Mhm.

Radiographic processing is necessary for the 

production of the useful visible image.

It links exposure to interpretation and 

influences quality.

Discussion of a systematic approach toward artifact.

Film interpretation affords the participant 

and understanding of the sources of artifacts.

Film identification,

test films and clues obtained by 

analyzing artifacts on radiographic films,

artifact film interpretation can 

be an enjoyable,

and yet it is a necessary aspect of uh 

processing.

And of course the function of the department.

Most of the time we have people who sort films,

they look for quality positioning,

correct exposure,

penetration,

amount of density on the film's correct identification 

of the patient's name and other 

pertinent information.

But in reality,

what they're doing is looking at the film to see if the film is of 

total acceptable quality Regarding 

processing.

We need to look at the film to see if one 

there are any artifacts or 

to uh if indeed,

we do have proper processing insofar as a sense 

of metric image.

So what is an artifact?

Well,

too many people and many languages in the world.

The word artifact is not used in 

discussing problems with our 

films or reasons to repeat the films.

The word is a defect.

So we might use the word defect or at least keep in the 

back of our minds when we talk about artifacts.

But the best way that you might consider looking 

at artifacts is to simply pick up films and be very 

critical as to what you see on the,

on the particular film.

And so far as positioning,

uh,

the general technique,

the marks on the film,

the processing conditions.

But in all of this,

there is a systematic approach and this is what we're 

going to discuss in this lecture.

To begin with,

an artifact or defect can be 

a it can 

be something that is unwanted.

It can be sensitive metric density,

that is unwanted or non useful density,

unwanted density.

Or it could be a physical defect insofar 

as uh it might be a scratch on the film that 

would be seen as increased density 

because of the pressure of the scratching causing an 

exposure which developed into metallic silver.

Or it may be that the scratch removed the 

gelatin,

in which case now we do not have silver,

We have an artifact that appears as a white mark where the 

silver,

which should be.

There has been scraped away.

One of the very most common kinds of 

artifacts would be static,

as in static electricity's we see in this 

slide,

we have three kinds of the study.

We have tree static smudge 

and crown.

Study the tree static starts at a base 

and branches out as a tree wood.

The crown static will start at a base 

and be smaller with fewer 

branches.

And many times you even see an actual 

crown and a little short race coming 

off from the crown or sort of rounded 

uh static line discharge line smudge 

static or just a little round discharge balls.

And we will look at these in greater details.

We go along so we have 

unwanted density,

that is density that you see there amongst the 

anatomy,

anatomical densities and it's 

unwanted.

Certainly,

it is confusing.

It interferes with the interpretation.

Another kind of unwanted density that 

we might consider to be sensitive,

metric artifacts or defects.

Here we have three images,

all identical,

except for the fact that we can see better in one.

We can any other consider the cloud formation 

in this particular radiograph.

What we're talking about is contrast levels.

Here we have a good moderately high 

contrast level in which we can see the cloud 

formation.

We can easily see the piles of snow 

amongst the bushes around the base of the building 

in this radiograph.

Do right.

You see that you have quite a bit 

darker image here and you've lost 

information.

You can see the piles of snow easier.

The clouds are harder to see,

but it's very difficult to see the window in the building 

coming over to the other extreme,

we have increased contrast,

we have very few shades of gray.

Now we've lost the clouds,

we've lost the piles of snow here,

but we can more easily see the window in the building.

So what we need is the correct level of 

contrast,

the correct level of densities throughout the entire 

film,

so that we can see such subtle little things as a snow 

starting to slide on the roof of the building so that we see 

all of the information.

And this certainly would be one thing to consider in 

discussing artifacts.

Do we have the best visualization of the 

information as the 

established level of quality shifted on us?

Has it slowly day to day?

Just lost a little bit?

So we want to look for since in symmetric shifts or 

changes or defects or abnormalities 

and in the general category of an 

artifact,

something that is unwanted in this 

particular slide,

we can see a skull radiograph of 

degree of quality now,

is that quality?

The quality that you've selected?

Is it better than yesterday or poor?

Poorer than yesterday?

So this would involve a judgment 

PN In this particular slide,

we have information which can be easily 

seen in the contrast,

the high contrast that we have in this center 

uh image.

Of course this is a phantom 

situation here,

it's washed away and here 

it's masked over with grey's.

Well,

in this case the grey or the 

lack of full penetration there is this due 

to exposure or have we simply 

overdeveloped,

fogged or underdeveloped?

Well,

now we have the problem of saying that whereas 

before we had the consideration,

is it at the correct exposure?

Now we have to decide whether or not we have both the 

correct exposure or correct processing 

or if one is correct and the other is wrong or if one 

is is a little incorrect and the others tried to 

compensate.

So we need to make decisions.

We can't just continue on day after day with 

this unknown.

So we use these clues.

We use these films that we work with every day to tell 

us how we're doing.

So in this way we can maintain 

consistency.

We maintain efficiency in the department.

Let's consider a little closer how we might want to 

look at radiographs insofar as looking for 

clues and an artifact sources.

In the first case,

we need to identify the sources of artifacts.

This would be in the case of an exposure to the 

film or damage to the film.

This can occur in one of three areas,

Dark room and handling.

This includes these four sub areas,

manufacturing of the actual film delivery to the 

warehouses and eventually to the dealer's warehouse and 

then finally to the hospitals storeroom.

Next we have before exposure,

after exposure and after processing and then the 

category of exposure itself with the not the correct 

exposure and then processing under 

dark room and handling.

To begin with,

we have manufacturing.

Several manufacturers put stencils on the 

film.

They have almost all manufacturers have emotion numbers on 

the boxes so that you can catalog these and 

you can write them down and keep a record of when the film was 

delivered and how it was stored,

and when it was used,

all films should be stored 

prior to exposure within the hospital on a 

FIFA system.

First in first out,

you use the the film in a 

way that you don't allow film to be 

left on the shelf too long 

before exposure also means that the film is taken 

to the dark room and it's put into the darkroom.

The pouches or bags are open and the 

ambient conditions within the bag are allowed to acclimate to 

the ambient conditions of the dark room for at least 

an hour before usage where possible 

after exposure imposes another restriction on 

how the film is handled.

And this is where dark room personnel should be the most highly 

skilled and trained after exposure.

After the film has been bombarded with radiation and light 

from intensifying screens,

the film,

any speed of film will be 

faster.

That means that with an equal exposure,

such as a handling exposure or 

pressure or static discharge,

that might occur before that may not 

damage the film.

But after exposure,

the film is much more sensitive to further 

exposure and we end up with 

increased artifacts occurring after exposure 

after processing.

We have the problems of view boxes.

View boxes need to be continually clean.

They need to be scanned with a common photographer's 

light meter to make sure that you have equal intensity throughout 

the light box.

You need to have equal intensity from the top to the bottom 

and you can use,

as I mentioned,

a common light meter.

One of the best ways to use it is to simply 

use the exposure values the 

numbers on the light meter And the light meter 

should read an e.

v.

of about 13 to provide the correct illumination.

As the bulbs deteriorate or 

as a view box gets dirty and incidentally in a clean 

environment such as a hospital,

it is possible to lose at least 10 of 

the illumination just from dust accumulating on the glass and on the 

bulbs.

So about once a month the view box should be 

inspected and or clean and 

uh bulbs replaced bulbs should all be 

replaced as matched bulbs for which there 

is a premium charged instead of just 

haphazardly one at a time.

Or to use common bulbs Unmatched in intensity 

from say a hardware store.

Also should you or radiologists have a 

preference for uh colored bulbs,

a pinkish tinge or more yellow instead 

of a daylight white.

Then consider making an entire view bank the same 

light intensity or light color 

instead of having different colours because certain colors along 

with a blue tint which is in the base will 

accentuate or uh 

diminish the ability to see information.

So the view box is important.

It's especially important for contrast 

levels.

As a view box is diminished,

you will have less like passing through the light areas of the 

radiograph and your radiograph will appear to have 

lost contrast.

It will appear this way the radiograph of course,

maybe excellent contrast,

an excellent exposure.

Excellent processing.

But the view box can deteriorate the image just as 

surely as any other factor going back to our 

Georgia.

And we can say that we have these 

factors associated with the handling of the film,

the dark room and the viewing on the view 

box.

Of course the sorting area by the view boxes and so forth,

must be kept free of coffee sugar and 

spills and and cigarette ashes so that 

the film is not damaged.

In this way exposure.

This involves the correct selection of screens focal film,

distance bucky grids and things of this nature,

processing the correct time temperature and activity 

relationship alignment of the transport components,

making sure the processors level and things of 

this nature.

So when you do have an artifact,

try to categorize it as one of these three 

general areas so that you don't end 

up rebuilding the process of.

For instance,

when you find actually that it was an exposure 

problem all along.

Now we can say that there are certain ways to mark the 

films to create test films that will allow you 

to accumulate information,

you will find that it's very difficult to 

solve an artifact problem.

Immediately,

in just one step many times,

you have to look at the artifact two or three times on 

23 films and accumulate information 

until you can make a valid decision as to what to 

do.

In this particular slide,

we see a listing 

of things to do.

We feed a film and when the film drops and receiver been 

lifted up and lay it on top of the processor and 

mark the leading edge and the edge that went down the 

side,

let's say next to the drive side of the process.

Er if you wish to orientate that way.

This way we know that if any marks on this upper surface 

where are writing is then this 

surface went through the process in a certain way 

facing upwards uh and hitting certain 

rollers and not hitting other rollers.

So mark the leading edge and put down the 

date and the time and any other information that is available to 

you.

Uh you may know that your thermometers on your 

processors need to be calibrated or that they are 

reading a couple degrees off.

Don't worry about it right down the temperatures,

the times any conditions that happen to exist at 

that moment.

We can then say,

okay,

perhaps you can run a few films through 

but you do not have time to sit down and 

and uh shut down the processor to analyze a 

problem.

You might want to record all data and then process 

some test films for referral.

Later on processing the standard 14 by 

17 and a variety 

of directions will allow you to stress the roller 

transport assembly if you first process some 

unexposed films,

if there's any damage done to the film that appear as 

black marks as an exposure that 

develops up,

we can take another film and flash it with white light.

Do not walk out into the white light 

area.

Just turn the white lights on real fast and this will give a 

good black image.

But if the surface of this film turns out to 

be brownish,

then we have deactivated developer 

or if there's a lack of blacks as you 

put it on a view box again,

we have deactivated developer.

If there's any picking off of 

gelatin or scratching the gelatin,

it'll appear as white marks on this film,

which should be very black.

These films should tell you pretty much what the problem 

is.

Help you to identify it.

Another category would be too as a last 

resort sort of flash of film with a 

light exposure such as 70 K.

V.

P two M.

S.

With par speed screens tabletop to 

just slightly excite the salt 

crystals in the film.

This makes the film as sensitive as films that are 

normally exposed and handled many 

times.

Uh,

quality control chief technologist may review a 

film and say,

well on these films,

I don't see the artifact and yet the radiologist complains of an 

artifact.

And that's because these films are less sensitive than 

the the actual patient films which have been 

sensitized.

Uh,

and then perhaps uh,

the artifact is put on after it went back into the dark 

room.

So we have clues on the film.

We have the patient's name that they 

When it was processed and handled.

We have uh,

the fact that the film and the screens and the cassette never 

exactly match.

And we know that the screens will enhance the original X.

Radiation beam about 100%.

So that if we look at the non screen area,

we can say that if the non screen area is 

fogged where the only exposure is made by X 

radiation,

that that means that if this 

area is also fog but not totally burned out,

that perhaps the fog is not due to radiation is 

probably due to chemical fog because chemistry does not 

know where the 

image starts and stop,

it just falls.

Everything.

We have the stencil mark on the film.

We have the general conditions of the 

film and be sure to look at both transmitted light 

and oblique light to try to try to find different clues,

as many clues as you possibly can.

Now let's go to view box and actually look 

at some radiographs and see some of the 

things we might consider.

The first thing to do is look at the overall radiograph.

In this case we see a hand,

we see the hand,

the exposure of the hand has been column mated.

And you can also notice that this is a phantom.

So it's a test film.

It's not a patient film.

We know that this non anatomical area out here 

should be uniformly gray and it's not we 

see a wispy cloud pattern here.

This is a desensitized king mark and exposure 

was placed on the film,

which caused the normal black area to be reversed 

so that what should be black is now white.

It was not developed up,

it was washed away in the fixer.

You won't be able to see this.

But in this particular radiograph,

there happens to be some wet pressure sensitization from dirt on 

rollers.

Pressing on this film has caused some 

since some silver deposits in the 

anatomical area.

And that would be most disconcerting to the radiologist.

And I'll show you better examples later on 

in this particular radiograph.

Well,

it's sort of uh light is,

it's hard to read the information we see over 

here,

that there's a white speck,

most likely uh debris on the screen,

which is absorbed the light.

So therefore there is no exposure in this area.

Here we see a dark glob of 

dirt and this dark cloud of dirt.

Did you see?

There happens to be a little piece of tape on the view box that I placed there,

but it could be just as easily crown markings or 

any other kind of dirt.

It causes the interpreter of 

the radiograph to work a little harder.

This particular radiograph,

would you say that this is a processing or exposure or a 

handling artifact?

Well,

certainly the film has been ripped and taped 

together so that might be handling.

But as you look at it,

you see dirt down here,

perhaps that's processing.

As it turns out,

this is a double exposure and the film is of no value to us 

anyway.

So it doesn't matter.

It turns out it is a process.

I mean it is an exposure artifact.

In the next two radiographs,

we can compare sensitive metric 

values.

You see two films.

They have different contrast levels between the 

two and we need to consider it.

Well,

is one better than the other or worse than the other.

Uh,

there are no real artifacts,

but there is a different level of quality 

and one is acceptable and one isn't,

that will leave to your judgment the last 

radiograph.

We can notice the Patients 

identification block up here and it says 

a date which I'll read us as 

1966,

the month and the day and some other the X 

ray number and so forth.

We see a very washed out fogged film.

We see that it's sort of modeled and that there are these little 

black marks.

These are chemical splashes and 

this sort of a rundown fogged appearance.

This is a result of manually processing in 

oxidized developer,

very old developer.

Now,

of course,

when you read radiographs,

you need to consider,

as I said in the beginning that you have to look at a lot of 

radiographs.

This sort of becomes a hobby.

So let's look at a number of radiographs and see what we 

find.

And uh,

the clues that we have and will start to 

accumulate some guidelines that you can 

then go to your own discard pile in the hospital,

pick out any old film,

put on a view box or handle it and see what you find.

And then start making notes or drawing on the films.

You'll see that I've done here.

So keep in mind our clues.

First of all,

we have the stencil on the film.

This tells us in this case that this is a high speed film.

It's very sensitive,

It requires less exposure to give us a 

certain level of density.

So therefore we must handle it more carefully.

This kind of high speed film will be a little more 

critical insofar as processing and the processor 

mechanical condition than with a par speed 

type of film.

A film that is less less fast 

to radiation.

A film that would require less exposed.

I mean require more exposure to give an equal level of 

density.

In this particular film,

we see that we have guide shoe marks.

Well,

the guide shoe marks indicate that the 

uh film had to be processed in 

this direction or this direction.

And the intensity of the guide to mark.

The uniformity will help you to 

determine which is the leading edge.

This is probably the leading edge for this particular processor.

The guide to mark's happen to be two inches apart and in this 

particular hospital it only could be produced by the M.

Four,

not the PICO X.

You or the proof X ray.

It had to be the Kodak M.

For processor.

And here we see another stencil on the film 

so that we have a number of clues right here on 

this blank sheet of film 

and incidentally those are both deposits of silver.

This stencil mark is cut into the film and it is it 

is silver.

We can see that there is a faint image of fog 

in this area 

and again the stencil mark in this particular case there is a 

slight staining a light yellow 

staining.

And we'll see more of this as we go along.

And the problem in this particular 

film was that it was processed a long time 

ago and it has developed 

uh staying in 

storage called archival stain or silver sulfide 

stain in this 

particular radiograph.

You look quickly over the entire radiograph and you may 

see a little bit of dirt and so forth.

But notice where the arrows are.

You see something that could be anatomy.

These little wispy guys are 

desensitized kink marks and this of course 

would be a problem to the radiologist.

These are handling marks,

not from fingernails or such is just a bending 

of the film.

And the bending of the film has caused an area that should 

be exposed to be reversed 

and it becomes unexposed.

If we look closer,

we see that these are areas in which 

the information,

the rib and so forth has been washed away.

Or if you will lost in intensity.

Notice also that we have a general level in these 

lighter areas,

at a general level of fog.

And over here on the non screen area where 

no radio,

no light hits,

just straight radiation that we have,

The two layers of the screen screens never exactly match 

each other.

And of course the film doesn't match either.

So there's an area here where we can see 

that there's no exposure.

And should this be fogged equal to this,

where there's a very,

very light exposure because of the contrast media,

then we can say,

well,

that's most likely going to be chemical fog that 

this area is exposed with 

radiation.

Remember over here where their screens,

the radiation be magnified 100 times.

This would be totally unacceptable insofar as the 

density levels and would be obvious that that was a 

bad radiograph.

Also,

we need to consider the screens,

The speed of the screen that's being used many 

times sensitive metric artifacts develop because 

one type of 

screen is being phased out or it's left in one 

cassette and it has not been removed from the system as 

the hospital moves on to new screens or to 

a different speed of screen.

So you need to uh make note of 

the speed of screen and also identify bad cassettes 

warped and damaged and things of this nature.

This film is an interesting one is often called alligator hide 

or leaded glass effect,

or stained glass effect.

And we see that the film is also 

ripping.

This was a tri acetate based film produced 

1949.

If we look more closely,

we can see that the film has shrunk and has bubbled 

up technically.

This is called base shrinkage because that's the tape based film 

shrinks.

The modern polyester bases do not 

this film.

Well,

if you look closely,

you'll see a light yellow tinge.

This is Dick Roeck stain up in the 

corner.

We see a sensitized kink mark.

The shape of a fingernail but not caused by a fingernail is 

caused by a flexing of the film,

a bending of the film and where the film bends,

it creates this pressure mark and that 

is silver.

If we go to the the 

blackboard,

this term decried stain results from a 

failure of the chemistry whereby,

well yeah,

die Croelick and we 

have a failure of the developer or the 

fixer or the development fixer are contaminated together 

or they're both partially uh deteriorated.

And the stain that we 

get is a yellowish cast a yellowish 

stain.

And this eventually we'll start producing pinks and 

yellows and so forth.

And we end up with uh heavily stained 

film.

But the stain occurs on the film as it's seen coming out of the 

process,

er not after spinning stories for a while.

So this is DI Kroeske stain.

It begins as a yellowish tinge and may end up 

as a purple.

And we'll see this.

As we go along 

here,

we see static discharges.

If you look closely,

you can see there's some smudge static up here in a random 

pattern.

This is due to an ungrounded workbench and there's this 

discharge through the film to a ground 

grounding uh shorting system 

and uh the static on the film 

is piles of silver.

It's an exposure.

This line along here is a lot of little 

dots.

It happens to be a beaded chain that was 

attached to a pair of scissors and this discharged 

uh causing the image on the film.

If you will,

we have white spots.

This is dirt on the screens that has caused a 

an absorption of the radiation.

If we look along the edge,

we see some lines coming in.

It's always difficult to determine if this 

blackish line is an increase in density or if 

in reality the darker line is normal and what is 

between is a loss of density as the source of artifacts.

It turned out.

This film was fed and 

a normal fashion this way.

And these lines which are very,

very faint,

but they are,

they're these lines are a result of a failure of the 

fixer to properly neutralize the developer.

So there is slight over development on this 

one edge,

we look more closely,

we can see that this is silver 

smudge static.

And again,

we have a screen identification.

We have this line from the beaded chain along the edge.

Again,

we have this increased density because we did not 

accurately stop development.

There's a pile of dirt just sitting right on the surface of the 

film and we have dirt on the screens 

here we see smoke study.

We can see the 

edge along here is heavily bombarded.

We look at these things more closely,

we have static again 

as silver 

smudge static.

Here we see wet pressure sensitization.

And this is a bombarding.

Here we go again.

To the blackboard.

This is a bombarding of the of the film by dirt on 

rollers and it causes a 

and exposure.

Let's go.

Yeah,

it's called wet pressure sensitization 

and this is often enhanced by the 

failure of the chemistry.

Here again is another form of wet pressure sensitization.

It is piles of silver 

and this particular radiograph there is so much 

pressure sensitization in this area that might be 

considered as a defect of the patient's 

bone structure 

and dirt on the radiograph,

scratch marks from lifting a film out of 

the rough receiver been 

sensitized king mark,

desensitized king marks.

There's a sensitized mark.

Again,

you can see the silver.

This is a film that's unclear due to the 

failure of the developer hardener and the film was 

over swollen and the fixer did not have enough time to 

fully clear and we see it's not clear and here it is.

This is also stained.

The film has twice the normal hyper retention level 

and there we see die acrylic stain.

Of course,

it's not a normal process film.

You can see the heavy staining colors 

and here again,

the purple color is very heavy decried stain 

run down and again the stain.

This is also called a curtain effect.

It is usually found in solar processing 

transport assemblies.

This is an excellent example of diet coke stain.

The surface will appear metallic sized,

almost a gold color.

And of course,

when we have guide shoe marks and general staining also,

so the list is endless.

We can continue.

But it's the kind of thing that these are just some 

typical examples.

Again,

having looked at this,

take some films out of the discard bin.

See what you find,

mark them down and save them.

Put them in a little file for yourself as you find better ones.

Discard the poor examples and eventually you build up an 

excellent artifact.

Teaching file.

I want to 

mm