M e d i c a l P hy s i c s a n d I n f o r m a t i c s • R ev i ew

Shetty et al.
Computed Radiography Image Artifacts

Medical Physics and Informatics

Review
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Computed Radiography Image

Artifacts Revisited
Chandrakant Manmath Shetty 1 OBJECTIVE. Computed radiography (CR) has provided a ready cost-effective transition
Ashita Barthur from screen film to digital radiography and a convenient entrance to PACS. This article revis-
Avinash Kambadakone its artifacts encountered in CR systems. These artifacts may obscure abnormalities, mimic a
Nilna Narayanan clinical entity, or hamper image quality.
Rajagopal Kv CONCLUSION. With the new-generation CR systems, software- and hardware-related
artifacts have decreased, making operator errors more evident. The purpose of this study is
Shetty CM, Barthur A, Kambadakone A, to establish the current trend of CR artifacts and the new facets in identifying and resolving
Narayanan N, Kv R problems quickly that will help prevent future occurrences. This article also brings to light
the importance of constant review required of this extensively studied topic to avoid diagnos-
tic misadventures.

Keywords: artifacts, computed radiography system
DOI:10.2214/AJR.10.5563
Received August 13, 2010; accepted after revision
September 14, 2010.
1
All authors: Kasturba Medical College Manipal,
Madhavnagar, Manipal, Karnataka 576104, India.
Address correspondence to C. M. Shetty
(drcmshetty@yahoo.com).
WEB
This is a Web exclusive article.
AJR 2011; 196:W37–W47
0361–803X/11/1961–W37
© American Roentgen Ray Society
C
omputed radiography (CR) sys-
tems based on photostimulable
phosphor (PSP) image detectors
(i.e., imaging plates) were first
introduced commercially in 1983 [1]. Such
systems are widely accepted in radiology de-
partments because they are cost-effective so-
lutions to the shift from conventional film-
based imaging to digital imaging, whereby
the existing radiography equipment can be
retained and used. The transition to digital
imaging is completed by installing CR read-
ers and replacing film-based cassettes with
image plate–based CR cassettes.
In our hospital, as in most major hospitals
in India, the CR system is used for most of the
hospital’s general radiography work flow. Un-
like the competing digital technology, CR is
particularly suitable for bedside radiograph-
ic examinations, which usually are the worst
images in general radiography because of the
emergency conditions under which the exam-
inations are performed. The wide latitude of
CR improves the consistency of good-quality
bedside radiographs. The image quality of CR
on large body parts, such as the chest and ab-
domen, is better than that of digital radiogra-
phy, whereas digital radiography is preferred
for small body parts and extremities. Also,
the CR system has the advantage of position-
ing flexibility for difficult views, because CR
cassettes can be placed in any position, which
is not possible in digital radiography sys-
tems [2]. Unlike digital radiography systems,
a multiple cassette size option is available in
CR systems. Even though digital radiography
is gaining in popularity, CR will continue to
play a significant role in an emergency setup.
After performing cost analysis and capacity
utilization of general radiography, CR still
scores over digital radiography [3].
In today’s era of CT and MRI, radiography
still remains the primary imaging technique.
Hence, it is imperative to improve the quality
of radiographs by constant advancements in
technology. However, even with technolog-
ic improvements in CR systems, we contin-
ue to encounter artifacts that degrade image
quality, leading to misdiagnoses that may
have medicolegal implications. In this arti-
cle, we discuss and illustrate the various CR
artifacts encountered in our clinical practice,
along with their remedial measures.
Workflow of CR Systems
CR Readout Process
Image acquisition is made using an imag-
ing plate, which is a PSP-based plate made
of barium fluorohalide (Figs. 1 and 2). One
imaging plate is used for each exposure. The
imaging plate is enclosed in a cassette, which
is similar to a screen film cassette. The plate
is now exposed to x-rays using standard ra-
diographic equipment. During the exposure,
electrons in the phosphor plate are excited to
a higher energy state; these excited electrons

AJR:196, January 2011 W37


are trapped and form a latent image. This la-
tent image is processed and retrieved by plac-
ing the imaging plate in a CR reader, which is
also called a digitizer.
Processing of Image
The following steps are used to process the
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image (Fig. 2), First the cassette is opened
in the CR reader with release of the imaging
plate from the cassette. Second, the imaging
plate is moved by the rollers for scanning by
the laser beam. Third, the laser light stimu-
lates the trapped electrons to become free and
return to a lower energy state, which results
in the release of light photons. The two lights
(laser light and the released light photon) have
different wavelengths, which forms the ba-
sis for image retrieval. This helps in identifi-
cation of the light photons of higher energy
and shorter wavelength by the photomultiplier
tube (PMT), because the image signal is sep-
arate from the laser light, which is of a longer
wavelength and lesser energy than the signal
from the CR digitizer (or reader). Fourth, the
light released from the imaging plate is col-
lected by the fiber-optic light guide and strikes
a PMT, where it produces an electronic signal.
Fifth, the electronic signal is digitized and
stored in a display monitor and later sent to a
PACS. Sixth, the image plate is then exposed
to a high-intensity halogen lamp, which eras-
es any residual energy remaining from a prior
exposure. Finally, the image plate is returned
to the cassette, which is ready for reuse.
Artifacts can be generated at each step of
the CR image work flow. CR artifacts are
broadly classified into image acquisition ar-
tifacts (Table 1) and image-processing arti-
facts (Table 2).
Image Acquisition Artifacts:
Operator Errors
Image acquisition is performed by radiog-
raphers with the use of an imaging plate. As
in film-based imaging, operator errors in CR
systems contribute to image acquisition arti-
facts. Operator errors are all the more likely
if the technique is new to the radiographer.
The cassette with the imaging plate needs to
be safely kept away from heat, humidity, and
any source of radiation. If the department
has multiple-vendor CR systems, CR cas-
sette orientation is important, because cas-
sette designs and constructions are different.
Operator errors include twin artifacts, uncol-
limated images, delayed scanning, exposure
through the back of the cassettes, inappro-
priate exposure factors, improper grid usage,
W38
Shetty et al.
scatter radiation, errors in cassette care and
carelessness, and the light bulb effect.
Twin Artifacts (Double Exposure)
The exposure technique during radiogra-
phy plays a very important role in preventing
erroneous diagnosis. If the radiographer acci-
dentally takes two subsequent exposures, one
during inspiration and another during expira-
tion, it will lead to duplication of images (Fig.
3). Double exposures can lead to errors in in-
terpreting the position of line and catheters [4].
Such erroneous diagnoses resulting from im-
proper exposure can have medicolegal impli-
cations. Double exposure is an operator error
that accounts for 2% of all rejected images [5].
Proper knowledge of the usage of x-ray equip-
ment is necessary to prevent such errors.
Uncollimated Images
Because the imaging plate is very sensi-
tive to scatter radiation, primary beam colli-
mation is very important not only to prevent
radiation exposure but also to prevent un-
sharp images (Fig. 4). If the image collima-
tion is not parallel to the imaging plate, prop-
er borders will not be recognized, resulting
in bizarre or nondiagnostic images [6]. Prop-
er collimation should be done in accordance
with the cassette size and the body part be-
ing imaged.
Delayed Scanning
The imaging plate contains PSP, which is
sensitive to x-rays. The PSP changes to an in-
termediately unstable state after receiving
energy in the form of x-rays. This state is not
stable, and if the phosphor remains unstim-
ulated, it returns to its normal state after a
prolonged delay through spontaneous phos-
phorescence. Thus, a delay between acqui-
sition and processing of the image will lead
to fading of the image (Fig. 5). Twenty-five
percent of the stored signals will be lost in
about 10 minutes to 8 hours after exposure,
and more slowly afterward [7]. One study
concluded that statistically significant degra-
dation of gray-level values and contrast oc-
curs in plates scanned half an hour or longer
after exposure [8]. In our experience, fad-
ing was evident after a delay of 24–36 hours.
The possible reason for this fading is that the
central primary beam consists of high-ener-
gy photons, whereas the low-energy photons
are in the periphery. Hence, the fading starts
from the periphery, a point that distinguishes
this kind of fading from that which occurs
because of underexposure.
To prevent this artifact, the delay between
exposure and the readout process should be
kept to minimum. This principle should be
inculcated in radiographers by proper train-
ing and knowledge about CR technology in
general and the imaging plate in particular.
Exposure Through the Back of the Cassette
Understanding of cassette orientation by
radiographers is important. Cassettes are de-
signed and constructed in different ways by
different vendors, so any exposure through
the back of the cassette will leave its own pat-
tern of artifacts [9]. In our case (Fig. 6), the
artifact could have been mistaken for a tra-
cheostomy tube if we had failed to recognize
its artifactual nature. Proper education of ra-
diographers in handling of cassettes should be
performed to prevent this type of artifact.
Inappropriate Exposure Factors
Overexposure—A wide range of respons-
es to various incident exposures is character-
istic of CR systems, whereas film is optimal-
ly sensitive to a restricted range of exposures.
This is because the acquisition and display
events occur separately so that compensa-
tion for under- and overexposures is possi-
ble with the algorithms applied to the digital
data. However, like any other electro-optical
system, CR has a fixed dynamic range and,
hence, a limit of adjustment [10]. Although
CR is more tolerant of incorrect exposure
factor selection, it cannot compensate for ex-
tra noise, loss in subject contrast, and a sig-
nal out of its range of adjustment. Overexpo-
sure of the imaging plate leads to irreversible
darkening of the image, obscuring minute
details (Fig. 7A).
Underexposure—In cases of marked un-
derexposure (Fig. 7B), the image will appear
grainy owing to quantum mottle. Such imag-
es can be identified by looking at a high sen-
sitivity number in the parameter display area,
and these images must be read with caution,
because subtle findings may be masked by
the reduced signal-to-noise ratio [11].
Proper exposure factors should be used
according to the body part and patient’s
build, to prevent poor image quality. Radiog-
raphers should be conversant about the dy-
namic range and limitations of CR systems.
Improper Grid Usage: Moiré Pattern
Selection of grid frequency is important, be-
cause grids with low grid line rates are known
to cause a moiré pattern, resulting in subopti-
mal image quality [9]. The moiré pattern is
AJR:196, January 2011
 Computed Radiography Image Artifacts

seen in images caused by using a grid with a
frequency of 33 lines/cm, which are orient-
ed with grid lines parallel to the plate reader’s
scan lines (Fig. 8). Grids with 60 lines/cm or
more should be used, and the grid lines should
also run perpendicular to the plate reader’s la-
ser scan lines [9].
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Care and Carelessness
CR cassettes with imaging plates must be
stored and handled carefully. Negligence with
imaging plates is one of the primary causes of
artifacts. Buckling occurs as a result of mis-
handling of imaging plates by radiographers
during the cleaning process, which causes
ed portions of the image, potentially making
abnormalities unclear [11, 12]. Reducing
backscatter by lowering the kilovoltage or by
more precise collimation will limit the prev-
alence and impact of this artifact.
Image-Processing Artifacts

Scatter Radiation
The imaging plate is highly sensitive to
scattered radiation (Fig. 9). Therefore, cas-
settes should be kept away from radiation
fields, because radiation leads to a deterio-
ration of image quality. No object should be
kept on a cassette when it is in a radiation
field, because the object will be imprinted on
the image, leading to unwarranted repeating
of the radiograph. Hence, the cassette must
be protected from all sources of ionizing ra-
diation, including scatter radiation, as well as
heat and humidity [9].
A cassette seen to be lying unidentified in
the radiography room should be erased be-
fore use. If the cassette was previously ex-
posed or kept in a field of radiation, it has to
be put through the process of erasure before
reuse because it will hamper the quality of
the image and cause erroneous artifacts.
kink marks (Fig. 10). Such marks tend to oc-
cur at the sites where the imaging plate is bent
and can imitate pathologic conditions. To pre-
vent this artifact, cassettes and image plates
should be handled with care.
Light Bulb Effect
Artifactual darkening of the lower and
outer portions of an image relative to the
remainder of the image is caused by back-
scattered radiation entering the PSP imag-
ing plate from the patient’s bed (Fig. 11). The
source of this artifact can be attributed to an
increased exposure for obese patients or un-
collimated x-ray beam. This increased expo-
sure is due to the wide dynamic range and
high sensitivity of the imaging plate. When it
occurs in a chest radiograph, this artifact can
be misread as a pneumothorax or pneumo-
peritoneum in a supine patient. It can also al-
ter the contrast and brightness of the affect-
Image-processing artifacts can arise from
the imaging plate, the rollers in the CR read-
er that carry the imaging plate, and the plate
reader, in which a laser is used to scan the
imaging plate. The light photons thus emit-
ted are collected by the plate reader or light
guide and are converted into electrical sig-
nals, amplified, digitized, and used to form
the image. Image-processing artifacts are
further subclassified into hardware- and soft-
ware-induced artifacts.
Hardware-Induced Artifacts
CR cassettes use storage PSP imaging
plates instead of conventional films and inten-
sifying screens. Imaging plates use the prin-
ciple of phosphorescence. As the name sug-
gests, they do not emit light immediately
after x-ray exposure; instead, they store x-ray
energy in the form of a latent image. The la-
tent image is later read in the CR machine

TABLE 1: Image Acquisition Artifacts

Artifact
Twin artifacts
Uncollimated images
Delayed scanning
Exposure through back of
cassette
Inappropriate exposure factors
Overexposure
Underexposure
Improper grid usage
Scatter radiation
Care and carelessness
Light bulb effect
Causes
Two subsequent exposures on same
imaging plate or double exposure
Improper collimation
Delay between acquisition and
processing of image
Poor basic knowledge of construction of Various patterns of shading according Proper education of radiographers in handling
cassettes
Improper exposure settings
Improper exposure settings
Usage of grids with low grid frequencies Different types of moiré pattern
Cassette placed in vicinity of scattered
radiation
Mishandling of imaging plate during
cleaning process
Back-scattered radiation entering
imaging plate from patient’s bed due to
increased exposure for obese patients
or due to uncollimated x-ray
Appearance Remedy
Duplication of images Proper knowledge of usage of x-ray
equipment
Unsharp images Proper collimation in accordance with
cassette size and body part
Fading of image Proper knowledge of radiographers to check
that no delay occurs between acquisition
and processing
to cassette design of cassettes
Darkening of image Proper exposure factors to be used based on
body part and patient build
Grainy image owing to quantum mottle Knowledge of dynamic range and its
limitations in computed radiography system
Usage of grids with 60 lines/cm or more; grid
lines should run perpendicular to plate
reader’s laser scan lines
Deterioration of quality of image and Protect cassette from any unwanted radiation
imprints of objects placed over and erase cassettes before using
cassette
Kink marks Cassettes and image plates should be
handled with care
Darkening of lower and outer portions Reduce back scatter by lowering the peak
of an image relative to remainder of kilovoltage or by more precise collimation
image

AJR:196, January 2011 W39

 Shetty et al.

using a laser. Hardware-induced artifacts can
be due to the imaging plate, rollers, plate
reader, and cassette.
Imaging plate artifacts—Imaging plate
artifacts can be attributed to cracks resulting
from aging of the imaging plate and roller-
induced artifacts. As the imaging plate pass-
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In some cases, artifacts are the result of
dust particles on the imaging plate. The im-
age in Figure 13 shows focal radiopacities
overlying the soft tissues that are due to dust
over the imaging plates, which mimics cal-
cification or foreign bodies embedded in
the soft tissue. Regular cleaning of imaging
Disparity artifacts are due to malfunction-
ing of rollers in the digitizer, which causes
defective scanning. The defective scanning
alters the image contrast in the upper and low-
er half of the image, because the laser beam
power determines the fraction of the stored
energy released, which in turn is influenced

es through the plate reader, the imaging plate
bends over the rollers. Over a period of time,
the plates show signs of mechanical stress in
the form of cracks. These cracks usually first
become visible on the edges of the imaging
plate, where they do not hinder image inter-
pretation for diagnostic purposes. As the de-
terioration progresses, cracks appear closer
to the central imaging plate area (Fig. 12).
If screens are not cleaned on a regular basis,
bent, or handled without cotton gloves, the
aging process is hastened [6]. Artifacts due
to cracks can be prevented by changing im-
aging plates. A properly maintained imaging
plate can last for 5 years, after which the im-
aging plate needs to be changed.
plates is the key to a good radiograph. Some
manufacturers recommend the use of ethyl
alcohol for cleaning imaging plates. Paper
towels or gauze should not be used because
they leave fibers on the plate; instead, the use
of lint-free cloth is advisable. After cleaning,
leave the plate to dry for approximately 10
minutes. Once weekly cleaning is advisable.
Roller artifacts—Rollers are used within
the CR reader to transport the imaging plate
for scanning of latent images by the laser and
subsequent erasure by the high-intensity hal-
ogen lamp. During this process, the imaging
plate is constantly in contact with the rollers,
which transport the imaging plate within and
outside the CR reader.
by the scan time. Higher laser power can re-
lease more of the trapped electrons, but this
happens at the cost of loss of spatial resolution
as a result of increased depth of the laser beam
and increased spread of the stimulator light in
the phosphor layer [7]. Thus, in the example
shown in Figure 14, the lower half of the im-
age was exposed to the laser beam for a longer
time, resulting in a brighter image output that
rendered the image suboptimal. This artifact
can be prevented by periodic cleaning of the
rollers in the CR reader machine.
Imaging plates can be damaged by the roll-
ers as well. Focal radiopacities, which appear
as dots, are caused by mechanical damage of
the imaging plate during its transport through

TABLE 2: Image-Processing Artifacts

Artifact
Hardware-induced artifacts
Imaging plate
Artifacts due to cracks on imaging
plate
Artifacts due to dust particles on
imaging plate
Roller artifacts
Disparity artifact
Damage of imaging plate due to
rollers
Dust over rollers
Malfunctioning rollers
Plate reader artifact
Cassette-related artifact
Software-induced artifacts
Image transmission errors
Communication error artifact
Data cable malfunctioning artifact
Artifact due to improper erasure
setting
Causes Appearance Remedy
Damaged imaging plates during Cracks Change imaging plate
frequent transportation
Dust particles wedged over imaging Focal radiopacities Regular cleaning of imaging plates with ethyl
plate alcohol
Malfunctioning of rollers in digitizer Defective scanning resulting in Periodic cleaning of rollers in computed
alteration in image contrast radiography reader
Mechanical damaging of imaging plate Focal linear radioopacities Warrants immediate cleaning of rollers
during transport through rollers
Dust deposited over imaging plate Multiple localized radiopacities Maintenance and cleaning of rubber rollers by
during transport through rollers company service personnel twice yearly
Slipping of feed rollers from transport Half-read image Periodic cleaning and recalibration of feed roll-
assembly ers
Dirt over light guide or beam deflector Linear radiopaque line Periodic cleaning of light guide by service
personnel
Cracked or weakened lead coating on Linear radiolucent lines Replacement of cassette
back of cassette
Power failure during image transmission Missing lines or pixels in Radiograph should be repeated
resulting image
Failure of data cables in the power unit Alternating radiopaque and Replace data cables
of digitizer or computed radiography radiolucent lines
reader
Wrong body part selection or Residual image is left in imaging Proper selection of body part for appropriate
malfunctioning halogen bulbs plate radiograph or halogen vapor bulbs must be
changed

W40 AJR:196, January 2011


the rollers. In the chest radiograph shown in
Figure 15, linear radiopacities are seen in the
right hemithorax, over the soft tissues and in
the lung field; unless one is careful, one can
easily misdiagnose the opacities as calcified
granulomas in the lung. This artifact warrants
immediate cleaning of the rollers.
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Dust on the rubber rollers is another source
of artifacts. The radiograph of the pelvis in
Figure 16A shows linear radiopaque lines
that can be traced outside the pelvic region.
These lines are due to dust on the rollers,
which is deposited over the imaging plate
during its transport through the rollers.
The multiple localized radiopacities seen
overlying the soft tissues of the left upper ab-
domen in the chest radiograph in Figure 16B
could probably be the result of soft-tissue cal-
cification. However, these opacities actually
were caused by dirt over a localized area on
the rubber rollers. To prevent this type of arti-
fact, maintenance and cleaning of the rubber
rollers by the manufacturer’s service person-
nel are required once every 6 months.
Artifacts can be caused by slipping of the
feed rollers, resulting in images being half
read. For the same reason, in the example in
Figure 17, the anterior half of a lateral skull
radiograph is not seen. The linear radiopaque
line over the lateral skull radiograph, found
incidentally, is a plate reader artifact caused
by dirt in the light guide. Periodic cleaning
and recalibration of the feed rollers is of im-
mense importance to prevent slippage of the
feed rollers. The light collection guide also
needs to be cleaned, but only by authorized
service personnel of the manufacturer.
Plate reader artifact—The light guide col-
lects light emitted from the beam deflector
when it is scanned by the laser, which then
strikes the imaging plate. This information in
the form of photons is taken up by the PMT
for further amplification and image readout.
Dirt over the light guide is seen as a linear ra-
diodense line over the skull lateral radiograph
(Fig. 17). Similar lines are also seen in Figure
18, which is a lateral radiograph of the knee
joint, where linear radiopaque lines are not-
ed overlying the femoral condyles. The light
guide inside the scan unit should be cleaned
by the manufacturer’s service personnel.
Cassette-related artifacts—The back of
the cassette consists of lead foil, which pre-
vents scattered radiation. Scatter radiation
through the back of the cassette produces
black lines. These lines are analogous to the
place where the lead coating was cracked or
AJR:196, January 2011
Computed Radiography Image Artifacts
weakened [9]. These lines can mimic frac-
tures unless they are traced beyond the mar-
gins of the involved bone. Figure 19 shows a
lead foil artifact mimicking a hairline frac-
ture of the head of first metacarpal bone.
This type of artifact can be remedied by
changing the cassette.
Software-Induced Artifacts
Software artifacts can be due to image trans-
mission errors and improper erasure settings.
Image transmission errors—Artifacts as-
sociated with image transmission errors can
be caused by either communication errors or
data cable malfunctioning. With a communi-
cation error artifact, the image, after digiti-
zation, gets electronically transferred to the
display station computer. If there is a pow-
er failure during this image transmission, the
resulting image may get corrupted and can-
not be further edited. This artifact is seen as
missing pixels [5] (Fig. 20). A repeat radio-
graph must be obtained.
With a data cable malfunctioning artifact,
the data cables take control signals to vari-
ous modules of the CR reader, such as the
laser gun, galvanometer jitter (beam deflec-
tor), and PMT, and are also responsible for
the power supply to the laser gun and PMTs.
Failure of transmission through these cables
to different modules can cause an artifact
(Fig. 21). The solution is to recheck and re-
place the data cables.
Improper erasure setting—The erasure set-
tings for different body parts are differently
calibrated. Before inserting the cassette into
the digitizer, the body part should be select-
ed properly, because this setting determines
the right erasure cycle time for the body part.
If either the body part is erroneously select-
ed or the power of the erasure halogen lamp
is weakened, a residual image is left on the
imaging plate (Fig. 22). This is confirmed by
another exposure on the same imaging plate,
where an image resulting from the previous
exposure overlaps the new image. Proper se-
lection of the body part for the appropriate ra-
diograph should be done, and the halogen va-
por lamps must be changed if they are weak.
In conclusion, it is necessary to identify and
pinpoint the source and type of CR artifacts
because they can cause diagnostic errors with
medicolegal implications. The people behind
the machine are important, because most arti-
facts are due to operator error. Hence, it is nec-
essary to have a practical guideline to monitor
the quality control program. This goal can be
accomplished by inspection of CR cassettes
and imaging plates, quality control of equip-
ment, and continual training of radiographers
and radiologists to use this technology effec-
tively to produce diagnostic-quality images.
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Fig. 1—Flowchart shows workflow of computed

radiography system.
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Galvojeter/
beam splitter
Light diverging lens

Laser source Photomultiplier tube

Amplified electrical signal

A/D digitization
Imaging plate

Plate readout
direction 10110101

Digital data output

Plate movement direction
Driving rollers Fig. 2—Flowchart shows computed radiography
readout process.

Fig. 3—Twin artifacts.

A, Postprocedure radiograph of kidney and upper
bladder of patient with ureteric calculus for whom
double-J stent was placed on left side shows two
double-J stents (arrows) resulting from double
exposure, one during inspiration and other during
expiration.
B, Repeat radiograph taken to reconfirm shows single
double-J stent (arrows).
A B

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 Computed Radiography Image Artifacts

Fig. 4—Uncollimated image resulting from lack of

primary beam collimation.
A, Radiograph of pelvis shows increased density
over midportion and to right side of pelvis because of
improper collimation.
B, Subsequent pelvic radiograph with proper
collimation shows uniform density over pelvis.
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A B

Fig. 5—Delayed scanning.

A and B, Radiographs of neck (A) and abdomen (B).
Radiographs were subject to delayed readout (after
48 h). Both radiographs show decreased density in
periphery as compared with center of images, as
fading of image starts from periphery (arrows).
A B

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Fig. 6—Exposure through back of cassette.
Radiograph of neck shows rounded radiopaque
ring shadow (arrow) on right lower part of neck,
which if overlooked, can be wrongly diagnosed as
tracheostomy tube.
Fig. 8—Improper grid usage leading to moiré pattern.
Radiograph of pelvis shows wavy radiolucent lines,
resulting in suboptimal image, that were caused by
usage of grid with frequency of 33 lines/cm.
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Shetty et al.
B C
Fig. 9—Scatter radiation. Cassette was kept
accidentally in radiography room with pen over it for
some time. Radiograph of abdomen shows fading of
image with image of pen overlying lumbar spine.
Fig. 7—Inappropriate exposure factors.
A, Radiograph of hands shows darkening of image
that obscures image details. Artifact is result of
overexposure.
B, Image shows underexposed grainy radiograph of
kidney and upper bladder in which quantum mottle is
evident and image quality is degraded.
C, Control radiograph of same patient as in B using
proper exposure factors.
Fig. 10—Kink artifact due to buckling of imaging plate.
Excretory urography radiograph shows curvilinear
marks (arrows) adjacent to right upper and lower
pole calyces, which can mimic pyelosinus contrast
extravasations. Other kink marks are seen in course
of left ureter, which can be mistaken for calculi.
AJR:196, January 2011
 Computed Radiography Image Artifacts
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A B
Fig. 12—Artifacts due to cracks on imaging plate.
Fig. 11—Light bulb effect. Chest radiograph shows curvilinear opacity overlying
A and B, Radiographs of chest (A) and abdomen (B) show darkening (arrows) in lower and outer portions of left clavicle (arrow), which suggests cracks due to
radiograph, obscuring details of image. Darkening occurs because of either high peak kilovoltage technique mechanical stress. Opacity can be misdiagnosed as
used in obese patients or improper collimation. parasitic calcification.

A B
Fig. 14—Disparity artifact. This artifact occurs
Fig. 13—Artifacts due to dust particles on imaging plate. because of malfunction of roller in computed
A and B, Radiographs of right elbow joint (A) and left thigh (B) show radiopacities (arrows) overlying soft radiography reader, causing defective scanning and
tissues, which mimic soft-tissue calcification or foreign bodies but are actually due to dust over imaging plate. resulting in alteration in image contrast (arrows) in
upper and lower half of chest radiograph. Lower half
of chest radiograph was exposed to laser beam for
longer time, which resulted in brighter image output
that rendered image suboptimal.

AJR:196, January 2011 W45

 Shetty et al.
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Fig. 15—Damage of imaging plate due to rollers. Chest

radiograph shows linear radiopacities (arrows) along
right lateral chest wall. One can easily misdiagnose
opacities as calcified granulomas in lung.
A B
Fig. 16—Dust over rollers.
A, Radiograph of pelvis shows horizontal radiopaque lines (arrows) that can be traced outside margins of pelvis.
B, Chest radiograph shows multiple scattered radiopacities (white arrows) overlying soft tissues of left upper
abdomen due to dirt over localized area on rollers. These can be misdiagnosed as soft-tissue calcification.
There is another radiopacity (black arrow) overlying right hypochondrium mimicking gallbladder calculus,
which is actually caused by roller damage to image plate.

Fig. 17—Malfunctioning rollers. Anterior half of
lateral skull radiograph is not visualized because
slipping of feed rollers, resulting image being half
read (black arrow). Radiopaque line (white arrow) is
plate reader artifact resulting from dirt in light guide.
Fig. 18—Plate reader artifact. Lateral radiograph
of knee joint shows horizontal thin radiopaque line
(arrows) overlying supracondylar region. Artifact is
attributed to dirt on light guide in plate reader.
Fig. 19—Cassette-related artifact. Vertical linear
radiolucent line (white arrows) seen over head of first
metacarpal simulates linear fracture (black arrow)
unless traced beyond margins of bone. Artifact is
caused by cracks in lead foil in back of cassette.

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Fig. 20—Communication error artifact. Lower part of
radiograph (arrows) of knee joint was not visualized
because of missing lines or pixels. Transmission
of image was truncated because of sudden power
failure.
AJR:196, January 2011
Computed Radiography Image Artifacts
Fig. 21—Data cable malfunctioning artifact.
Lateral view radiograph of lumbar spine shows
alternating radipaque and radiolucent lines obscuring
image details. Problem was narrowed down to
malfunctioning data cables in computed radiography
reader.
Fig. 22—Artifact due to improper erasure setting.
Radiograph of kidney and upper bladder shows
superimposed residual chest radiograph image,
which is seen in form of ribs and clavicle shadows
(black arrows). Artifact was due to inadequate
erasure setting for chest radiograph. Also note two
side markers (white arrows).
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