By Dr Mangal S Mahajan

X-ray artifacts

Definition

 An unintended, unwanted visual aberration in an x-ray image

Types of artifacts

1. Positive density x-ray artifacts

 They are DARK marks

 Generally they occur in the developer step

2. Negative density x-ray artifacts

 They are LIGHT mark

 They can occur in any step in processing

3. Transmitted x-ray artifacts

 These marks generally show up best looking through them on a view

box
 Usually occurs in any processing step

4. Reflected x-ray artifacts

 These are marks that show best by looking at light reflected off of the
film
 Most commonly a wash problem

Positive density x-ray artifacts

1. Black Streaks
2. Black Bands
3. Black Spots
4. Water marks
5. Developer streaks

Cause

 Black streaks sometimes are a result of developer streaks

 By Dr Mangal S Mahajan

 Black bands and streaks are due to

 Exposure of films to light
 Leak in the cassette
 If the film packet is kept open in the dark room and the lights are put
on accidentally
 Black spots could be a result of mottle or due to spillage of developer
on the film
 Power failure when the film is processed in a auto processor leading
to dark wide band formation
 If these are due to cassette leak then it would appear at the same
side of the film
 Light exposed films from packet would show this defect mainly at the
top of the films

Water marks

 Caused by water droplets on the film surface

 Appear-round dark spots of various sizes because of migration of
silver particles

How to avoid dark spots

 Improvement in dark room handling will solve the majority of these

artifacts
 However, for mottle, replacement is the only option. Change of
cassettes in case they are defective will eliminate this problem

Developer streaks

 These appear as brown or black streaks or clouds appearing on the

film
 Sometimes they can cover the entire film surface
 Usually not observed in all films in a packet, only some films will show
such artifacts
 They are usually prominent in the white portion (specifically of chest
radiographs) of X-ray film
 By Dr Mangal S Mahajan

 Causes
 Exact cause is not known
 Failure to agitate the films in the developer
 Failure to rinse the films adequately
 Failure to agitate the film when first immersed in the fixer
 Failure to stir the processing solution thoroughly after replenishment
 Seen very rarely in automatic processors, which clearly indicates this
defect has a relationship to manual processing only
 Use of ice in developer tank can sometimes give rise to these streaks
due to formation of temperature as well as different concentration
zones of developer

How to avoid developer streaks

 Agitate film vigorously in stop bath or rinser for 10 to 15 secs to stop

the action of developer completely
 Change water in stop bath everyday
 Dilution of high activity developer

Negative density artifacts (white spots)

Appearance

 As diffused white spots (diffused negative kinks are sometimes

misinterpreted as white spots)
 Shiny white spots with black centers
 Small white spots running parallel from edges of the film (white
streaks)
 Generalized white spots all over the film sometimes alternating with
tiny black spots

Cause

1. Moisture
 It is the most common cause of diffused white spots
 Incidences of such spots may increase during or immediately after
monsoon
 By Dr Mangal S Mahajan

2. Cassete marks
 Caused by
 Dust, hair, fragments of paper etc or by screen defects
 Appear - Corresponding white mark on the radiograph
3. Grid marks
 This gives rise to thin parallel white lines on the film
 Cause
 Using the grid upside down
 When the grid remains fails to move i.e. remains stationary during
film exposure
 If the grid ratio is too high
 If the x-ray tube & the film distance is less the grid cut-off will be more
4. Screen marks
 Any deposit on the surface of intensifying screen like dust particles,
fluff, hair, surface scratches etc
 Image artifact-appears white on radiograph
5. Photo activation of interleaving paper
 This causes Shiny white spots
 However, they will appear as tiny spots, as compared to dust spots
6. Contamination of the interleaving paper or due to moisture absorption
by interleaving paper
 This causes White streaks
 These can be easily identified from the rest of the types of white
spots since they would appear at one specific site and one specific
dimension on the film
7. Paper mottling artifact
 During manual loading of the film in the cassette in the darkroom the
yellow paper remains along with it (towards the tube side of cassette)
& the film is exposed in this situation
8. Air-bell marks
 Caused by
 Formation of air bubbles in the developer solution, which prevents the
developer from reaching the underlying film
 Splashing of water drops on the film during manual handling
 By Dr Mangal S Mahajan

 Appear - Small clear circular spot on the radiograph

9. Aging of the screen
 After five years or so, the fluorescent crystals on the intensifying
screens begin to lose their ability to fluoresce, leaving small areas of
non-exposure (lack of black) which we see as "white" dots diffusely
spread over the film.
 How to avoid
 Buy new intensifying screens
 It is possible to put new screens in old cassettes, but it is not
recommended
10 Finger marks
 Cause
 Handling the surface of the film with fingers especially contaminated
by contact of chemicals or metal causes transfer of moisture
modifying the action of the developer during processing
 Manual handling carries the risk of spotting or splashing film surface
with developer, fixer or water.
 Avoided by - Automated film handling
 How to avoid
 Proper storage under air conditioned atmosphere and controlled
humidity is the key
 Regular cleaning of screens will help removing dust
 Usually the inner pouch of films has enough margins to fold it back. A
slight effort to fold it back after taking out the film would help minimize
entry of moisture to some extent. This can avoid pre-exposure of
films also
 White spots due to screens would appear due to a damaged super
coat. In such cases, change of screens will eliminate such defects

Transmitted x-ray film artifacts

a. Positive transmitted x-ray film artifacts

1. Pressure marks
2. Static marks
3. Slap lines
 By Dr Mangal S Mahajan

4. Crescents
5. Light fog

Pressure marks

 Occur due to application of undue pressure to the film emulsion

before or during the development

Appearance

 Larger usually white marks

 Pressure damage before exposure-white mark
 Pressure damage after exposure-dark mark
 The magnitude of pressure is also determinative in the appearance of
the pressure marks

Cause

 Pressure marks due to improper storage

 Stacking of boxes of film on top of one other
 Pressure mark during developing in a auto processor
 Usually occur during the developer step when the swollen rollers
press over the film emulsion too hard
 Pressure marks during manufacturing process
 Cause-stress suffered by emulsion during film manufacturing
 Appearance-unpredictable
 Repeated incidence of pressure marks of similar appearance from
same box characterizes this artifact

How to avoid pressure mark

 Do not stack the cassettes one above other instead keep them
vertical sidewise
 Check the rollers in the autoprocesser if they are swollen

Static marks

Cause
 By Dr Mangal S Mahajan

 Handling of film by machine or operator produce static electricity

during friction between the film & other objects like intensifying
screen, loading bench etc that triggers chemical changes in the
emulsion mimicking exposure

Occur in following situations -

1. During film manufacture

2. Film transport system of rapid film changers

3. Feed mechanism of the film processors

4. Cassette loading or unloading activities.

5. Synthetic clothing materials like nylon

Appearance

 Black

1. Tree static

2. Crown static

3. Pin static

4. Crows feet

How to avoid static mark

1. Use an antistatic mat, clean cassettes and feed tray with antistatic
cleaner
2. Regular cleaning of screens with antistatic screen cleaning solution
helps to reduce incidences of branch static
 Ideally screens should be cleaned once in 15 days
 Application of screen cleaner should be carried out as per instructions
given on the bottle
 While cleaning screens, one should never use concentrated 'soap'
solution
 By Dr Mangal S Mahajan

 Put a few drops of screen cleaner on a soft cloth (should not be a

fibrous cloth), apply evenly on screens, and keep the cassette open
for 10 minutes
 Allow the solution to dry completely and then close the cassette
3. Handle the films gently
4. Loading bench should be grounded to prevent build-up of static
electricity

Slap lines

Appearance

 A single dark line appearing at 1-2” from leading or trailing edge of

film (perpendicular to direction of transport)

How to avoid

 Check guide shoe alignment in developer rack and that the

crossovers aren't slowing down the transport

Crimp mark / crinkle marks / crescents / nail marks

Cause

 Occurs due to careless handling in the darkroom due to acute

bending of the films over the end of the finger especially the larger
films

Appears

 Curved black or white lines about 1cm in length

How to avoid

 Proper handling, films should always be held from two diagonally

opposite ends to avoid such artifacts
 Automatic daylight film handling system

Fog
 By Dr Mangal S Mahajan

 It is the generalized darkening of the film

Types

 Exposure to light - because

 Light leakage in darkroom
 The safelight contains too large a bulb
 The safelight housing /filter is cracked
 The safelight filter series is incorrect
 Exposure of the film to the safelight is prolonged specially at short
distances
 Light accidentally put on in the darkroom while box is open
 Leakage in cassette
 Film box accidentally being kept open
 Light leakage through pass box
 Do not allow light until the films have been fixed for at least one
minute
 Exposure to x-rays or radio nuclides

 Film should be shielded from this by sufficient distance & sufficient

thickness lead

 Chemical fog - because

 Development for long time

 Development at high temperature

 Using oxidized developer (it also stains the film brown)

 Prolonged or repeated inspection of the films during development

 Contamination from corroded tanks

 Age fog - because

 Outdated films (mottled or uniform fogging)

 Films stored under high temperatures

 By Dr Mangal S Mahajan

 Films stored under excessive humidity

b. Negative transmitted x-ray film artifacts

1. Pick off

2. Scratches

3. Blocked screen

Pick off

Cause

 Almost always a guide shoe alignment problem or swollen rollers

forcing film into the shoes

Appearance

 Small white specks where the emulsion has been removed on the
film
 Appears anywhere on the film

Scratches / Surface damage

Cause

 Usually a guide shoe or loose hardware in one of the racks. May

occur in any step of processing
 Abrasions to the film emulsion due to badly adjusted processor film
transport system

Appearance

 Appears parallel to direction of transport

 Long parallel lines that may stretch entire length of film

Pi marks

 Suggestive of damage produced by one of the transport rollers in the

film processor
 By Dr Mangal S Mahajan

 Detected by - view radiograph under reflected and transmitted light,

locate any roughness by fingers

Reticulation / Frilling

 Partial or complete detachment of the emulsion from the base

exposing the glossy base material due to adverse processing
condition

Blocked screen

Cause

 Usually when the radiation strikes the screen in the cassette it glows,
exposing the film to blue or green light. A damaged or dirty screen
will not glow properly so it is called a blocked screen

Appearance

 Light spots or speckles will be seen on the processed film

Reflected x-ray film artifacts

1. Algae
2. Improper washing

Algae

Appearance

 Appears as dark random marks on film

 May scratch off with your fingernail

How to avoid

 Drain wash tank when not in use

 Observe regular cleaning intervals using algaecide on the wash rack
 Clean rack and working tank with a strong bleach solution. Rinse
well, rinse more. Adjust water supply so more water circulates
 By Dr Mangal S Mahajan

through the tank. Use caution not to overflow the wash tank drain.
Drain water when not in use
 Consider photo brome, but be aware this may damage some
processors
 Always consult manufacturer before

Improper washing

Appearance

 Film may come out looking quite dirty or even sticky or wet.

How to avoid

 Check that fixer and wash tanks are full of the appropriate fluid

Stains

They develop after months and years of storage

 Brown
 Use of oxidized developer
 Variegated color pattern
 Inadequate rinsing
 Grayish-yellow or brown
 Excessive fixation or use of exhausted hypo fixer agent which
becomes firmly bound to the emulsion so that it cannot be removed,
staining the film brown) followed by inadequate washing.
 Grayish-white scum
 Incomplete washing