Notebook Two

Grids
Grid Types
There are two types of grids:
Parallel Grids
Focused Grids

Parallel grids are made with lead and interspace strips that run parallel to each other.
These grids are best used at long SIDs because the x-ray beam will be straighter and
more perpendicular. Perpendicular grids are less common than focused grids because
their strips do not line up with the divergence of the x-ray beam. This will cause grid cutoff
on the edges especially at short SIDs.

(Grid Cutoff is when the primary beam is angled into the lead which will absorb an
undesirable amount of primary radiation.)

Focused grids are designed so that the central grid strips are parallel and as the strips
move away from the center they become more inclined. The lead strips are designed to
match the divergence of the x-ray beam. Unlike the strips in the parallel grids, if these strips
were to extend into space, they would intersect along a line in space known as the
convergence line. This is important to know because in order for the grid to be properly
focused, the x-ray tube must be located along the convergence line. The label on the grid
will identify the focal range within which the tube should be located.

Grid Patterns
Grid strips are made to run in one or two directions:
Linear
Criss-cross or cross-hatched
Linear grids are grids whose lead strips only run in one direction. They are more common
in the clinical practice because they can be used when the procedure requires tube
angulation. These grids allow the radiographer to angle the tube, but only along the
direction that the lines are running, which is usually along the long axis. So if the grid was
located in the x-ray table then the strips would run along the long axis of the table, so you
can angle towards the head or the feet of the patient.
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Criss-Cross or Cross-Hatched grids are made by placing two linear grids on top of one
another so the strips are creating right angles. When using this type of grid, tube angulation
is not recommended because anyway you angle the tube you will get grid cutoff because
the lead strips are now running in both directions. This is why you will rarely see this type of
grid in the clinical setting.

*There are also times where grids are classified by the direction the grid lines run within the
grid. Grids lines can run along the long axis or the short axis. Short axis grids come in
handy when taking portable chest x-rays.*

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When it comes to grids, there are four qualities to their construction:
Grid Material
Grid Ratio
Grid Frequency
Lead

Grid material:
Grids are made of a series of radiopaque strips that alternate with radiolucent
interspace strips. The radiopaque strips are made out of lead due to its high atomic
number and its ability to absorb scatter radiation. The radiolucent strips are typically made
out of either aluminum or plastic fiber because these materials allow scatter radiation to
pass right through them.

Grid Ratio:
Grid ratio is defined as the ratio of the height of the lead strips to the distance
between the lead strips. Grid ratio has a major influence on the ability of the grid to improve
contrast.
Grid ratio = h / D h = lead strip height D = interspace width

Grid Frequency:
Grid frequency is defined as the number of grid lines per inch or centimeter. Grids
are made with a range in frequency from 60 to 200 lines/inch or 25 to 80 lines/cm. The
most common frequency that we see in today's grids are from 85-103 lines/inch. Higher
grid frequencies have thinner lead strips. You can determine the total quantity of lead in a
grid by combining the grids ratio and frequency. The lead in a grid is what determines the
grids efficiency at cleaning up scatter. Lead is measured in mass per unit area or grams
per square centimeter. Typically, the greater the lead content is in a grid, the higher the grid
ratio and the lower the grid frequency. So, as the lead content of a grid increases, the
ability of the grid to remove scatter and improve contrast increases.

Lead:
As stated above under grid frequency, the greater the lead content is in a grid, the
higher the grid ratio and the lower the grid frequency. Also, because lead is fairly heavy, you
can guess that a grid that is heavier than others, has a higher lead count and thicker lead
strips.

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Grid Selection:
Selecting the appropriate grid can be a complex process. Typically once a grid is
chosen and installed it is not easily changed. So it is usually up to the departments
administrator and radiologists on what grid is chosen and installed. Grids are used to
absorb scatter and scatter adds exposure to the IR, so the better the grid is at absorbing
the scatter, the less exposure the image receptor will receive and you wont have a good
image. So, you must increase the dose given to the patient to allow the image receptor to
receive an adequate amount of scatter to create a good image. This means you would
increase the mAs, and there is an equation to do this correctly. The grid conversion factor
(GCF) will give you the correct amount of mAs needed to take an adequate image.

Grid Conversion Factor Formula:

GCF = mAs with the grid/ mAs without the grid

And when you are converting from one grid ratio to another, you would use the formula:

mAs1/mAs2 = GCF1/GCF2

Where: mAs1 = original mAs

mAs2 = new mAs
GCF1 = original grid conversion factor
GCF2 = new grid conversion factor

So, it is important to note that the better the grid cleans up scatter, then the dose to the
patient will be greater.

Grid Performance Evaluation:

There are two ways grids are evaluated to test their efficiency.
These are:
Selectivity
Contrast Improvement Ability

Selectivity is measured by using the following formula:

Selectivity = % primary radiation transmitted
% scatter radiation transmitted
Grids that absorb a greater percentage of scatter than primary radiation are described as
having a greater degree of selectivity.

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A grid with higher lead content would have a greater selectivity. The better a grid is at
removing scatter, the greater will be the selectivity of the grid.

Contrast Improvement Ability is the best way to measure how well a rid functions and it's
ability to improve contrast in the clinical setting. This is dependent on the amount of scatter
produced , which is controlled by kVp and volume of irradiated tissue.
The contrast improvement factor (also known as the K factor), can be measured using
the following formula:
K = Radiographic Contrast with the Grid
Radiographic Contrast without the Grid
Most grids have contrast improvement factors between 1.5 and 3.5 which means that
contrast is 1.5-3.5 times better when using a grid.
The higher the K-Factor, the greater the contrast improvement.

Grid Errors:
When using grids, there are errors that can happen if you use them improperly.
Focused design grids typically have the most errors because they are designed to
coincide with the divergence of the x-ray beam. The tube must be correctly centered and
aligned at the correct distance to avoid any errors. Proper tube and grid alignment is
essential to prevent the unwanted absorption of primary radiation which is known as grid
cutoff.

There are four errors that our book talks about:

Off-Level
Off-Center
Off-Focus
Upside-Down

An off-focus error occurs when the x-ray tube is angled across the long axis of the grid
strips. This is can be caused by improper tube or grid positioning. An example of when this
could happen is when you are taking a portable chest and the patient's weight is unevenly
distributed on the grid causing the tube to not properly lined up with the grid. When an
off-focus error happens, there is an undesirable absorption of primary radiation, which will
result in an image with a decrease in exposure across the whole image.

An off-center error will occur when the x-ray tube is not centered along the central axis of a
focus grid. In a focus grid, the center grid strips are perpendicular and and become more
and more inclined away from the center. This design coincides with the divergence of the
x-ray beam coming from the x-ray tube. So, if the x-ray beam is not perfectly centered to the

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perpendicular strips on the grid, they will not correspond with each other and the result will
be a decrease in exposure across the entire image.

Focus Grids are designed to be used at very specific distances identified as the focal
range which is labeled on the front of the grid. When a grid is used at a distance other than
the one specified on the label, the result will be an off-focus error. This error results in grid
cutoff along the edges of the image. Higher grid ratios require accurate positioning to
prevent grid cutoff.

Lastly, there is an upside-down error. A focused grid has an identified tube side based on
the way the grid strips are angled. If the grid is upside down scatter radiation will still be
able to pass through the perpendicular strips, but as they angle away from the center, the
scatter radiation will be absorbed. This will cause peripheral grid cutoff.

The Air Gap Technique

This is a technique, like a grid, to reduce the amount of scatter that reaches the image
receptor. The air gap technique is an alternative to the use of a grid. This technique is used
by placing the patient at a greater object image receptor distance (OID). This creates an
air gap between the patient and the IR. By moving the patient away from the IR, the amount
of scatter reaching the IR will be reduced. Because there is less scatter reaching the image
receptor, there will be an improvement in contrast on the produced image. There is a
disadvantage to this technique and that is the loss of sharpness on the image due to the
increase of OID. Gould and Hale showed that a 10 inch air gap has the same amount of
scatter clean as a 15:1 grid for a 10-cm body part. However, a 15:1 grid was shown to be
more effective at cleaning up scatter than the air gap technique when it came to a body
part that was 20-cm or thicker.

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