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