physics, Vol. 36, No. 7, July 2009

FIG. 15. Simulated beam spectrum comparison of 0.5 mm Cu and 3.0 mm

Medical Physics, Vol. 36, No. 7, July 2009

The mass attenuation coefficients used in the simulation

Pure Al Alloy 1190 Alloy 1100 0.5Cu/1Al 0.5Cu/2Al 0.5Cu/3Al

Mean 6.7638 6.788 5 6.880 3 6.656 7 6.753 9 6.846 0

Medical Physics, Vol. 36, No. 7, July 2009

“Performance evaluation of computed radiography systems,” Med. Phys.

Medical Physics, Vol. 36, No. 7, July 2009

You might also like