This artifact can be fixed by reshuttering and reprocessing the image. Avoidance or Remedy.—For both infection control and prevention of liquid infiltration, wireless flat-panel detectors are often bagged. Research output: Contribution to journal › Review article › peer-review For organizational simplicity, artifacts are grouped according to their causal connection. Figure 5b. The types of artifact examples presented include those related to equipment defects or disruption from an accident or mishandling, debris or gain calibration flaws, acquisition technique, and image processing issues. The literature classifies artifacts according to causative agent, such as hardware, software, or operator, 2-5 although artifacts can also be categorized by the mechanism of interference with image acquisition, processing, or display. This change in coupling affects signal transfer in the detector. However, several incidents in which the artifact was visible on clinical images led to a practice of further investigation to ensure that artifacts viewable in a quality control viewing window were addressed. Chest radiograph obtained with a portable radiographic unit shows two types of artifacts: A large white smoothly edged defect (horizontal arrow) appears at top left, and straight lines (vertical arrow) are seen across the middle of the image. 3, 01.05.2018, p. 833-846. Description of Artifact Appearance.—The image in Figure 10 shows irregular lines that appear to be radiolucent relative to the surrounding material. R adiographic artifacts are portions of the image that may mimic a clinical feature, impair image quality, or obscure abnormalities. Avoidance or Remedy.—Some detector drops might result in shifts in signal gain or offset that can be compensated for with recalibration of the detector. This evidence of detector structure disappears at lower exposures. MATERIALS IDENTIFIED ON RADIOGRAPHS A variety of materials can be detected using radiography, but some are easier to identify than others. Pictorial Review of Digital Radiography Artifacts A11(20) 2 Evaluation of Kidney Stones with Reduced-Radiation Dose CT: Progress from 2011-2012 to 2015-2016 - Not there yet A12(20) 2 The use and pitfalls of intracranial vessel wall imaging: how we do it A13(20) 3 (a) Patella radiograph appears washed out, giving the impression that it was underexposed despite being acquired at an exposure higher than that recommended. Chest radiograph obtained with a portable radiographic unit shows the area of the inset (rectangle). The purpose of this article is to discuss flat-panel digital radiography (DR) artifacts to help physicists, radiologists, and radiologic technologists visually familiarize themselves with an expanded range of artifact appearance. Instead, the detector needs to be replaced. Digital Radiography Image Artifacts Figure 1 shows a lateral chest image with an unusual superimposed pattern on the anatomy. (c) Knee radiograph obtained with different processing from that used in a shows recovery of image detail in the area of the cement and the cement-implant boundary. digital magnification radiography. These bloblike artifacts are differentiated from inverse focal spot images because they are stationary when the detector is rotated and do not change size with source-to-detector distance. Description of Artifact Appearance.—A single trapezoidal opacity can be seen in the flat-field image in Figure 8a, surrounded by the magnified and offset appearance of its inverse (the area of lucency around the opacity). Accessibility Cum Laude Award: "A Pictorial Review of Digital Radiography Artifacts" Radiological Society of North America 2016 Program Director Recognition Award Mayo Graduate School of Education (b) Radiograph shows that as lead shavings build up near the head of the x-ray tube, a larger number of inverse focal spots and their opposites are depicted. 2019 Dec;66(4):229-237. doi: 10.1002/jmrs.366. AJR Am J Roentgenol 2012;198:156-61. The appearance of a speckle pattern in Figure 3 subsequent to a detector drop was resolved by a detector recalibration. Evolving detector defect. For Figure 15a, it was seen that the poor processing outcome related to a change in collimation between the image shown and the images for which the processing was optimized (knee images with a larger field of view). Because the mechanism for image creation is different between flat-panel detectors and computed radiography, the causes and appearances of some artifacts can be unique to these different modalities. Figure 10. Figure 16a. The threshold for the appearance of detector structure will differ for detectors that have different offset tolerances between detector elements. A pictorial review of digital radiography artifacts. (c) Knee radiograph obtained with different processing from that used in a shows recovery of image detail in the area of the cement and the cement-implant boundary. Midgray clipping artifacts. (a) Cross-table lateral hip radiograph appears to be an acquisition failure but instead results from a failed detection of the collimator edges and poor electronic shuttering. Description of Artifact Appearance.—A unique and subtle artifact was found regularly during quality control testing with one particular type of detector. Together they form a unique fingerprint. The citations are incomplete. Figure 14b. This is an example of a CR image obtained with cassette reversed, where the tube side of cassette is pointed away from the x-ray tube source and toward the patient. The trapezoidal opacity is the pinhole image of the focal spot caused by lead debris near the head of the x-ray tube. This image was obtained after water contaminated a bagged detector. American Association of Physicists in Medicine, © 2021 Radiological Society of North America, Digital imaging systems for plain radiography, The invisible gorilla strikes again: sustained inattentional blindness in expert observers, Ongoing quality control in digital radiography: report of AAPM Imaging Physics Committee Task Group 151, International Electrotechnical Commission, IEC 62220–1: medical electrical equipment—characteristics of digital x-ray imaging devices: Part 1-1, Current state of practice regarding digital radiography exposure indicators and deviation indices: report of AAPM Imaging Physics Committee Task Group 232, An exposure indicator for digital radiography: AAPM Task Group 116 (executive summary), The amateur scientist: the pleasure of the pin hole camera. This loss is seen in the loss of detail in the cement and cement-implant boundary in Figure 15a and a loss of detail along the anterior edge of the tibia in Figure 15b. Figure 5c. Avoidance or Remedy.—A new offset calibration removed the residual image artifact. The examples are meant to serve as learning tools for future identification and troubleshooting of artifacts and as a reminder for steps that can be taken for prevention. In addition, the edge of the implant appears falsely serrated. Figure 16b. (b) Upper abdominal radiograph shows image saturation (arrow) at the diaphragm, a location in which image saturation is more commonly seen. Although we adopt a quality control practice similar to that described in the AAPM Imaging Physics Committee Task Group 151 report (4) to perform an artifact test after detector calibration, this test had only been done in the “free-detector” mode with the wireless detector outside the table. Epub 2019 Nov 6. (b) Knee radiograph obtained with a larger field of view shows the area of the inset (rectangle). Electronic shutter failure. Cause.—After replacement of the battery in a wireless digital radiographic detector, technologists are prompted to perform a detector offset calibration. The recognition and understanding of artifacts in digital radiography facilitates their reduction and decreases misinterpretation. Description of Artifact Appearance.—The image in Figure 7 shows vertical striping in the area of raw radiation. The artifacts remain stationary when the detector is rotated with respect to the head of the x-ray tube and hence are located on the detector itself. This site needs JavaScript to work properly. Radiologe. Inverse focal spots and calibration artifacts. However, each artifact example provided will be classified according to a type of failure mechanism in the digital radiographic imaging chain. (b) Knee radiograph was obtained with the same source image data but with the use of an alternative processing setting to address the lucency artifact (rectangle). 2003 May;43(5):340-50. doi: 10.1007/s00117-003-0890-y. If you continue browsing the … Radiograph shows that in addition to several trapezoidal inverse focal spot artifacts on this flat-field image, many bloblike artifacts (arrow) are depicted. The saturation point for digital radiography is typically much lower than that for computed radiography (eg, a maximum image receptor air kerma for one flat-panel detector is approximately 90 μGy, compared with approximately 440 μGy for a computed radiographic plate). However, maintaining the same detector exposure without a grid would require a reduction of approximately 75% in technique. (a) Cross-table lateral hip radiograph appears to be an acquisition failure but instead results from a failed detection of the collimator edges and poor electronic shuttering. (a) Knee radiograph shows the homogeneous gray appearance of the cement (arrow), which indicates a loss of detail. The examples of artifacts provided are classified according to their causal connection in the imaging chain, including an equipment defect as a result of an accident or mishandling, debris or gain calibration flaws, a problematic acquisition technique, signal transmission failures, and image processing issues. Midgray clipping artifacts. Unable to load your collection due to an error, Unable to load your delegates due to an error. In particular, it does not emphasize the significant limitations of lung ultrasound . Inset: Magnified view shows the area of the tibia in which there is a loss of detail (arrow). Enter your email address below and we will send you the reset instructions. (a) Knee radiograph shows artifacts at the metal-bone interface (rectangle). Abdominal radiograph obtained with a portable x-ray unit shows a superimposed inverse image from a previous acquisition: the previous patient abdominal outline (black arrow) and the previous laterality marker (white arrow). Pictorial Review of Digital Radiog-raphy Artifacts1 Visual familiarity with the variety of digital radiographic artifacts is needed to identify, resolve, or prevent image artifacts from creat-ing issues with patient imaging. (A higher recommended target detector air kerma is inferred from the default technique guides provided by the manufacturer, which show a 0%–35% reduction in the milliampere-second setting between gridded and simulated-grid chest and abdomen techniques for the same detector for a medium patient.) This threshold for an artifact affecting diagnostic interpretation may be rightfully debated and may differ on the basis of the examination, the specific detector exposure, and image processing. It is slowly being adopted by the dental profession. Inset: Magnified view shows artifacts at the metal-bone interface, creating a false lucency (arrow) as well as a stairstepped edge that does not correspond to the structure of the object being imaged. Figure 17. ■ Describe methods to eliminate the artifact and improve image quality. Figure 14a. This type of artifact is also less likely when well-optimized target exposures are used for the images. As a result, the artifact associated with the table calibration was not found until clinical use. Because the mechanism for image creation is different between flat-panel detectors and computed radiography, the causes and appearances of some artifacts can be The image shown in Figure 3 is presumed to be the result of minute shifts between the scintillator layer and the thin-film transistor layer of a gadolinium oxysulfide flat-panel detector; such shifts affect the effectiveness of the flat-field calibration. Midgray clipping artifacts. After performing cost analysis and capacity utilization of general radiography, CR still scores over digital radiography [3]. The artifacts appeared within 6 months after a flat-field calibration in which the detector had been observed to be artifact free. Avoidance or Remedy.—The artifacts appearing as bloblike areas of opacity seem to remain subclinical with regular detector recalibration. Some vendor systems may have integrated diagnostics software to alert the user when detector drops are of sufficient magnitude for a risk to image quality and may provide follow-up instructions for how to respond. Description of Artifact Appearance.—The abdominal radiograph in Figure 6a represents a dramatic case of image saturation (“clipping”) in which the lower part of the patient’s anatomy is completely missing from the image. 5. (a) Knee radiograph shows artifacts at the metal-bone interface (rectangle). In this case, when a detector battery needed replacement during the middle of an examination, the technologists bypassed the calibration in “urgent” mode. The increased occurrence of image saturation artifacts with simulated-grid images, compared with gridded images, can be logically related to a higher recommended detector air kerma relative to gridded techniques. Without a complete history, many unusual artifactual shadows cannot be adequately identified. Description of Artifact Appearance.—The shadow image of detector electronics appears superimposed on a patient image in Figure 5a. Examples are provided of artifacts that were found on clinical images or during quality control testing with flat-panel detectors. Figure 6a. Figure 13b. (a) Knee radiograph shows the homogeneous gray appearance of the cement (arrow), which indicates a loss of detail. Detector drop. Avoidance or Remedy.—In Figure 16b, the image processing was adjusted to eliminate the false lucency; however, the adjustments did not satisfactorily resolve the false structure on the edge of the hardware. (b) Repeat patella radiograph obtained after reshuttering to the area within the dashed lines on a and then reprocessing shows that the appearance is greatly improved. Avoidance or Remedy.—Image processing settings were adjusted to avoid the loss of information. Review of the images taken with the detector after the drop showed that the white band grew progressively larger with time, until the detector was pulled from service. Specific artifacts include those that are due to flat-panel detector drops, backscatter, debris in the x-ray field during calibration, detector saturation or underexposure, or collimation detection errors, as well as a variety of artifacts that are processing induced. 1, 2 With the development of digital radiography (DR), a new set of artifacts is introduced. Examples are provided of artifacts that were found on clinical images or during quality control testing with flat-panel detectors. This article revisits artifacts encountered in CR systems. 49, No. OBJECTIVE Computed radiography (CR) has provided a ready cost-effective transition from screen film to digital radiography and a convenient entrance to PACS. The examples are meant to serve as learning tools for future identification and troubleshooting of artifacts and as a reminder for steps that can be taken for prevention. (d) Knee radiograph obtained with different processing from that used in b shows recovery of image detail in the tibia. Cause.—The image processing algorithm incorrectly identified the collimator blades and incorrectly applied electronic shutters. It is extremely important, to the extent that it is possible, that the radiologist is able to have confidence that image information relates to the patient anatomy rather than being false information pertaining to an image artifact. 2008 May;63(5):487-98. doi: 10.1016/j.crad.2007.10.014. The exposure was approximately double what was recommended for the patient in a and was 40% greater than what was recommended for the patient in b. (c) Knee radiograph obtained with different processing from that used in a shows recovery of image detail in the area of the cement and the cement-implant boundary. Both images were acquired as part of quality control testing of portable x-ray units, with no added material in the x-ray beam, at 80 kVp, and with an image receptor air kerma of 17.5 μGy. The lead shavings created opaque-appearing pinhole images of the focal spot, with the size and location depending on the location of the speck relative to the focal spot and the detector. CONCLUSION. Image saturation. Interpreting the image problem as an acquisition failure, the technologist repeated the acquisition, with the result obtained with proper shuttering shown in Figure 13b. (d) Knee radiograph obtained with different processing from that used in b shows recovery of image detail in the tibia. Brossoit KT, Magnuson D, Schueler B, Walz-Flannigan A. Description of Artifact Appearance.—Grid lines appeared on the chest radiograph obtained with a portable radiographic unit shown in Figure 17. We saw an increase in image saturation artifacts with the initial use of simulated-grid acquisition, most frequently along the diaphragm at abdominal imaging, as shown in Figure 6b. Share this link with a friend: Copied! These artifacts may obscure abnormalities, mimic a clinical entity, or hamper image quality. Given the importance of being able to visualize this boundary in arthroplasty imaging, it is an important artifact to address. Other artifacts are more subtle and not as easily seen on a clinical image. The processing setting had worked well for knee images with a larger field of view but did not work well with the small field of view. Detector drop. Pictorial Review of Digital Radiography Artifacts - YouTube Walz-Flannigan AI,Brossoit KJ,Magnuson DJ,Schueler BA, Pictorial Review of Digital Radiography Artifacts. It is important that the image be reprocessed after the correct shutter is applied because the values of interest for processing have an effect on the final image appearance. Prevention and treatment information (HHS). Failure of detector offset correction. This backscatter-related artifact is more possible with certain imaging geometries that use a wireless detector outside a table or upright holder, a situation in which it may be more challenging to properly angle the detector or use tight collimation (as in some cross-table imaging). Inset: Magnified view shows the area of the tibia in which there is a loss of detail (arrow). Because the mechanism for image creation is different between flat-panel detectors and computed radiography, the causes and appearances of some artifacts can be unique to these different modalities. For routine quality control testing with a uniform phantom, we have established a strategy that uses a qualitative visual assessment with a viewing window that provides the identification threshold. Grid-line suppression failure. Figure 2. Detector calibration limitations. Because the mechanism for image creation is different between flat-panel detectors and computed radiography, the causes and appearances of some artifacts can be Digital radiography is becoming more prevalent in veterinary medicine, and with its increased use has come the recognition of a number of artifacts. With the development of digital radiography (DR), a new set of artifa cts is introduced. Ideally, any artifacts that create deviation from ideal detector performance would be resolved; however, it is more practical to have a threshold for artifact identification to help determine when an effort should be put into resolution. (b) Repeat patella radiograph obtained after reshuttering to the area within the dashed lines on a and then reprocessing shows that the appearance is greatly improved. Backscatter. National Library of Medicine Visual familiarity with the variety of digital radiographic artifacts is needed to identify, resolve, or prevent image artifacts from creating issues with patient imaging. Visual familiarity with the variety of digital radiographic artifacts is needed to identify, resolve, or prevent image artifacts from creating issues with patient imaging. Cause.—The projection of a pillow edge on the detector during calibration became recorded in the flat-field correction. Figure 9. Technique recommendations, as provided by the vendor, suggested between a 0% and 35% reduction in the milliampere-second setting between grid use and simulated-grid use in acquisitions. (a) Abdominal radiograph obtained with a portable radiographic unit shows the effect of excessive image exposure that resulted in a patient’s femurs and surrounding soft tissue being lost from the image. Adjustment of the collimator prevented further rubbing with the lead port cylinder, reducing the appearance of these artifacts. The following cases demonstrate the utility of plain radiography in foreign body evaluation. In addition, it was helpful for technologists to understand the effect of choosing the urgent mode and to avoid doing so, if possible. We report types of occurrence by analyzing the artifacts that occurs in digital radiography system. Description of Artifact Appearance.—In the image in Figure 16a, the processing creates a false appearance of lucency between the bone and metal, a finding that might be suggestive of a loosening (Fig 16a, inset). Description of Artifact Appearance.—After a leak in a patient’s water mattress during imaging, an image was acquired that shows banding throughout (Fig 4). Inverse focal spots and calibration artifacts. Although it is not a novel concept that liquids do not mix well with sensitive electronic equipment, unless such an incident is noticed, reported, and addressed, it may result in imaging failures during examination of a patient. However, in situations with higher image receptor air kerma targets or for patient images that may have a greater pixel value dynamic range (greater difference between the thickest and thinnest anatomic features), there could be a higher probability of detector saturation. Although most artefacts that occur in conventional radiography have become familiar, computed radiography (CR) systems produce artefacts that differ from those found in conventional radiography. Information may be lost (“clipped”) from an image when an exposure exceeds the dynamic range imposed by an image processing algorithm or in some circumstances in which the exposure exceeds the dynamic range of the image receptor. Med Phys. Inset: Magnified image shows detail of grid lines. Our method is similar to what is described in the report from the American Association of Physicists in Medicine (AAPM) Imaging Physics Committee Task Group 151 (4), which uses a qualitative visual evaluation of flat-field images in which anatomic image processing has not been applied (ie, “original data,” as described in international standard IEC 62220-1) (5). Cause.—The cause of these artifacts was found when the collimator was removed from the x-ray tube (Fig 9). Alsleem H, Davidson R, Al-Dhafiri B, Alsleem R, Ameer H. J Med Radiat Sci. A pictorial review of digital radiography artefacts. Avoidance or Remedy.—An imaging failure of this type caused by electronic shutter failure can be fixed through reshuttering and reprocessing the image, rather than requiring a new acquisition. Identified the collimator scraping against the beam-shaping port cylinder, reducing the appearance of detector electronics, created by image!, Dayne J. ; Magnuson, Beth a Vinogradskiy YY, Lofton BK, white RA Dynamic range are! With the x-ray tube there is a loss of detail altering the appearance of patella radiographs well routine. Radiolucent wavy lines ( arrow ) or Remedy.—The artifacts appearing as bloblike areas of raw radiation in the of. Email with instructions to reset your password Library of medicine 8600 Rockville Bethesda. Article, examples of artifacts from flat-panel detector–based digital radiographic systems are presented some are to... 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