2 Jam ke-1/Chapter 10a
WE WILL LOOK AT…
Radiograph & film critiquing
Problem solving for radiographic images
Problem solving for processing &
technical errors
ASSESSING RADIOGRAPHIC
QUALITY
When we look at the final radiographic image,
we automatically assess:
the degree of blackness & white,
the shades of grey representing various
anatomical structures
i.e. correct exposure factors used for the ROI (kVp
& mAs), correct patient positioning, correct
anatomy seen, anatomical marker present &
correct, identification present & correct, image
sharpness
ASSESSING
RADIOGRAPHIC
QUALITY
BASED ON IMAGE
QUALITY
PARAMETRY
IMAGE QUALITY
PARAMETRY
1. Density
2. Exposure factors
3. Processing
4. Radiographic contrast
5. Sharpness
6. Satter radiation
7. Poor S/F contact
8. Focal Spot size
9. Magnification & OFD
RADIOGRAPHIC IMAGE QUALITY
PARAMETRY
1. DENSITY
Density is the degree of blackening of the film
It is related to the exposure factors used (kVp
& mAs)
It is also related to the processing technique
2. EXPOSURE FACTORS
A general term referring to the
FACTORS that affect on the exposure
i.e. kVp, mAs, FFD, focal spot, grid etc
The following 2 slides are:
an excellent summary of differentiating
between a light or a dark film &
the correct terminology for each situation
EXPOSURE FACTORS
Image too dark
1. the film is overexposed - too much mAs or
2. the film is overpenetrated – too much kVp
So how do we tell which one it is??...
1. If the soft tissues are black but the bone cortex
can still be seen, it is overexposed (too much
mAs)
2. If the cortex of the bone is burnt out, it is
overpenetrated (too much kVp)
EXPOSURE FACTORS
Image too light, If the image is too light:
The film is underexposed or
The film is underpenetrated.
So how do we tell which one it is??...
1. If the background of the radiograph is not black,
the mAs was too low
2. If the bony trabeculae cannot be seen or there
are white areas with no density in the ROI, the
kVp was too low
3. PROCESSING-
UNDERDEV.1
TOO LOW RADIATION Vs UNDERDEVELOPMENT
Underdevelopment occurs due to
diluted, exhausted or cold developer or
developing for too short a time
All areas of the film are too light
including the background
The finger test can be used! Put finger
behind a black, non-patient area. If you
can see your finger, the film is
underdeveloped.
Notes :
Both an underexposed radiograph & an
underdeveloped film have grey
background
TOO LOW RADIATION Vs UNDERDEVELOPMENT
Overdevelopment occurs when the
developer is too hot or the film is in for
too long
The unexposed silver halide crystals are
converted to metallic silver resulting in
development fog (a uniform darkening of
the film)
3. PROCESSING-
OVERDEV.1
TOO MUCH RADIATION Vs OVERDEVELOPMENT
Both make the film too dark
In the metal marker area, overexposed
films will still be white, whilst
overdeveloped films will be darkened
PROCESSING REMEDY
Top up chemicals with replenisher, not water
Changing the developer regularly
Use correct developer temperature
Use correct developing time
Warm up automatic processors fully before
using
REMEMBER
If the radiograph is too dark, you may still get
enough diagnostic information using a bright light
to view it (not the most optimal situation)
If the radiograph is too pale, it is NOT diagnostic!
IF THE ROI IS UNDEREXPOSED OR
UNDERPENETRATED, REPEAT THE
RADIOGRAPH
4. RADIOGRAPHIC
CONTRAST
The difference between
various shades of grey
(densities) on the film
CONTRAST
High contrast = white image on a black
background with few shades of grey
High contrast = low latitude
High contrast doesn’t allow a large range of
anatomy to be visualised
If the kV was too low & there was
insufficient penetrating power, there will be
no bony trabeculae & there will be areas of
white on the film where no x-rays reached
the film
CONTRAST
Low contrast = the film has too many
shades of grey
Described as a ‘flat film’
The higher the kV, the lower the contrast
Fogging can also contribute to low
contrast
Underdevelopment can also result in a
‘grey, flat’ film
5. SHARPNESS
“The clarity of structures visible on a
radiograph”
Image sharpness can be affected by a
large number of factors
Movement Unsharpness
A common cause on abdominal & chest
views due to respiration or struggling
Can occur if the tube stand or plate
moves
Can be minimised by sedation or
anaesthesia of the patient
Use sandbags, troughs etc
Keep exposure time as low as possible
6. Scatter Radiation
Unsharpness caused by scatter
radiation occurs when x-raying thick or
dense tissues
This can be reduced by collimating to
the ROI
Use a grid
7. Fog
Darkening of the film unrelated to the
radiographic image
Fog is an unwanted increase in density
Fog reduces radiographic contrast
Fog makes it look as if ALL the image is being
viewed through a grey veil
Fog can be caused by:
scatter radiation, exposure of the film to
radiation, exposure to white light, unsuitable
safelight filter, safelight too close to workbench,
prolonged storage, overdevelopment
8. Poor film-screen contact
Caused by a shrinkage of the felt pad
behind the intensifying screens
Also, there could be an artifact in the
cassette & the felt pad will cause
blurring in the same spot
This will decrease image sharpness
9. Focal Spot Size
Fine focus provides fine definition but
limits your exposure
Broad focus allows higher exposure but
some detail is lost
This may be minimise this by keeping
the object-film distance (OFD) as short
as practicable & maintaining a
reasonably long FFD
10. Magnification & OFD
The diverging x-ray beam
produces some magnification
Increasing magnification leads
to an increased penumbra
effect
This may be minimised by
positioning the object close to
the cassette as possible
A standard FFD of 100cm or
115 cm maximum is preferable
BASIC ERRORS IN
RADIOGRAPHY
No coning
No identification
No left or right markers
Not centering on the ROI
Wrong FFD
Wrong exposure factors for the film/screen
type or receptor sensitivity
Not having the x-ray beam perpendicular to
the cassette
BASIC ERRORS IN
RADIOGRAPHY
Basic grid problems
Endotracheal tube still in
lead on the x-ray cassette
Double exposure
Wet or contrast agent
Hands, opaque restraint devices or lead
gloves in the radiation field
GRID DOUBLE-CHECKS
1. Centre the beam to the centre of the
grid
2. Be sure the grid is level
3. If a focussed grid is used:
Use correct FFD
Place the ‘tube side’ upwards
4. Use correct exposure factors for grid
type
TECHNICAL ERRORS
X-ray film is also sensitive to extraneous
pressure, fumes, humidity, rough handling &
temperature
For these reasons, unexpected artifacts,
technical errors sometimes appear on
radiographs
Can happen to manually or automatically
processed films
Repeat rates can be as high as 10%! Causing
undue waste of time, money & additional
radiation to patients & staff
TECHNICAL ERRORS
A technical error may destroy the diagnostic
value of the radiograph
Or radiographic quality may be diminished,
but deemed useable
This compromises the whole diagnostic
quality of the examination
Some errors are sporadic; some regular
Recognition of a pattern is helpful when
searching for the cause & corrective action
TECHNICAL ERRORS
Artifacts may be classified on their appearance:
Is the artifact concentrated to a single area or
spread throughout the film?
Is the artifact clear (radiolucent) or dark
(radiopaque)?
Is it cloudy?
Does the artifact appear to be on the surface of
the film?
By this process, most artifacts can be recognised &
corrective action taken to eliminate them
2 jam ke-2/Chapter 10b
RCF
Radiography Critique Form
Radiographic Critique Form (RCF)
DAFTAR CHECK RCF YA ATAU TIDAK
Persayaratan identifikasi
Penempatan marker dengan benar
Gambaran anatomi dalam radiograf?
Apakah gambaran anatomi tampak sesuai dengan proyeksi ini?
Apakah kolimasi lapangan radiasi cukup? Dan tetap mengindahkan ALARA (limitasi, justufikasi,
optimasi)?
Proteksi radiasi, presentasi, menghalangi gambaran obyek?
Garis tepi luar kortek tulang, patren trabekula tulang, dan atau struktur soft tissue terlihat
tajam?
Radiograf terlihat tanpa distorsi?
Ukuran film benar, regio organ anatomi terlihat sesuai dan benar?
Menggunakan alat penerima gambar yang sesuai?
Kecukupan daya penetrasi sinar dengan kerapatan?
Kecukupan kontras gambar?
Upaya pencegahan terhadap artefak gambar?
Outcome yang dikehendaki ( contoh; pemakaian sinar-x dapat memperlihatkan nilai diagnostik dai
regio organ anatomi)?
Kesimpulan Radiograf ini adalah :
DITERIMA/ACCEPTED
DITOLAK/REJECTED
Jika ditolak/rejected, apa tindakan koreksi yang sebaiknya dilakukan untuk memperbaiki ketidak sesuaian ? (diskripsikan
dalam lembar terpisah)
In Class
GROUP’ ASSIGNMENTS:
Gambar 1
In Class
GROUP’ ASSIGNMENTS:
FIRST ASSIGNMENT:
Buat Review jurnal berupa Resume dari
Pokok bahasan 10a ini.
Review jurnal di tulis tangan pada kertas
folio bergaris, diberi identitas mhs, tgl, dan
tanda tangan masing-masing
Di Kumpulkan di minggu depan
In Class
GROUP’ ASSIGNMENTS:
SECOND ASSIGNMENT:
A.LAKUKAN penerapan PERTAMA evaluasi
& kritisi radiograf dengan ppt sesi 10a
B.LAKUKAN penerapan KEDUA evaluasi &
kritisi radiograf menggunakan RCF berbasis
pada hasil butir – A terhadap Radiograf
(gambar 1)
Di Kumpulkan di minggu depan
