Pediatric Radiology

, Volume 44, Issue 3, pp 313–321 | Cite as

Guidelines for anti-scatter grid use in pediatric digital radiography

  • Shannon FritzEmail author
  • A. Kyle Jones
Original Article



Pediatric radiography presents unique challenges in balancing image quality and patient dose. Removing the anti-scatter grid reduces patient dose but also reduces image contrast. The benefit of using an anti-scatter grid decreases with decreasing patient size.


To determine patient thickness thresholds for anti-scatter grid use by comparing scatter-to-primary ratio for progressively thinner patients without a grid to the scatter-to-primary ratio for a standard adult patient with a grid.

Materials and methods

We used Solid Water™ phantoms ranging in thickness from 7 cm to 16 cm to simulate pediatric abdomens. The scatter-to-primary ratio without a grid was measured for each thickness at 60 kVp, 70 kVp and 80 kVp for X-ray fields of view (FOV) of 378 cm2, 690 cm2 and 1,175 cm2 using indirect digital radiography (iDR) and computed radiography (CR). We determined thresholds for anti-scatter grid use by comparing the intersection of a fit of scatter-to-primary ratio versus patient thickness with a standard adult scatter-to-primary ratio measured for a 23-cm phantom thickness at 80 kVp with an anti-scatter grid. Dose area product (DAP) was also calculated.


The scatter-to-primary ratio depended strongly on FOV and weakly on kVp; however DAP increased with decreasing kVp. Threshold thicknesses for grid use varied from 5 cm for a 14 × 17-cm FOV using iDR to 12 cm for an 8 × 10-cm FOV using computed radiography.


Removing the anti-scatter grid for small patients reduces patient dose without a substantial increase in scatter-to-primary ratio when the FOV is restricted appropriately. Radiologic technologists should base anti-scatter grid use on patient thickness and FOV rather than age.


Anti-scatter grid Scatter-to-primary ratio Digital radiography Abdominal radiography Pediatric radiography Radiation dose 


Conflicts of interest



  1. 1.
    Carlton RR, Adler AM (2012) The grid. In: Principles of radiographic imaging: an art and a science, 5th edn. Delmar Cengage Learning, Clifton Park, pp 257–272Google Scholar
  2. 2.
    Alzen G, Benz-Bohm G (2011) Radiation protection in pediatric radiology. Dtsch Arztebl Int 108:407–414PubMedCentralPubMedGoogle Scholar
  3. 3.
    European Commission (1996) European guidelines on quality criteria for diagnostic images in paediatrics. Accessed May 1, 2013
  4. 4.
    American College of Radiology (2008) ACR-SPR practice guidelines for general radiography. Accessed May 1, 2013
  5. 5.
    International Atomic Energy Agency (2013) Safety report series No. 71, radiation protection in paediatric radiology. Accessed May 1, 2013
  6. 6.
    Ween B, Olstad M, Jakobsen JA et al (2009) Pediatric digital chest radiography, comparison of grid versus non-grid techniques. Eur J Radiography 1:201–206CrossRefGoogle Scholar
  7. 7.
    IEC International Standard 60627 (2001) Diagnostic X-ray imaging equipment—characteristics of general purpose and mammographic antiscatter grids. International Electrochemical Commission, ISBN 2-8318-5953-0Google Scholar
  8. 8.
    Hall EJ (2002) Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 32:700–706PubMedCrossRefGoogle Scholar
  9. 9.
    Amis ES Jr, Butler PF, Applegate KE et al (2007) American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 4:272–284PubMedCrossRefGoogle Scholar
  10. 10.
    Conway BJ, Duff JE, Fewell TR et al (1990) A patient-equivalent attenuation phantom for estimating patient exposures from automatic exposure controlled X-ray examinations of the abdomen and lumbo-sacral spine. Med Phys 17:448–453PubMedCrossRefGoogle Scholar
  11. 11.
    American College of Radiology (2008) ACR Practice Guideline for Diagnostic Reference Levels in Medical X-ray Imaging. Accessed May 1, 2013
  12. 12.
    Yaffe M, Fenster A, Johns HE (1977) Xenon ionization detectors for fan beam computed tomography scanners. J Comput Assist Tomogr 1:419–428PubMedCrossRefGoogle Scholar
  13. 13.
    Floyd CE Jr, Lo JY, Chotas HG et al (1991) Quantitative scatter measurement in digital radiography using a photostimulable phosphor imaging system. Med Phys 18:408–413PubMedCrossRefGoogle Scholar
  14. 14.
    Fetterly KA, Schueler BA (2007) Experimental evaluation of fiber-interspaced antiscatter grids for large patient imaging with digital x-ray systems. Phys Med Biol 52:4863–4880PubMedCrossRefGoogle Scholar
  15. 15.
    American College of Radiology (2012) ACR-AAPM-SIIM practice guideline for digital radiography. Accessed May 1, 2013
  16. 16.
    American College of Radiology (2011) ACR-SPR guideline for the performance of abdominal radiography. Accessed May 1, 2013
  17. 17.
    Rosenstein M, Beck TJ, Warner GG (1979) Handbook of selected organ doses for projections common in pediatric radiology. HEW Publication FDA pp. 79–8079Google Scholar
  18. 18.
    Rosenstein M (1988) Handbook of selected tissue doses for projections common in diagnostic radiology. HEW Publication FDA pp. 89–8031Google Scholar
  19. 19.
    Maher KP (1993) Comparison of scatter measurement techniques in digital fluoroscopy. Phys Med Biol 38:1977–1983CrossRefGoogle Scholar
  20. 20.
    Yaffe MJ, Johns PC (1983) Scattered radiation in diagnostic radiology—magnitudes, effects, and methods of reduction. J Appl Photogr Eng 9:184–195Google Scholar
  21. 21.
    Kleinman PL, Strauss KJ, Zurakowski D et al (2010) Patient size measured on CT images as a function of age at a tertiary care children’s hospital. AJR Am J Roentgenol 194:1611–1619PubMedCrossRefGoogle Scholar
  22. 22.
    Aichinger H, Dierker J, Joite-Barfuß S et al (2012) Scattered radiation. In: Radiation exposure and image quality in X-Ray diagnostic radiology, 2nd edn. Springer, Berlin, pp 53–66CrossRefGoogle Scholar
  23. 23.
    Curry TS III, Dowdey JE, Murry RC Jr (1990) Christensen’s physics of diagnostic radiology, 4th edn. Lippincott, Williams, and Wilkins, PhiladelphiaGoogle Scholar
  24. 24.
    Goske MJ, Charkot E, Herrmann T et al (2011) Image Gently: challenges for radiologic technologists when performing digital radiography in children. Pediatr Radiol 41:611–619PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Imaging PhysicsThe University of Texas, M. D. Anderson Cancer CenterHoustonUSA

Personalised recommendations