Essentials of Digital Imaging

Module 4 Transcript

©2016 ASRT. All rights reserved.

 Essentials of Digital Imaging
Module 4 – Image Analysis

1. ASRT Animation

2. Welcome
Welcome to Essentials of Digital Imaging: Module 4 – Image Analysis.

3. License Agreement

4. Objectives
After completing this module, you will be able to:
 Evaluate the effects of exposure changes on the appearance of a digital image.
 Evaluate the appearance of a digitally acquired image to assess quantum mottle and saturation.
 Discuss the relationship between exposure field recognition and the appearance of a digital
image.
 Recognize motion on a digital image.
 Locate different types of artifacts on a digital image and state their probable cause.

5. Evaluating Digital Images

The changes in exposure that affect density and contrast for film do not have as much of an effect on
the appearance of digital images. This is due to digital processing that creates the image for display.
However there are a number of factors that can affect the brightness of the image and also the contrast.
The overall appearance of a digital image can be affected by a number of factors such as under
exposure, or quantum mottle, over exposure, or saturation, scatter radiation, grid cut, and motion from
the patient. Additional factors that can impact image quality are exposure field recognition errors, an
unexpected attenuator in the field of view, or the menu selection for the procedure.

6. Quantum Mottle
Quantum mottle, more often referred to as noise, in a digital image can be caused by multiple factors
that affect the appearance of the image. Noise results in a mottled, or grainy, appearance caused by
random variations of signal intensity on the image. Noise caused by low exposure to the image receptor
means a low number of x-ray photons strike the receptor resulting in the phenomena known as
quantum mottle. Basically, quantum mottle in digital images is caused by insufficient signal strength.

Remember that the distribution of photons in the x-ray beam is not uniform. On occasion, when low
levels of radiation are used to produce an image, the captured data are the random pattern of x-ray
photons within the beam along with patient anatomical information. In other words, there are not
enough x-ray photons striking the receptor.

Oftentimes the only way to correct for the quantum mottle is to produce a new image that has an
increased number of x-ray photons striking the image receptor. When the repeated image is produced
with a greater number of photons striking the receptor it results in an image of better diagnostic quality.

7. Evaluating Noise
In addition to quantum mottle the exposure index for the image indicates that the image was obtained
with a low level exposure. The only way to reduce the amount of noise present in the image would be to

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
increase the amount of x-ray photons striking the image receptor which increases the signal strength
available to create the image.

The impact of quantum mottle is most noticeable when assessing the low contrast resolution of a
radiograph. The impact on visibility from quantum mottle of low contrast structures is easily
demonstrated using a low contrast detail phantom. As quantum mottle increases the ability to visualize
subtle differences in differential attenuation is decreased. The circles in the phantom represent
variations in tissue attenuation.

8. Over Exposure
A misconception about digital imaging systems is that the system has the capability of correcting for
errors involving receptor exposure. Digital systems are designed to analyze the signal extracted from
the image receptor and to display that image with a specific image appearance. The image will fail to
display properly due to the over exposure in instances where the signal strength approaches or exceeds
the system’s dynamic range. Saturation is the result of over exposure to the point where the dynamic
range of the digital system is no longer capable of accurately reproducing the image data for display.
The point at which saturation occurs is dependent upon the digital imaging system being used.

An example of this is a thoracic spine image that demonstrates saturation in the lung field. The
presence of saturation in the image results in an inability to visualize the lung field within the over
exposed area regardless of manipulating image brightness.

9. Saturation
The elbow radiograph on the left represents an acceptable level of exposure in the image. The image on
the right represents a level of exposure that has resulted in saturation. The level of receptor exposure
beneath the soft tissue portions of the saturated image exceeded the dynamic range of the pixel values.
The outcome is that the soft tissues surrounding the bony anatomy are not able to be visualized. To
correct for saturation the technologists must reduce the level of exposure striking the image receptor.

The lateral cervical spine image on the left shows a level of exposure with a signal strength that
exceeded the dynamic range of the pixel values in soft tissue areas and some bony structures. Attempts
to adjust the brightness of the image in order to demonstrate soft tissue and bony detail were
unsuccessful. The image must be repeated at a lower level of exposure in order to produce a satisfactory
image. The repeat image was performed at a lower level of exposure which eliminated saturation and
allows for the visualization of soft tissue and bony detail.

10. Scatter Radiation

Scatter radiation does not contribute useful information to the radiographic image. In situations where
scatter makes up a significant portion of the radiation striking the image receptor, there is a decrease in
the image contrast.

An example of scatter affecting image quality is observable on an abdominal radiograph where a

significant portion of radiation striking the image receptor seemingly is composed of scattered photons.
The image was produced without using a grid which clearly demonstrates the loss of visibility because of
scatter radiation hitting the receptor. When a grid was used during the repeat examination, much of the
scatter was attenuated. The visibility of structures is significantly improved by reducing the amount of
scatter radiation striking the image receptor.

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
11. Grid Use
Using a grid for certain radiographic examinations can aid the technologist in improving image quality.
An abdominal radiograph produced without the use of a grid demonstrates decreased image contrast
resulting in poor visibility. After attempts to manipulate the brightness and contrast of the image it still
was not possible to achieve an optimal level of visibility of structures that is achieved by producing a
radiograph on the same patient with a grid. Regardless of the imaging system used the presence of
significant scatter will result in worsened image quality.

12. Grid Cutoff

Proper alignment with the central ray can be difficult when performing a radiographic examination using
a grid. The grid is designed to attenuate scatter radiation to improve image quality. Failure to properly
align the central ray with the grid also will result in the absorption of the portion of the primary beam
that represents anatomical information. The effect on the finished radiograph is an image that is
displayed with a significant reduction in visibility referred to as grid cutoff.

More specifically, grid cutoff occurs when the beam is not centered transversely to the grid. In addition
to poor image display, in some circumstances the exposure to the image receptor is low enough to
produce visible quantum mottle because of the insufficient signal striking the receptor. The presence of
grid cutoff often is accompanied by an exposure indicator that suggests a low level of radiation exposure
was used to produce the image. Additionally, grid cutoff might occur from an off level grid error or
when using an improper SID or an upside down focused grid.

13. Off Center Grid

Another complication in medical imaging associated with improper transverse alignment of the central
ray and the grid is the impact of grid cutoff on image contrast. It might appear that an image is degraded
by significant scatter radiation striking the image receptor. In reality, the exposure indicator proves that
a low level of exposure was used to produce the image and the presence of quantum mottle tells the
radiographer that poor image contrast is a result of grid cutoff. Image quality is easily improved by
accurately aligning the central ray to the grid.

14. Inverted Focused Grid

When a focused grid is inverted, grid cutoff is visible along the edges of anatomy on the finished
radiograph. The diminished image quality results because the lead strips of the grid are no longer
parallel to the divergent primary x-ray beam.

15. Knowledge Check

16. Knowledge Check

17. Improper SID

Grid cutoff also can occur as a result of a source-to-image receptor distance, or SID, that is too close to
the grid. The cutoff is demonstrated along the lateral margins of the radiograph. In addition to the
presence of grid cutoff, the exposure index likely will indicate a low level of exposure was used for the
examination even if the technologist has selected proper exposure factors.

Sometimes two different types of grid cutoff can be visualized on a single radiograph. An example is an
elbow radiograph demonstrating misalignment between the x-ray tube and the grid that is performed
using a SID that is too short. The system was a cassette-less DR unit with a built in grid. The technologist

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
performing the examination did not ensure that the beam and grid were properly aligned before making
the exposure and the incorrect SID was displayed on the DICOM header of the image.

18. Exposure Field Recognition

Recognition of the edges of the exposure field play an important role in ensuring an image will display
correctly. An exposure field recognition error occurs when the computer fails to identify collimated
borders of a radiograph. When the computer can’t find the borders, it causes a rescaling error, which
often affects the brightness and contrast of an image. An exposure field recognition error during image
processing will often result in an image displayed with inadequate brightness.

An example of when this error can occur is when 2 exposures can be made on 1 image receptor. The
individual exposure fields should be recognized during image processing although; sometimes the
analysis of the image data fails to recognize the exposure field borders. Details about the examination
suggest that the radiographic exposure was accurate for the examination evident by the absence of
quantum mottle. Mottle, or noise, would normally be present if a low level of exposure produced the
image. This validates that the diminished image quality is the result of an exposure field recognition
error.

In this instance, the area within the white box determined the level of image brightness as well as the
exposure index. The lack of exposure within the region of interest, or ROI, led to a rescaling error that
produced a low level of brightness and the exposure indicator reflected a low level of exposure even
though the level of exposure was adequate.

19. Recognition Errors

Some radiographic exams can present a unique challenge in attempting to produce diagnostic quality
images. An example is a cross table lateral lumbar spine. Locating the spine and properly centering the
anatomy of interest to the image receptor is not difficult to achieve but is a skill that is acquired after
much practice. Improper alignment of the body part with the central ray and image receptor can result
in an exposure field recognition error. An exposure field that is not accurately localized during image
processing produces a final image that fails to display the proper brightness even though the
appropriate level of radiation exposure was used. The system has the ability to reprocess the image data
by realigning the region of interest to match the collimation margins. Upon making that adjustment, the
image can be significantly improved.

20. Unexpected Attenuator

Joint replacement surgery is common and is something that the technologist needs to be aware of
before obtaining a radiographic image. Knowing about the surgery beforehand can aid the technologist
in selecting the most appropriate technique for the examination. When an unexpected, highly
attenuating material is present, it might negatively impact the brightness of the image when it is
displayed.

Metal rods contribute to an image displayed with inadequate brightness. Rescaling, following the
computer’s analysis of the image data, can result in a radiograph that is too dark. The rods represent a
significant portion of low exposure within the data and therefore the rescaling process adjusts image
brightness to take into account the low level of radiation exposure to the area of interest.

21. Menu Selection

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
The menu selected for image processing is critical to displaying the image properly. The menu selected
for each unique examination contains specific levels of brightness, contrast, edge enhancement, and
equalization. Selecting a menu that is not assigned to the examination being performed because it
displays the image better can lead to potential medicolegal concerns.

In some circumstances, selecting the incorrect processing menu can provide a more pleasing
appearance to the viewer even though it holds changes in image processing that might be unacceptable
for the exam. Keep in mind, the change in processing also can produce an exposure indicator that
suggests there was an increase in radiation exposure to the patient, when in fact; there is no difference
in exposure between the images being displayed. Image processing menus are carefully developed and
should only be used for the examinations that they have been assigned to.

22. Image Blur

Blurred images are caused by motion or changes in a geometric factor during image production. Motion
is the predominant cause of blur in radiographic images. Technologists can minimize geometric blur
when selecting technical factors, such as SID, OID, and focal spot size. Blur caused by geometric factors
is best assessed using specific test phantoms.

Image blur often is caused by patient movement. It is sometimes difficult to immediately recognize
motion on radiograph but when using the zoom feature blur from motion becomes apparent when the
edges of bony structures of interest are fuzzy or unclear.

When motion produces blurring in an image it is often difficult to observe on the technologist
workstation without using image zoom. The image zoom feature is essential for assessing the presence
of motion in an image. Image zoom enlarges the radiograph making some of the finer details easier to
see when motion is otherwise undetected. This function makes any blurred anatomy clearly visible and
indicates the need to repeat the examination.

23. Size Distortion

Radiographic distortion occurs as a result of changes in the relationship between the primary beam and
image receptor. Size distortion is a misrepresentation of the true size of the object due to changes in
distance between the tube, body part, and image receptor. An example of size distortion is
magnification. The size of the image receptor affects the size of the image display. This change in display
size should not be confused with magnification from changes in SID and OID.

The two most common factors that are responsible for size distortion because of their effect on the
distance between the object of interest and the image receptor are source-to-image receptor distance
and object-to-image receptor distance.

The Waters method is used to demonstrate the orbits. By tilting the head and placing the patient's chin
on the image receptor, a 25- to 37-degree angle is formed between the orbitomeatal line and image
receptor. This angulation not only projects the petrous portion of the temporal bones below the inferior
border of the orbits, allowing the orbits to be evaluated free of superimposition by the petrous ridges
but also brings the orbital margins further from the image receptor resulting in slight magnification of
the structures. The combination of these effects makes it possible to better evaluate the orbits for injury
such as blow out fractures.

24. Shape Distortion

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
Shape distortion is a misrepresentation of the true shape of an object due to a change in the angular
relationship of the tube, body part, and image receptor. Shape distortion causes objects of interest to be
elongated or foreshortened.

When a patient is positioned for an oblique projection of the hip as opposed to using a standard AP
projection the site of injury and the orthopedic hardware can be better evaluated. The wing, or ala, of
the ilium appears elongated, the pubis is foreshortened, and the ischium is in profile achieving the goal
of demonstrating placement of the surgical pin outside of the joint.

Another example of shape distortion is a PA axial projection of the scaphoid using ulnar deviation. The
scaphoid is elongated because of the 20o angle of the tube to the part and image receptor. Another
option is to instead angle the image receptor 20o using a radiolucent sponge. Size distortion also can be
applied to the PA axial scaphoid projection by placing a radiolucent positioning device underneath the
wrist to bring the wrist further from the image receptor, increasing the OID.

25. Exposure Index

It’s important to understand what the exposure index values represent, along with factors that affect its
accuracy. If exposure index values are outside the optimal range, however, noise or other problems
appear. Factors that can influence the accuracy of the exposure indicator, regardless of the system used,
include exposure field recognition, collimation, and unexpected structures in the exposure field.

The implementation of the international standardized exposure indicator known as the Exposure Index
started in 2008. The purpose was to establish a common Exposure Index across manufacturers and
vendors of digital x-ray equipment. The end result is that the manufacturers utilize an exposure index
that is linearly proportional to the amount of radiation received by the detector.

Each department then develops a Target Exposure Index that results in the production of quality images
at acceptable dose levels. In addition to the Target Exposure Index, the user of the equipment will be
able to determine compliance with the desired value by assessing the Deviation Index for the exposure.

The Deviation Index is displayed using a scale of minus 3 to plus 3. A Deviation Index of 0 indicates that
the exposure matches the Target Exposure Index. A Deviation Index of +1 represents 25% more
exposure than the Target Exposure Index where a Deviation Index of -1 represents 20% less exposure
than the Target Exposure Index. Furthermore, a Deviation Index +3 represents 2X more exposure than
the Target Exposure Index and a Deviation Index of -3 represents that the exposure was about ½ the
Target Exposure Index.

26. Evaluating Exposure Indicator

When all the exposure received by the receptor, not just the areas within the collimated borders, is
included in calculating the exposure indicator, the exposure index likely will be miscalculated. Often this
occurs when 2 radiographs are exposed onto a single image receptor. The area between the 2 images
represents a very low exposure level. This area was incorporated in the histogram values and
subsequently altered the calculated exposure indicator. The result was a value that indicated an
insufficient amount of radiation.

This 2-on-1 radiograph of the forearm also demonstrates a faulty exposure indicator calculation. The
technique used was acceptable, but the exposure field borders weren't recognized, which decreased
contrast and brightness. The histogram is very wide with an increase at the lower end of exposure

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
intensities, where it includes the area between collimated fields. If that area had not been included in
producing this image, the display would have been appropriate and the exposure indicator would have
been properly calculated.

27. Histogram Analysis Error

It is possible to produce a chest radiograph using satisfactory kVp and mAs values; however, if a lead
apron is included in the exposure field the apron can cause an error in the histogram analysis. The apron
is an additional attenuator that produces an extra peak at the low-intensity area of the a priori
histogram. As a result, the values result in an exposure indicator miscalculation. The miscalculation
suggests that the plate is grossly underexposed, when in fact it isn't. Additionally, a rescaling error
occurs that leads to an inappropriate display of image contrast and brightness.

Another example of a histogram analysis error occurs when including too much of the abdomen in the
exposure field for a portable chest examination. The radiograph is processed using a chest menu that
expects a chest-shaped histogram therefore; the calculation of the exposure indicator is inaccurate.

The low-level exposure area below the diaphragm is included in the histogram and produces an
incorrect exposure indicator, leading the technologist to believe that the image receptor was
underexposed. Using the zoom feature on the image allows the technologist to evaluate for noise on the
radiograph. If no significant noise is found it suggests that the image was not underexposed.

Technologists must make sure that collimation is appropriate when looking at exposure indicators.
Checking for additional attenuators within the exposure field and being certain the expected anatomy is
shown ensures the histogram values are calculated correctly.

28. Recording Multiple Images

Recall that recording multiple images on a single receptor can cause overexposed and underexposed
areas. Exposure field margins are altered by overlapping exposure fields in the center of the receptor
and nonparallel alignment of exposure field edges. The lookup table uses all the data on the plate,
rather than just the image data, to produce the image display. The current recommendation is to record
only 1 image per receptor to avoid potential data analysis errors.

29. Knowledge Check

30. Knowledge Check

31. Digital Image Artifacts

Artifacts in digital imaging can be grouped by image receptor type. The image receptor is a
photostimulable phosphor plate, called a PSP, or flat panel detector with a thin-film transistor, or TFT.
Artifacts also might be categorized by their causes or where they occur and can be produced by Image
receptors, processing equipment or electronic component issues. In addition, artifacts occur because of
mistakes made in patient positioning or preparation. The latter errors are called exposure artifacts.

32. PSP Artifacts

Various types of artifacts occur with photostimulable phosphor plate systems. These systems use a
phosphor plate, transport mechanism, optical components, and assorted electronic components. The
potential for unique artifacts that can be replicated are easily identifiable by disruptions in plate
transport, dirty or damaged phosphor plates, dirty or damaged optical components, and malfunctioning

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
electronic devices. However, it is possible that the cause of an intermittently appearing artifact might
not be identified until it is replicated. Artifacts associated with the plate and optical components will
reduce the intensity of light collected by the optical system. The reduced intensity causes an artifact to
appear bright on the image.

Scratches, dents, and stains are artifacts on a PSP plate that can severely damage the phosphors. When
the plate is scratched or dented, the affected area can’t absorb x-rays. If the plate is stained, light
emission is reduced or cannot happen. The artifact along the edge of the image is where the phosphor
has chipped away from the support base. The white line in the soft tissue is a scratch and the white
specs are dust spots on the phosphor.

33. Plate Based Artifacts

At first an artifact might be missed. When looking at an image using magnification the artifact should
become more apparent. The bright line artifact in the medial aspect of the humeral head was caused by
a dirty plate. Many digital artifacts appear bright, or white, on the finished image. Once identified, the
cause can be determined. Primary causes of bright artifacts likely are a damaged or dirty plate or
damaged or dirty optical components. Plate based artifacts remain localized to the same area of an
individual plate.

Sometimes artifacts begin to look familiar. This occurs because the same plate is used for multiple
radiographs. If technologists don’t notice the artifact on the image, and the plate isn’t taken out of
service to be cleaned, the artifact will continue to appear degrading numerous patient examinations
throughout the day. For this reason, it is important that technologists check images for artifacts
continuously.

34. Routine PSP Cleaning

PSP plates require routine cleaning and inspection by technologists to make sure the plates produce
artifact-free images. One reason it’s so important to regularly clean PSP plates is that many artifacts that
can’t be seen on a technologist’s workstation are easily seen by the radiologist on his or her
workstation. The quality, resolution, brightness, and contrast resolution capabilities of monitors used by
radiologists are far superior to the monitors used by technologists.

Sometimes the artifact can't be seen on a technologist’s workstation unless the image is significantly
magnified and altered. However, on a radiologist’s workstation, the artifact might be immediately
apparent and look like a foreign body.

It also is important that a manufacturer approved cleaning solution is used during the periodic cleaning
of PSP plates. Cleaning plates with the wrong solution can cause an irreparable artifact created as the
solution soaks into the phosphor layer and leaving a stain. The stain disrupts the normal emission of
light from the plate during the plate reading process. The PSP must be removed from service and
disposed of according to the facility’s waste removal policy.

35. Processor Artifacts

Differentiating between the artifacts located on a plate and one that occurs during plate processing can
be challenging when the questionable plate is not immediately available. The artifact’s appearance
generally provides some clues. Plate artifacts generally don’t cross the entire axis of a plate; they only
appear on images from the defective plate. On the other hand, processing artifacts run along an entire
plate axis and appear on nearly all images regardless of the plate used.

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
36. Optical Component Artifacts
Based on the construction of a plate reader, it might seem improbable for the inside to become dirty.
Certain artifacts represent that they assuredly do. The actions of inserting the cassette into and
removing the cassette from the reader allow for artifact generating contaminants to be introduced into
the equipment. Artifacts such as a piece of hair located on an optical component transmitting light from
the plate are a perfect example. A hair stuck to one of the optics can block the signal in that area of the
image causing a "wig-wag" pattern as the hair moves back and forth during processing. Some plate
readers have a built in cleaning feature that technologists can employ to decontaminate a portion of the
optical system, removing the debris from the device.

37. Dirty Light Guide

Some artifacts are more subtle than others. Arrows identify a line that runs along the second phalanx.
The line represents a loss of image data caused by a dirty light guide in the plate reader. Dirt blocked the
plate’s signal and therefore the signal couldn't travel up the light guide through the photomultiplier tube
to the analog-to-digital converter. The line runs the entire length of the plate and is parallel to the
direction the plate traveled through the reader.

38. Flat-panel DEL Artifacts

A source of artifact with flat panel units occurs within the detector elements, or DELs. In some cases the
artifact is difficult to distinguish on a full-sized image. The arrows point to a small bright line in the chest,
just below the humeral head. The partial loss of a row of DELs on the flat-panel detector caused this
artifact. To fix this problem, the detector is recalibrated. If the artifact is still present following
calibration then a field service engineer should be contacted to further investigate the issue.

39. Image Evaluation Factors

There are several factors that are used to evaluate digital images. In the past, factors that were used for
analog imaging were simply visual characteristics, such as; density, contrast, image blur, and distortion
that couldn’t have been manipulated. With digital evaluation, however, factors are a mix of visual cues
and numerical values which include brightness, image blur, distortion, noise, and the exposure indicator.
To better evaluate the digital image, it can be magnified and the brightness, and contrast levels can be
adjusted, to further investigate artifacts and image blur.

40. Knowledge Check

41. Knowledge Check

42. Image Analysis

What is causing the degraded image quality?
a. exposure field recognition error.
b. quantum mottle.
c. saturation
d. scatter.

43. Image Analysis

A 3-on-1 projection of a finger demonstrates an exposure field recognition error. A rescaling error
occurred during the computer’s analysis of the image data. Because the field borders weren't
recognized, the exposure data were included in the image data, including the intrafield area between

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
collimation borders on the receptor. When the values were incorporated into the analysis process there
was a rescaling error and the lookup table application didn't display the appropriate brightness. Such 3-
on-1 exposures are not uniformly accepted as a method to acquire images of extremities. Using 1-on-1
exposures basically ensures that this type of error won't occur, provided that collimation borders adhere
to the rules for exposure field alignment. This error is evident because the image displays too dark and
the technical factor selection used were appropriate for the exam.

44. Image Analysis

What is causing the degraded image quality in the cervical region?
a. exposure field recognition error.
b. quantum mottle.
c. saturation.
d. scatter.

45. Image Analysis

The cervical region is saturated. Imaging structures with large variations in part thickness that are
adjacent to each other is challenging. The use of a compensating filter would be appropriate in order to
create a more uniform attenuation of the beam between the upper thoracic and cervical vertebrae.

46. Image Analysis

What is causing the degraded image quality on these radiographs?
a. scatter.
b. fog.
c. grid cutoff.
d. saturation.

47. Image Analysis

The technologist confirmed that the correct technique was used; however, grid cutoff occurred.
Improper alignment of the grid reduces the demonstrated contrast regardless of the receptor used. If
this image had been repeated with the grid appropriately aligned with the x-ray beam, the image would
have been acceptable.

48. Image Analysis

What is causing the degraded image quality?
a. exposure field recognition error.
b. quantum mottle.
c. saturation
d. scatter.

49. Image Analysis

The grainy appearance of the image represents under exposure. Quantum mottle occurs when there is
insufficient exposure to the image receptor. When the strength of the signal is weak from insufficient x-
ray photon interaction with the image receptor the result often is a mottled effect, or image noise.

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
50. Image Analysis
Both images were both produced with the same technique factors. What is causing the difference in
appearance of the two images?
a. menu selection.
b. grid cutoff.
c. saturation
d. quantum mottle.

51. Image Analysis

The selection of the correct menu for an exam is important to ensure an image displays correctly. In
some circumstances the exposure indicator is accurate although here the image appearance is different
and the exposure indicator values are different by a factor of 2.

52. Image Analysis

The image on the left is a PA projection of the wrist and the image on the right is a lateral projection.
What is causing the degraded image quality?
a. scatter radiation.
b. exposure field recognition error.
c. underexposure of lateral wrist.
d. overexposure of the PA wrist.

53. Image Analysis

The thickness of the body part changed the attenuation of the x-ray beam. One fundamental principle of
imaging is when the thickness of the object being imaged changes, the level of exposure also must
change.

Working with a digital image receptor still requires technologists to adjust the exposure level to achieve
an appropriate image display. The exposure level for a lateral projection should increase so the same
amount of radiation strikes the receptor as in the PA image. In doing so, both images would display with
equal brightness and contrast.

54. Image Analysis

What is causing the artifact on this radiograph?
a. stain.
b. scratch.
c. dent.
d. dirt.

55. Image Analysis

The artifact of the scratch on the full image is more apparent using magnification. The bright line in the
tibia is a scratch on the photostimulable phosphor plate.

56. Image Analysis

What is causing the artifact on this radiograph?
a. scratched PSP.
b. stained PSP.

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
 c. dented PSP.
d. dirty PSP.

57. Image Analysis

The dirty PSP artifact is difficult to see on a full-sized image but the magnified image makes the artifact
more apparent. The bright specks in the upper abdomen are there because the PSP needs to be cleaned.

58. Image Analysis

What is causing the artifact on these radiographs?
a. scratched PSP.
b. stained PSP.
c. dented PSP.
d. dirty PSP.

59. Image Analysis

On the first set of radiographs the arrow points to a small bright dot in the acromial process. On the
radiographs of an AP shoulder the arrow points to a similar small bright dot in the soft tissue above the
clavicle. The artifact is similar because it is actually the same artifact in both sets of images. Until the
plate is cleaned every radiograph produced using this digital unit will demonstrate the same small bright
dot.

60. Image Analysis

What is causing the artifact?
a. dirty light guide.
b. corroded optical component.
c. hair stuck to an optical component.
d. scratch on the PSP plate.

61. Image Analysis

The line identified by the white arrows runs through the metacarpals and represents the image data loss
caused by a dirty light guide. Dirt blocked the signal from the plate so that the signal couldn’t travel to
the analog-to-digital converter. The line runs the entire width of the plate and is parallel to the direction
the plate passed through the reader.

62. Image Analysis

What 2 artifacts are visible on this radiograph?
1. dirty light guide.
2. corroded optical component.
3. hair stuck to an optical component.
4. scratch on the PSP plate.
a. 1 and 2
b. 2 and 3
c. 1 and 4
d. 3 and 4

63. Image Analysis

A dirty light guide in the plate reader produced the line identified by the white arrow labeled "A." Dirt
blocked the signal from the plate stopping the signal from travelling up the light guide, through the

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis
photomultiplier tube, and to the analog-to-digital converter. The horizontal line identified by the white
arrow labeled "B" was caused by a scratch on the PSP plate.

64. Conclusion
This concludes Essentials of Digital Imaging: Module 4 – Image Analysis. You should now be able to:
 Evaluate the effects of exposure changes on the appearance of a digital image.
 Evaluate the appearance of a digitally acquired image to assess quantum mottle and saturation.
 Discuss the relationship between exposure field recognition and the appearance of a digital
image.
 Recognize motion on a digital image.
 Locate different types of artifacts on a digital image and state their probable cause.

65. References
American Association of Physicists in Medicine. AAPM Report No. 116. An exposure indicator for digital
radiography. [Link] Published July 2009. Accessed February
14, 2013.

Bushong SC. Radiologic Science for Technologists: Physics, Biology, and Protection. 10th ed. St Louis, MO:
Mosby Elsevier; 2012.

Carlton RR, Adler AM. Principles of Radiographic Imaging: An Art and A Science. 5th ed. Clifton Park, NY:
Thomson Delmar Learning; 2012.

Carroll QB. Radiography in the Digital Age: Physics, Exposure, Radiation Biology. Springfield, IL: Charles C
Thomas; 2011.

Carter CE, Vealé BL. Digital Radiography and PACS. St Louis, MO: Mosby Elsevier; 2009.

Practice Standards for Medical Imaging and Radiation Therapy. Radiography practice standards.
American Society of Radiologic Technologists website. [Link]
regulations/practice-standards/practice-standards. June 19, 2011. Accessed February 14, 2013.

Seeram E. Digital Radiography: An Introduction for Technologists. Clifton Park, NY: Delmar Cengage
Learning; 2011.

Strategic Document. Version 2012-3, April 11, 2012. Digital Imaging and Communications in Medicine
website. [Link] Accessed February 14, 2013.

©2016 ASRT. All rights reserved. Essentials of Digital Imaging Module 4 – Image Analysis