Professional Documents
Culture Documents
CR Artifacts
CR Artifacts
Computed radiography (CR) systems based on photostimulable phosphor (PSP) image detectors (i.e., imaging plates) were first introduced commercially in 1983. Widely accepatable since they are costeffective, particularly suitable for bedside radiographic examinations in emergency conditions
ADVANTAGES OVER DR
The image quality of CR on large body parts, such as the chest and abdomen, is better than that of digital radiography. Advantage of positioning flexibility for difficult views, because CR cassettes can be placed in any position. A multiple cassette size option is available. A significant role in an emergency setup. After performing cost analysis and capacity utilization of general radiography, CR still scores over DR
Workflow of CR Systems
CR Readout Process Image acquisition is made using a PSPbased plate made of barium fluorohalide; enclosed in a cassette The plate is exposed to x-rays using standard radiographic equipment. During the exposure, electrons in the phosphor plate are excited to a higher energy state; these excited electrons are trapped and form a latent image which is then processed & retrieved in CR reader
Processing of Image STEP 1 :- The cassette is opened in the CR reader with release of the imaging plate from the cassette. STEP 2 :- The imaging plate is moved by the rollers for scanning by the laser beam. STEP 3 :- The laser light stimulates the trapped electrons to become free and return to a lower energy state, which results in the release of light photons.
Now, the two lights (laser light and the released light photon) have different wavelengths, which forms the basis for image retrieval. And the photomultiplier tube (PMT) identifies these higher energy and shorter wavelength light photons STEP 4 :- Light released from the imaging plate is collected by the fiber-optic light guide and strikes a PMT, where it produces an electronic signal.
STEP 5 :- The electronic signal is digitized and stored in a display monitor and later sent to a PACS. STEP 6 :- The image plate is then exposed to a high-intensity halogen lamp, which erases any residual energy remaining from a prior exposure. STEP 7 :- The image plate is returned to the cassette, which is ready for reuse.
Artifacts
Any irregularity on an image that is not caused by proper shadowing of tissue by the primary x-ray beam.
Are undesirable optical densities or blemishes on a radiograph. Can be very interesting at times. You become the detective, what caused that?
A, 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).
Double Exposure
2 exposures made on top of each other exposure artifact
Lack of contact between film and cassette can cause blurring of the image
Patient motion
Double exposure
Uncollimated Images
Causes :- The imaging plate is very sensitive to scatter radiation, Primary beam collimation is reqd. to prevent
radiation exposure unsharp images
Appearance :- Uncollimate, bizarre or nondiagnostic images Remedy :- Proper collimation should be done in accordance with the cassette size and the body part being imaged.
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.
Delayed Scanning
Causes :- PSP changes to an intermediately unstable state after receiving energy in the form of x-rays. This state is not stable, and if the phosphor remains unstimulated, it returns to its normal state after a prolonged delay through spontaneous phosphorescence. Appearance :- Delay will lead to fading of the image. 25% of stored signal will be lost in 10 min to 8 hrs after exposure and more slowly afterward.
The fading starts from the periphery because central primary beam consists of highenergy photons, whereas the low-energy photons are in the periphery.
(Thus, distinguishes from underexposure)
Remedy :- The delay between exposure and the readout process should be kept to minimum.
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).
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.
Overexposure
Causes :- Improper exposure settings. CR has a fixed dynamic range and, hence, a limited adjustment and it cannot compensate for extra noise, loss in subject contrast, and a signal out of its range of adjustment. Appearance :- Irreversible darkening of the image Remedy :- Proper exposure factors to be used based on body part and patient build.
Radiograph of hands shows darkening of image that obscures image details. Artifact is result of overexposure.
Underexposure
Causes :- Improper exposure settings Appearance :- The image will appear grainy owing to quantum mottle. Subtle findings may be masked by the reduced signal-tonoise ratio Remedy :- Proper exposure factors should be used according to the body part and patients build, to prevent poor image quality.
A, Image shows underexposed grainy radiograph of kidney and upper bladder in which quantum mottle is evident and image quality is degraded. B, Control radiograph of same patient as in B using proper exposure factors.
Improper grid usage leading to moir 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.
grid lines and the scanning laser are parallel moir effect
Scatter Radiation
Causes :- Imaging plate is highly sensitive to scattered radiation. If the cassette placed in vicinity of scattered radiation. Appearance :- Deterioration of quality of image and imprints of objects placed over cassette Remedy :- No object should be kept on a cassette when it is in a radiation field. The cassette must be protected from all sources of ionizing radiation, including scatter radiation, as well as heat and humidity. If the cassette was previously exposed or kept in a field of radiation erase it before using
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.
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.
Light bulb effect. A and B, Radiographs of chest (A) and abdomen (B) show darkening (arrows) in lower and outer portions of radiograph, obscuring details of image. Darkening occurs because of either high peak kilovoltage technique used in obese patients or improper collimation.
Image-Processing Artifacts
Appearance :- Cracks on the film, Focal radio-opacities mimicking calcification of foreign bodies in soft tissues Remedy :- Clean the imaging plate, handle with cotton-gloves. Change the plate if reqd. To remove dust regular cleaning of imaging plates with ethyl alcohol. Paper towels or gauze should not be used because they leave fibers on the plate; After cleaning, leave the plate to dry for approximately 10 min [Once weekly].
Artifacts due to cracks on imaging plate. Chest radiograph shows curvilinear opacity overlying left clavicle (arrow), which suggests cracks due to mechanical stress. Opacity can be misdiagnosed as parasitic calcification.
Artifacts due to dust particles on imaging plate. A and B, Radiographs of right elbow joint (A) and left thigh (B) show radiopacities (arrows) overlying soft tissues, which mimic soft-tissue calcification or foreign bodies but are actually due to dust over imaging plate.
Dust in imaging plate can cause white marks on image Both in film/screen and computed radiography
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 halogen lamp. During this process, the imaging plate is constantly in contact with the rollers. Disparity artifacts are due to malfunctioning of rollers in the digitizer, which causes defective scanning Appearance :- Alteration in image contrast Remedy :- Periodic cleaning of rollers
The lower half of the image was exposed to the laser beam for a longer time, resulting in a brighter image output that rendered the image suboptimal.
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 GB calculus, which is actually caused by roller damage to image plate.
Malfunctioning rollers
Causes :- Slipping of the feed rollers, resulting in images being half read. Appearance :- Half-read image Remedy :- Periodic cleaning and recalibration of feed rollers
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.
Cassette-related artifact
Causes :- Cracked or weakened lead coating on back of cassette. Scatter radiation through the back of the cassette produces black lines
Appearance :- Linear radiolucent lines mimicking fractures (but sometimes can be traced beyond bone margins)
Remedy :- Replacement of cassette
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.
Software-Induced Artifacts
Can be due to Image transmission errors Improper erasure settings
Causes :- Power failure during image transmission (the image, after digitization, gets electronically transferred to the display station computer)
Appearance :- Seen as missing lines or pixels in resulting image. Remedy :- Repeat radiograph is required.
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.
ii. Data cable malfunctioning artifact Causes :- Failure of data cables in the power unit of digitizer or CR reader. Appearance :- Alternating radiopaque and radiolucent lines Remedy :- Replace data cables
CONCLUSION
It is necessary to identify and pinpoint the source and type of CR artifacts because they can cause diagnostic errors & Medicolegal implications. Most artifacts are due to operator error. Hence, a practical guideline to monitor the quality control program should be ensured. This goal can be accomplished by inspection of CR cassettes and imaging plates, quality control of equipment, and continual training of radiographers and radiologists to use this technology effectively.