When x-raying a patient with emphysema, which technique adjustment is recommended?

• A. Increase KVP, MAS remains the same
• B. Decrease KVP, MAS remains the same
• C. Standard technique
• D. Decrease MAS, KVP remains the same

Answer: (D)

Emphysema creates hyperinflated lungs with more air, so the chest tissues attenuate X-rays less than normal. With this increased transmission, a radiograph taken at standard technique can appear overexposed. To compensate while keeping image quality and patient dose reasonable, you reduce the mAs and leave the kilovoltage peak the same. Maintaining the same kVp preserves beam penetration and the overall contrast needed to visualize the diaphragms and bronchovascular markings, while the lower mAs lowers receptor exposure to match the increased transmission. Raising kVp would further reduce contrast, and lowering kVp could lead to underpenetration; standard technique would not specifically address the hyperinflation.