PART 1 · PRINCIPLES OF RADIOGRAPHY

1IMAGE FORMATION

All radiographic images reflect a pattern of x-ray photons (particles of energy) that have
passed through the subject with a proportion being absorbed, depending on the nature of
the tissue (fluid, soft tissue or bone). X-rays are a form of energy, which are emitted from
tungsten when the metal is subjected to a stream of electrons. In traditional radiography
using non-screen film the x-rays emitted from the x-ray machine pass through the patient,
subsequently causing ionisation of silver halide embedded in the emulsion coating the
film (exposure). The introduction of fluorescent intensifying screens into radiographic
cassettes adds one further step to the process: the x-rays cause light to be emitted from
the screens and it is this light that ionises the silver. Because one x-ray photon produces
many light photons the x-ray machine exposure settings can be reduced when screens
are used. The latent image present on the film is then converted to the familiar
radiographic image by processing the film through liquid developing and fixation
chemicals.

Regardless of whether the x-ray system is film-based, CR (computed radiography) or DDR

(direct digital radiography), the image produced reflects the quantity of x-rays passing
through the subject. Starting at the source of the x-ray beam, the machine controls allow
variation of the total number of x-rays emitted per exposure (milliamperes and time,
mAs) and of their energy (kilovoltage, kV). Insufficient mAs will result in an overall grey
appearance to the image (under-exposed). For most equine orthopaedic radiography
high-contrast images are desirable and these are achieved by using a ‘low-kV technique’.
Exposures of less than 70 kV result in x-rays with moderate energy, which are readily
absorbed by tissue that is slightly thicker or has a higher atomic number. If the energy is
increased (higher kV) more x-rays will pass through the subject to the image, resulting in
less contrast. The overall exposure of the film also depends on the distance between the
machine and the film (film-focus distance, FFD) and this should be kept constant to
ensure image consistency.

Regions of film that are not exposed to x-ray photons (e.g. under metal markers) will be
white following processing, while regions exposed to the primary beam without any
absorption by the subject will be black. All other regions will be various shades of grey
and the combination of the various regions of grey comprises the image of the structure
being examined. CR and DDR systems retain this convention, although the images can
be manipulated post acquisition. Dense tissue with a high atomic number (e.g. bone)
absorbs more x-rays than fluid, muscle or fat. Thicker and denser tissues also absorb
more x-rays; therefore, a region of sclerotic bone will appear slightly whiter than
adjacent bone. 3
 PART 1 · PRINCIPLES OF RADIOGRAPHY

IMAGE FORMATION

Radiography produces a two-dimensional image of a three-dimensional structure and to

compensate for this reduction in information at least two views of the region being
radiographed are usually required.