Radiographic Artifacts

NOT ESPECIALLY OLD OR VALUABLE Chris Ober, DVM,

PhD, DACVR

Artifacts Defined
Any opacity on the radiograph that does not correspond to an actual anatomic structure Any misrepresentation of an actual anatomic structure Anything decreasing radiographic quality

14 February 2011

Quick CR primer
Cassette exposed by xrays; storage phosphors excited

Quick CR primer
Cassette exposed by xrays; storage phosphors excited Cassette put into reader

Quick CR primer
Laser shines onto detectors

Quick CR primer
Laser shines onto detectors Excited phosphors give off light photons

Quick CR primer
Laser shines onto detectors Excited phosphors give off light photons Light photons travel through light guide

Quick CR primer
Laser shines onto detectors Excited phosphors give off light photons Light photons travel through light guide Image produced by computer

Quick DR primer
Panel exposed by xrays, detectors excited Data sent directly to computer via cord Image created

Sequence: Film-Screen
Film storage & handling Positioning Exposure Film handling Film processing
Manual Automatic

Image archiving

Sequence: CR (With Cassette)

Cassette storage Positioning Exposure Postexposure Cassette reading Workstation

Sequence: DR (No Cassette)

Panel storage Positioning Exposure Image reading & transfer Workstation

Another Classification System

Color
Black White

Storage & Pre-Exposure Handling Artifacts

Screen-Film Pressure Abrasions & Scratches Fingerprints Static electricity Material in cassette Fog Light leak CR & DR Storage scatter (CR)

Distribution
Focal Regional or Global

Pressure Artifacts Film Crease Crescents (SF)

Black & focal Cause: rough handling Pressure from crease causes activation of crystals NOT caused by fingernail (usually)

Pressure Artifacts Film Crease Crescents (SF)

Abrasions & Scratches (SF)

Black or white, focal Cause: rough handling Black: pressure from abrasion activates crystals White: emulsion has been removed (scratch) Can feel texture in emulsion

Fingerprints (SF)
Focal White: most common
Oil on fingertips blocks developer

OR
Fixer on fingertips

Fingerprints (SF)
Focal White: most common
Oil on fingertips blocks developer

Fingerprints (SF)
Black: less common
Developer on fingertips

Prevent:
Keep fingers dry and clean Touch only film edges

OR
Fixer on fingertips

Hogge JP, et al. RadioGraphics 1999.

Static Electricity (SF)

Black & focal Two patterns
Branching Smudge / Spot

Static Electricity (SF)

Prevent:
Moderate humidity Avoid friction while handling film Antistatic cassette cleaners

Cause: electrical discharge

Static Electricity (SF)

Material in Cassette / Dirty Screen (SF)

White & focal Sharp margins (close to film no penumbra) Cause: Visible light photons from screen cant reach and expose film emulsion

Hogge JP, et al. RadioGraphics 1999.

Material in Cassette / Dirty Screen (SF)

THUS radiolucent material can still cause this artifact Common causes
Hair Dust

Fog (SF)
Increased blackness, usually regional or global Definition: any unwanted film exposure / development Decreased image contrast and detail

Fog (SF)
Causes:
Light exposure Heat
(store at < 68 F)

Fog (SF)

Humidity
(keep at 30-50%)

Radiation (including scatter) Chemicals Old film

Hogge JP, et al. RadioGraphics 1999.

Light Leak (SF)

Black, focal to global A form of fog Sources:
Storage bin (along 1 edge) Cassette not closed (1 edge or corner) Overhead light Safelight filter crack

Storage Scatter (CR)

Black & global Like fog unwanted exposure of CR plate Causes:
Background radiation Scatter from imaging procedure

Jimnez DA, et al. Vet Radiol Ultrasound 2008.

Positioning Artifacts
Screen-Film Magnification Foreshortening / distortion Patient rotation Upside-down cassette Grid cutoff CR & DR Magnification Foreshortening / distortion Patient rotation Upside-down cassette (CR) or panel (DR) Grid cutoff

Magnification
Object closer to film:
Closer to normal size Sharper margins

Object farther from film:

Magnified Less distinct margins

Foreshortening / Distortion
X-ray beam does not pass perpendicular to long axis of structure Differential magnification of structure

Foreshortening / Distortion

Patient Rotation
A form of distortion Lesions may be masked by atypical superimposition on normal anatomy Unusual projection of normal anatomy may be incorrectly diagnosed as abnormal

Upside-down Cassette (SF)

White & focal Springs & latches on back of cassette block x-ray beam Global lightness Lead backing absorbs some x-ray photons (film appears underexposed)

Upside-down Cassette (SF)

Upside-down Cassette (SF)

Upside-down Cassette (CR)

White & multifocal Construction of cassette back absorbs x-rays Pattern depends on manufacturer

Upside-down Cassette (CR)

Upside-down Panel (DR)

White & multifocal Electronics in the back of the panel absorb x-rays

Grid Cutoff (SF, CR, DR)

White, regional to global Orientation of lead strips in grid requires appropriate geometry relative to x-ray beam Wrong geometry lead strips attenuate more x-rays

Laterally Decentered Focused Grid

Off-Level Focused Grid

Result: Too white across entire image

Result: Too white across entire image

Upside-Down Focused Grid

Distance Decentered Focused Grid

Similar to upsidedown grid
OK in the center, Markedly too white at periphery

Often not as severe as upside-down grid

Result: OK in the center, Severely too white at periphery

Combined Lateral and Distance Decentering of Grid

Screen-Film

Exposure Artifacts
CR & DR Motion Double exposure (CR) Overexposure (Saturation) Underexposure Material obstructing x-ray beam Motion Double exposure Overexposure Underexposure Material obstructing x-ray beam

Result: OK on one side, Gradually whiter toward other side

Motion (SF, CR, DR)

Blurring of moving parts Exposure does have a finite interval Reduce with:
Better restraint Sedation Decreased exposure time

Motion (SF, CR, DR)

Double Exposure (SF, CR)

Appearance of 2 summated images Cause: Cassette inadvertently exposed more than once
Press exposure trigger twice Forget to change cassette after first view

Double Exposure (SF, CR)

SF: Black, global
2 exposures = overexposure artifact

CR: Normal grayscale

Wide latitude can usually accommodate the overexposure

DR: Cant happen

Image is transferred to computer immediately

Double Exposure (SF, CR)

Overexposure (SF)
Black & global Patient info label normal Cause: Too much activation of emulsion crystals
High mAs or kVp Line surge Double exposure, Fog

Saturation (CR, DR)

Black, may only be apparent in parts of image Just like SF overexposure High exposure maxes out sensitivity range of detector
Anatomy (esp. thinner parts) may be burned through

Saturation (CR, DR)

Black, may only be apparent in parts of image Just like SF overexposure High exposure maxes out sensitivity range of detector
Anatomy (esp. thinner parts) may be burned through

Paradoxical Overexposure, Saturation, & Planking (DR)

Paradoxical Overexposure, Saturation, & Planking (DR)

Underexposure (SF)
White & global Patient info label normal Cause: Too little activation of emulsion crystals
Low mAs or kVp General x-ray obstruction X-ray tube troubles

Underexposure: Quantum Mottle (CR, DR)

Noisy & global Computer algorithms adjust image to remain gray Low signal level causes grainy appearance and poor contrast & sharpness Cause: As with SF

Underexposure: Quantum Mottle (CR, DR)

Material Obstructing X-Ray Beam (SF, CR, DR)

White, focal Cause: Any radiopaque structure in the path of the xray beam
On patient In patient On table On cassette

Material Obstructing X-Ray Beam (SF, CR, DR)

Material Obstructing X-Ray Beam (SF, CR, DR)

OMG! Its a fracture fragment!

or gravel on the table.

Material Obstructing X-Ray Beam (SF, CR, DR)

Material Obstructing X-Ray Beam (SF, CR, DR)

Material Obstructing X-Ray Beam (SF, CR, DR)

Material Obstructing X-Ray Beam

Post-Exposure Handling Artifacts

Screen-Film Pressure Abrasions Fingerprints Static electricity Fog Light leak CR & DR Not Applicable

Processing / Reading Artifacts

Screen-Film Overdevelopment Underdevelopment Insufficient mixing Incomplete fixation Incomplete washing Pi lines (LAB) Guide shoe lines (LAB) Kissing defects CR & DR Dirty light guide (CR) Cassette debris (CR)

Overdevelopment (SF)
Black & global Patient info label also black Cause: Too much metallic Ag forms in emulsion crystals
Developer too hot Developed too long

Underdevelopment (SF)
White & global Patient info label also white Cause: Too little metallic Ag forms in emulsion crystals
Developer too cold Developed too little time

Insufficient Mixing (SF)

Inadequate Fixation (SF)

Initially film is cloudy and milky Over time appears yellow/brown Dichroic stain

Incomplete Washing / Rinsing (SF)

Fixer remains
Cloudy, sticky residue Yellow-brown stain Sulfur smell

Kissing Defects (SF)

Dirty Light Guide (CR)

White & focal Sharp white line Cause:
Light emitted from plate reaches light guide Dirt blocks path for an entire line of data No light along that line = assumption that there was no exposure

Dirty Light Guide (CR)

White & focal Sharp white line Cause:
Light emitted from plate reaches light guide Dirt blocks path for an entire line of data No light along that line = assumption that there was no exposure

Dirty Light Guide (CR)

White & focal Sharp white line Cause:
Light emitted from plate reaches light guide Dirt blocks path for an entire line of data No light along that line = assumption that there was no exposure

Cassette Debris (CR)

White & focal Sharp margins Essentially the same as FS dirty cassette EXCEPT

Cassette Debris (CR)

Problem is that photons emitted from plate during reading dont reach photomultiplier tube (Contrast with FS, where light photons from screen dont reach film)

Workstation Artifacts
Screen-Film Not Applicable CR & DR Faulty Transfer (DR) Clipping Planking Uberschwinger

Faulty Transfer (CR, DR)

Appearance: Anything goes, generally distorted anatomy Cause: Problems in data transfer to workstation
Memory problems Communication errors (e.g. loose cables) Power fluctuation

Faulty Transfer (DR)

Uberschwinger (CR, DR)

Black & focal Black lines occur around dense structures
Can be mistaken for loosening or infection of implants

Uberschwinger (CR, DR)

Cause: Certain processing algorithms (edge-enhancement)

What Have We Learned?

People can manage to screw up any stage of the radiographic process. Recognizing artifacts and when they occur is the only way to make good radiographs. Look up Mr. Yuk on Wikipedia for a video that scarred my childhood.