Radiographic contrast

Last revised by Raymond Chieng on 15 Jul 2023

Radiographic contrast is the density difference between neighboring regions on a plain radiograph. High radiographic contrast is observed in radiographs where density differences are notably distinguished (black to white). Low radiographic contrast is seen on radiographic images where adjacent regions have a low-density difference (black to grey). 

Contrast scale

As radiographs have varying regions of density, one cannot simply make assumptions based on a small region of interest. It is due to this that the radiographic contrast of an entire image is referred to as 'long-scale' or 'short-scale.' 

Short-scale contrast

Short-scale radiographs are considered 'high-contrast' whereby density differences albeit greater, overall possess fewer in density steps (lesser shades of grey).

Long-scale contrast

Long-scale radiographs are considered 'lower-contrast' whereby density differences are less noticeable however possess many more shades of grey. Long-scale radiographs are preferred while examining the lung fields, where subtle changes in density are pertinent to a diagnostic image.

Contrast control


Radiographic contrast is dependent on the technical factors of the radiographs taken. The kilovoltage (kV) during the radiographic examination will determine the primary beams' energy; higher energy effects increased penetrating power. A primary beam with greater kV results in an overall rise in penetration through all tissues (decrease in attenuation differences), therefore resulting in a lower contrast radiograph. Hence the high kV technique of the chest x-ray is employed to present a more uniformly dense image to better appreciate the lung markings.

A 15% increase in kV will essentially correlate to an increase in density similar to double the mAs 2.

Scatter radiation 

Scatter radiation travels in all directions 6and will decrease the contrast of the radiograph. Factors that contribute to scatter radiation are increasing volume of tissue, tube kilovoltage, the density of matter, and field size.3 Ways to reduce scatter include close collimation, grids, or air gap technique 3. However, the use of grids will increase the dose to the patient because it also attenuates the primary beam apart from the scattered radiation 4. Meanwhile, the air gap technique willl increase the geometric unsharpness of the image due to increase in patient-film distance, reduced field of view, and increase in patient dose 5.

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Cases and figures

  • Figure 1: the chest x-ray is a long-scale, low contrast image
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  • Figure 2: the hand x-ray is a short-scale, high contrast image
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  • Figure 3: image quality
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