The AAPM/RSNA Physics

Tutorial for Residents

Technical Aspects of Screen-Film Radiogra-
This article meets the phy, Film Processing, and Quality ControP
criteriafor 1.0 credit
Joel E. Gray, PhD
hour in Category 1 of
the AMA Physician’s
Recognition A u’ard.
To obtain credit, see The broad goal of quality control (QC) of screen-film radiography and film pro-
the questionnaire on cessing is to provide radiographs of consistent, high quality. Achievement of
pp 171-1 76 this goal requires attention to several areas, including QC of the screen-film sys-
tern and photographic processor, acceptance testing of all components, and
skill in analysis of film artifacts to “diagnose” the processor problems causing
the aberrations. Methods to reduce waste, recycle by-products, and reuse re-
sources such as silver are also part of the QC process. To optimize the photo-
After reading this article
graphic process, one should use the film, chemical solutions, processor, and
and taking the test. the
screens and cassettes produced by one manufacturer or the combination rec-
reader u’ill:
ommended by the film manufacturer. Important film processing
variables in
. Understand the basic (eg, density, density difference, and base plus fog) are recorded on control
principles of photographic
charts, which plot the variables as a function of time and allow easy analysis of
processor QC and control
changes in operating levels. Many variables can affect any component in the
charts and acceptance test-
ing. screen-film imaging system; problems caused by manufacturing batch-to-batch
variation, which is perhaps the most pervasive variable, can be lessened by
. Be aware of the many
sources of variablilitv in purchasing film, screens, and cassettes in large batches and of the same batch
the photographic process. and by purchasing photographic chemicals in concentrated form and mixing

. Be familiar with the con-

them as needed. Acceptance testing ensures that the product meets expecta-
cept of silver recovery as a tions, ensures that its performance meets specifications, and establishes the op-
financial resource and as an erating level for the ongoing QC program.
environmentally sound pro-
cess.
U INTRODUCTION
#{149}
Recognize a small Quality control (QC) of screen-film imaging systems covers a broad area, including arti-
sample of artifacts that facts introduced by many sources (1); QC of the photographic processor and screen-
may appear on film radio- film imaging system; acceptance testing of the processor, screens (including cassettes),
graphs.
film, and chemical solutions; and silver recovery, including the handling of waste prod-
ucts from film processing. Although the radiology team, including the radiologist, medi-
cal physicist, technologist, and darkroom technician, may not need to know all aspects

Abbreviations: QA quality assurance, QC = quality control

Index terms: Acceptance testing . Images, processing . Images. quality . Radiography . Quality assurance Screens
#{149}

and films

RadloGraphics 1997; 17:177-187

I From the Department of Diagnostic Radiology, Mayo Clinic and Foundation, 200 First St, SW, Rochester, MN 55905.
From the AAPM/RSNA Physics Tutorial at the 1995 RSNA scientific assembly. Received June 26, 1996: revision requested
October 9 and received October 3 1 : accepted November 1 . Address reprint requests to the author.

. RSNA, 199’

177
 of QC, it is essential that they be aware of the proximately 40,000 possible combinations of
effort required to produce quality radiographs. film, chemical solutions, processors, and inten-
This article introduces QC in general and QC sifying screens. Consequently, it is prudent to
for the screen-film imaging system and film pro- use the film, chemical solutions, processor, and
cessor. Guidelines for acceptance testing of all intensifying screens produced by one manufac-
components, along with acceptable variability, tuner or to use the combination recommended
are presented, and silver recovery and other by the film manufacturer. The manufacturer de-
ways of reducing chemical waste are discussed. signed these items as a system so that they are
Finally, artifact detection and diagnosis are illus- optimized as a system. Furthermore, if prob-
trated through a series of clinical examples. lems are encountered, it is almost impossible
for anyone to have a complete understanding of
U QUALITY ASSURANCE AND QUAHTY all the possible combinations and potential
CONTROL trouble spots.
It is important to differentiate between quality Film, chemical solutions, processors, and in-
assurance (QA) and QC. QA is an overall system tensifying screens should be thought of as an
for monitoring or assuring quality. QA includes imaging system. We would not think of buying
quality assessment, continuing education, QC, an x-ray tube from one company, an image in-
efficacy, utilization review, and outcomes as- tensifier from another, a video camera from a
sessment. QA is the broad concept or program third, and a video monitor from a fourth and
that focuses on an institution’s goals for quality trying to make these four items work together
medical care and quality outcomes. as a system. We rely on one manufacturer to
QC refers to the tests and controls devel- produce the imaging portion of our x-ray imag-
oped to monitor important variables in the pro- ing system. Likewise, we should rely on one
cess. SpecifIc technical measurements are made manufacturer to provide the radiographic film,
to monitor the output of a process, for ex- chemical solutions, processor, and intensifying
ample, the kilovoltage of an x-ray generator. If screens and we should use them as a system.
the control limits are reached or exceeded, QC
requires a change in the process. For example, . Control Charts
if the kilovoltage reaches or exceeds the eon- Control charts are the key to a QC program. A
trol limits, the generator must be recalibrated. control chart is a graphical presentation that
shows the value of interest (eg, the mid-density
. Goal of QC on a processor control chart) plotted as a fune-
The goal of QC is to provide consistent quality tion of time (Fig 1). (Mid-density is a film den-
output or a consistent quality product. For ex- sity of approximately 1 .20 above the base-plus-
ample, in photographic processing, the
goals fog level of the film.) A control chart allows for
are to provide consistent density or film speed, easy analysis of the data, as opposed to looking
consistent contrast, and a consistent base-plus- at numbers written in a log or in a table. More
fog level. One-hour photofinishers have had important, it allows for evaluation of trends,
stringent QC programs in place for many years. that is, slow changes in the operating level over
In fact, the 1-hour photofinishers do a better time (Fig 2). Even though these changes may
job of film processor QC than many radiology not result in the variable of interest reaching or
departments! The 1-hour photofinishers must exceeding the control limit, the trend indicates
provide optimal quality because if customers that, given sufficient time, this will occur. A
are not satisfied they will not return to that par- trend indicates that the development process is
ticular photofinisher. Unfortunately, the patient out of control. Consequently, whenever trends,
never knows the reason for the repeated radio- or drifts in data, are apparent, the cause should
graphs or the poor photographic processing be determined and corrected.
that results in a degraded x-ray image. Conse- All the values in film processing should be
quently, the radiology department is not under centered around the operating level (Fig 2).
the same pressure faced by the photofinisher to If the values are consistently above or below
produce a quality product. the operating level, the development process
should be adjusted to center the values around
. Optimization of Photographic Pro- the operating level; the operating level should
cessing not be adjusted so that it is centered in the
Photographic processing is a relatively simple data.
process that uses a developer solution, fixer so- A control chart also shows immediately if
lution, and wash. Unfortunately, there are ap- values reach or exceed the upper control limit
or the lower control limit. Any time a value
reaches or exceeds the control limit, it should

178 U Imaging & Therapeutic Technology Volume 17 Number 1

 X.RAY PROCESSING CONTROt CHART Cfr&Ch

Drift
Zi5h1 flr.iL v,.

___
P,’(,,,’ “I rt, M,,h

-: UCL #{149}__..........7L

OL --;74:;/

LCL

I I I I I I

Date
Figure 2. Schematic control chart shows the up-
per control limit (UCL), operating level (OL), and
lower control limit (LCL). The data plotted here
clearly indicate a trend or drift. Even though all the
data points are within the control limits, with the
exception of the last point, the development pro-
cess is clearly out of control and needs to be modi-
fled to eliminate the drift. This drift should have
been apparent after the first five or six data points.
--]
The last data point exceeds the upper control limit,
since the process was allowed to continue even
S/i
though it was out of control. If corrective action had
been taken earlier when it was first apparent that
Figure 1. Typical photographic processor control
the process was out of control (ie, when the drift
chart shows the QC results for a mammography pro-
was first noted), the data points would not have cx-
cessor. In addition to the three sections on the chart
ceeded the control limits.
that are used to monitor the density difference, mid-
density, and base-plus-fog level of the film, there are
three other important sections. In the lower left cor-
ncr are the date and replenishment rate for the de- . Establishing Operating Levels and
‘eloper and fixer. Any time changes are made in the Control Limits
replenishment rates, the changes should be re- In many cases, it is easy to establish the operat-
corded in this area. The area immediately to the ing levels and control limits. For example, for x-
right of the replenishment rate section is used to
ray generator kilovoltage, the operating level is
record the date and the temperatures of the devel-
the level selected on the generator (eg, 80
oper and wash water. Any time changes are made in
kVp). The control limits are then selected on
either of these temperatures, the date and respective
temperatures should be recorded. In the lower right
the basis of appropriate criteria (eg, usually ±5
corner is a section labeled “ Remarks, “ which is used kVp).
to record other modifications made to the processor. For photographic processing, the selection
It is also important to record the date that new of operating levels is more difficult. The mid-
replenisher solutions were added to the replenish- density level must be established at a density of
ment tanks or when the processor was serviced. approximately 1 .20 or higher. One step on the
This information is often valuable when it is neces- sensitometric step tablet or step wedge that
san’ to troubleshoot problems with the photo- produces a density at the appropriate level
graliic processor.
should be selected. A small mark should be
placed on that step to ensure that the same step
is evaluated each time. The density difference
be plotted on the control chart and circled (Fig must be established as the difference between
1). Corrective action is then taken; that is, the the densities of two specific steps. The two
cause of the problem is determined and the steps that are usually selected result in densities
problem corrected. A new sensitometric con- of 0.45 or higher and approximately 2.50 or
trol strip is then processed, with the new data
being plotted on the same date.

January-February 1997 Gray U RadloGraphics U 179

 higher. Small marks should be placed on these
steps to ensure that the same steps are used for
every measurement of the density difference.
Finally, the base-plus-fog level is established on
the basis of the density measurement of a por-
tion of unexposed film that has been processed.
The base-plus-fog level usually is around 0.18-
0.20 in density.
The control limits for the mid-density and
density difference should be set, ideally, at
±0. 10. In other words, if a mid-density of 1.25
has been selected, the upper control limit
should be 1 .35 and the lower control limit
should be 1 . 1 5. It may be easier to set the con-
for processor QC: a sensitometer (left), densitometer
trol limits at ±0. 1 5 initially until the QC pro-
(right), and sensitometric control strip (foreground).
gram is functioning and variations in the proees- The sensitometer is used to expose the film to a
son have been minimized. However, one should known, constant amount of light through a step
strive to set the control limits at ±0. 1 0 as soon wedge. The resultant film strip, known as a sensito-
as possible after the initiation of the QC pro- metric control strip (or sensi strip), shows a series of
gram. density steps that have a known exposure. The den-
Only an upper control limit is needed for the sitometen measures the optical density of the sensito-
base-plus-fog level of a film. The limit should be metric control strip.

set at +0.05 above the initial base-plus-fog level.

. Daily Processor QC order listed: (a) developer temperature, (b) de-

The same brand and type of film used for elini- veloper immersion time, (c) replenishment rate,
cal images should be used for QC testing of the (ci) solution level, (e) replenishment tank level,
film processor. Films react differently to the by- and (J) water temperature. If all these are cor-
products of development. For example, type A rect, the only thing left to do is to change the
film may show minimal changes to variations in developer solution. It is relatively easy and inex-
the condition of the processing chemicals, pensive to change the developer solution. How-
whereas type B film shows dramatic differ- ever, one must ensure that the appropriate
enees. If the processor is monitored with type amount of developer starter is added to the de-
A film but most of the film processed in the veloper tank as part of the fresh solution.
processor is type B, then changes that affect im-
age quality may not be detected by the proces- . Sources of Variability
sor QC program. In the diagnostic imaging process, there are
Daily processor QC includes several steps many sources of variability, including the batch-
(briefly presented here). First, the sensitometric to-batch variation of anything that is manufac-
strips should be exposed with a sensitometer tured. Because most manufacturing processes
(Fig 3), and then, within a short period (ie, 1-2 cannot be reproduced exactly, one can expect
hours), processed in the photographic proces- variations from batch to batch in terms of the
sons. The densities of the marked steps and the intensifying screens, cassettes, film, and chemi-
base-plus-fog level should be read with a densi- cal solutions. The photographic processor also
tometer. The density difference should be de- introduces variables into the process.
termined from the two appropriate marked
steps. These values should be plotted immedi- Screen and Cassette Variability.-There is a
ately on the control chart, which should be ana- wide variety of screens and cassettes, with the
lyzed for data points that exceed the upper or cassette front thickness and attenuation varying
lower control limits and for drifts in the data. If among different types of cassettes (as well as
any data points reach or exceed the control lim- because of batch-to-batch variability). In many
its or if drifts are obvious, immediate corrective departments, one may fmd various types of
action is required. screens and cassettes in use. This may create
For photographic processor QC, six items difficulties if the technologist uses the wrong
should be checked if corrective action is re- type of screen or cassette for a particular exami-
quired. These items should be evaluated in the nation. All the cassettes may appear to be the
same but may contain different screens. This
may be even more confusing in that films may
be inconsistently light or dark.

180 U Imaging & Therapeutic Technology Volume 17 Number 1

 Processor Immersion Times (seconds)

Solution 90-second Cycle Extended Cycle Rapid Cycle Quick Cycles

Developer 19.3 37.4 12.8 94*

Fixer 14.5 28.1 9.7 7.1
Wash 10.0 19.0 6.5 4.8

* Applicable for the Kodak 480 BA processor (Eastman Kodak, Rochester, NY); special chemistry required.

It is often stated that the output of intensify- plenishment rates must be increased appropri-
ing screens changes with time. However, the ately. Furthermore, replenishment rates must
amount of change is relatively minor. The major be set properly and must be consistent. For ex-
variation in intensifying screen output is caused ample, more or less replenisher could be
by manufacturing batch-to-batch variability. pumped into the developer tank as the head
The best solution to the problems caused by pressure in the replenishment system increases
screen and cassette variability is to purchase or decreases (ie, as the amount of replenisher in
cassettes in large batches and ensure that the the replenisher tank increases or decreases).
screens and cassettes are part of the same man- The processor immersion time (Table) refers
ufacturing batch. The cassettes and screens to the time that a film is in a particular solution.
should be tested to determine their speed. The duration of the immersion is measured
Once this has been done, cassettes with differ- from the time that the leading edge of the film
ent speeds can be isolated to different areas. enters the solution of interest until that same
For example, all the slower cassettes could be leading edge enters the next solution. These im-
placed in one area of the radiology department, mersion times are very short, which empha-
and faster cassettes could be placed in another sizes the need to ensure proper chemical aetiv-
area. ity levels and proper processor operation.
One must monitor the processor sensitomet-
Film Emulsion Variability. -In addition to rically, that is, use freshly exposed sensitomet-
batch-to-batch variation in film emulsion, one rie control strips to determine the chemical ac-
must be concerned with aging and storage eon- tivity levels of the developer and fixer solu-
ditions. The characteristics of the film, includ- tions. All other methods of monitoring these
ing speed, contrast, and base plus fog, change levels do not provide useful information about
with time. No radiographic film should be used the way photographic chemical solutions inter-
after its expiration date. If the film is not stored act with a particular film. For example, there
under the proper conditions (eg, at a tempera- have been proposals to monitor the pH and
tune not higher than 70#{176}
F and a humidity not specific gravity of the developer solution. How-
higher than 50%), the aging effects may be ac- ever, both these measurements are meaningless
celerated. because there are so many components in the
Batch-to-batch variability among film may re- developer. The specific gravity will be the same
quire a change in all setup or calibration levels as long as the total amount of solids placed in
for phototimers and laser cameras. To minimize the solution is the same, regardless of what
this problem, film should be purchased in large these components are. Likewise, the developer
batches (eg, a 3-month supply at one time), and is a heavily buffered solution, so the addition of
all the film should have the same emulsion other components probably
will not affect pH.
batch number. There are two basic rules for minimizing pro-
cessor variability: (a) use the chemical solu-
Processor Variability. -There are many vari- tions, temperatures, and immersion times nec-
ables associated with the photographic proces- ommended by the film manufacturer, and
son. For example, the developer temperature (b) monitor the processor with all film types
must be consistent (to within ±0.5#{176}F). The used in that processor.
processing must speed
be consistent and as
specifIed the manufacturer.
by Depletion and Chemical Variability. -One final source of
oxidation of the chemical solutions must be variation is the photographic chemicals, either
compensated for by using the appropriate re- the processor or the replenisher solutions. In
plenishment rates. If for any reason the deple-
tion and oxidation rates are increased, the re-

January-February 1997 Gray U RadioGraphics U 181

 addition to batch-to-batch manufacturing varia- The basic rule to minimize chemical vanabil-
tion, the proper mixing of the chemical solu- ity is to purchase photographic chemicals in
tions may also affect the quality of film process- concentrated form and to mix them as they are
ing. Specific instructions are provided by the needed.
manufacturer and must be followed to maintain
consistency in the photographic activity of the U ACCEIANCE TESTING
chemicals. Storage conditions are important: Acceptance testing first,is the
and a very im-
Both low and high temperatures can cause portant, step
in the QC program. The goals of
problems with the chemicals. Extremely low acceptance testing are to: (a) ensure that you
temperatures may cause some of the chemical got what you paid for, (b) ensure that the per-
components to settle out of the solutions, formance of the product meets specifications,
whereas high temperatures may increase the and (c) establish the operating level for the on-
oxidation rate of the chemicals. Finally, the going QC program. In addition to meeting the
type or brand of chemicals being used is ex- performance specifications, one should ensure
tremely important. As noted, the type of ehemi- that the new product performs
as well as or
cals used should be the type recommended by better than products currently in use. For ex-
the film manufacturer for a particular film type. ample, a new x-ray generator should perform at
It is difficult to ensure the quality of the least as well as a 2- or 3-year-old generator of
chemicals if they are purchased in a premixed the same brand and type.
form; one cannot be assured that the brand and
type of chemical solutions received is the same . Screen Acceptance Testing
as that ordered. For better consistency, it is rec- One of the most important factors to be
ommended that concentrated chemicals be pur- checked in acceptance testing of intensifying
chased and mixed on an as needed basis at the screens is speed uniformity; that is, are all the
hospital or clinic facility. Chemical mixing is new screens able to produce the same density
relatively easy because most chemicals are sup- on the film for the same exposure to the
plied as concentrated solutions. Consequently, screen? In addition, the new screens should
it is necessary to add only the appropriate produce film densities similar to those pro-
amount of water and stir to obtain working so- duced by the current screens. If not, the new
lutions. screens must be isolated to one area or re-
A major source of problems in chemical van- turned in hopes of obtaining screens that pro-
ability is contamination. Contamination can oe- duce densities closer to those achieved with
cur from the introduction of unwanted chemi- the present ones. New screens intended for use
cals in the mixing and transportation process or in one particular area should have density con-
of fixer into the developer in the processor it- sisteney better than ±0. 10. All screens of the
self. Such contamination can occur when the same type, mounted in the same cassettes,
processor is serviced or when chemicals are should produce densities within ±0.20.
added to it. Care must he taken to avoid ehemi- New screens and cassettes should be
cal contamination. checked closely for artifacts, in addition to
Photographic chemicals oxidize over time speed uniformity or density consistency. In this
unless sufficient film is processed. Approxi- ease, a uniform exposure should be made such
mately 50 sheets of 35 x 43-cm dual-emulsion that a density of approximately 1 .50 is pro-
film (or its equivalent) must be developed every dueed. The uniformly exposed and processed
8-hour period of operation to maintain the film should then be closely examined on a view
chemical activity level in the processor. If this box to determine if artifacts are present.
volume is not possible, one should consider the Screen-film contact should be evaluated for
use of “flood replenishment. In flood replen- “ all new screens and cassettes. The tool for test-
ishment, a predetermined amount of replenis- ing screen-film contact is a copper mesh that is
her is added to the processor at specified times imaged with a uniform exposure. The resultant
throughout the day, thereby maintaining the ac- images are viewed from a distance of about
tivity level of the developer. Developer starter 1 m. Any gray or dark spots represent areas of
solution must be added to the replenisher solu- poor contact.
tion before it can be used for flood replenish-
ment. Information about this approach can be . Processor Acceptance Testing
obtained from the film or chemical solutions Relatively extensive testing of the processor is
manufacturers. required when it is first installed. Information
about processor acceptance testing is available
in the literature (2-6). A few of the variables

182 U Imaging & Therapeutic Technology Volume 17 Number 1

 that must be evaluated as part of the processor oxygen demand. The silver ion, by itself, is con-
acceptance testing include (a) temperature ac- sidered hazardous because it has a high biologic
curacy, (b) temperature stability, (c) replen- oxygen demand. However, the silver in photo-
isher accuracy, (d) recireulation system, (e) so- graphic fixer solutions is tightly bound to the
lution filtration, and (J) dryer temperature. The sodium thiosulfate ion, which means that the
acceptance criteria should be those stated by silver in this solution does not affect the bio-
the manufacturer of the processor. logic oxygen demand. Unfortunately, this fact is
not understood by most regulators, and they
. Film Acceptance Testing consider fixer to be “dangerous.”
Film must be evaluated to ensure that the speed
(mid-density), density difference (contrast), and . Reduction and Recycling of Film
base-plus-fog level are satisfactory compared Processing By-products
with those of previous batches of film. The ac- Because it is environmentally sound to reduce,
ceptance limits are as follows: mid-density, recycle, and reuse the by-products of photo-
±0. 1 5; density difference, ±0. 1 5; and base plus graphic processing, this approach is presented
fog, +0.03. for minimizing the amount of silver and other
The best
method for film acceptance testing chemicals put into the sanitary sewer system.
is to compare two batches of film that have In some countries, it is necessary to recycle or
been exposed and processed at the same time return to the manufacturer all the expended de-
(to avoid processor variations). veloper and fixer. This is a rather costly process
because it requires the shipment of large quan-
. Chemical Solutions Acceptance Test- tities of liquid containing primarily water. Con-
ing sequently, every
effort must be made to mini-
As noted, only sensitometric tests are meaning- mize the amount
of waste being produced.
ful in the evaluation of photographic chemical The amount of chemicals consumed can be
solutions. The values to be evaluated include reduced by minimizing the replenishment rates
the capability of the chemical solutions relative while optimizing the chemical activity levels.
to the speed (mid-density), the density differ- Most replenishment rates specified by the
ence (contrast), and the base-plus-fog level of manufacturers of chemical solutions or film
the final image. The acceptance limits are as have a substantial amount of tolerance. Conse-
follows: mid-density, ±0. 10; density difference, quently, the developer replenishment rates can
±0. 10; and base plus fog, +0.03. often be reduced by as much as 20%-40% with-
out affecting the quality of the photographic
U SILVER RECOVERY AND PROTECT- processing. However, such reduction must be
ING THE ENVIRONMENT done under close sensitometric monitoring to
By-products of the photographic process in- ensure that problems in image quality are not
elude (a) used developer, (b) used fixer, introduced. Wash water flow rates can also be
(c) wash water (with trace amounts of fixer and reduced but not below the point at which the
silver), (‘0 silver from the fixer, and (e) film sodium thiosulfate is adequately removed from
(which contains silver). the film.
Used developer contains between five and The photographic fixer solution can be re-
10 different chemical components and is an al- used as part of a manufacturer-supported fixer-
kaline solution with a pH of 10.0-10.3. Proper reuse or recycling program. In initial evalua-
disposal is required in many countries and some tions, we found that 50%-60% of the fixer can
states in the United States. be recycled without adding any chemicals
Used fixer is composed of four to eight (replenisher) to the fixer. This recycling meth-
chemical components and is an acidic solution od requires a carefully controlled environment
with a pH of 4.2-4.5. Expended fixer contains and the electrolytic removal of silver from the
silver in amounts that can range from 2-6 g/L to
as low as 5-500 mg/L for a solution in which a
substantial amount of silver has been removed.
The environmental concerns about silver are
based on the free silver ion and the biologic

January-February 1997 Gray U RadioGraphics U 183

 fixer solution before it is recycled. Further-
more, fixer recycling should be undertaken
only with the assistance of the film and chemi-
cal manufacturer. In the future, one may expect
to see fixer recycling programs being devel-
oped and promoted.
The silver recovered from the fixer, photo-
graphic film, or wash water can be reused. Sil-
yen from the fixer solution can be reclaimed in
different ways and can become a source of rev-
enue. It is normally sold through a broker to a
firm that uses silver, such as a photographic
film manufacturer. The silver from film can be
removed and sold to a silver recycling firm. The
polyester base material used in radiographic
film can also be recycled.

. Silver Recovery from Fixer Solu-

tions processing artLacts. 1 .._ rk streaks that appear to
There are several methods for recovering silver be liquid running down the film are from developer
from fixer solutions. The first method employs that was on the crossover rollers. This probably oc-
curred during changing of the chemicals, during
a device called a replacement cartridge and a
cleaning of the processor, or when someone re-
“tailings” process, that is, a system in which the
moved a jammed film from the processor. The dank
fixer slowly trickles through the replacement horizontal lines are hesitation marks, caused by the
cartridge. The silver-laden fixer flows through a film being stopped momentarily in the processor.
cartridge (usually about 5 gallons [20 L] in size)
filled with steel wool. The iron in the steel
wool is replaced with silver, and a sludge eon-
sisting of iron and silver is produced. This tech-
nique may also be used after an electrolytic sil-
yen reclamation process to remove more of the
silver from the fixer solution.
Unfortunately, when the replacement car-
tridge approach is used, the silver is of poor
quality, so there is a low return on investment
of time and resources. In addition to the re-
sources required for the tailings process, one
must handle and ship the 5-gallon (20-L) con-
tainers of sludge to a silver reclamation facility.
Furthermore, although the replacement car-
tridge method can reduce the silver concentra-
tion to 5 ppm (5 mg/L or less) at the specified
flow rates (100-300 mljmin), this process can-
not be used for recycling of photographic fixer.
Another recovery method, the ion exchange * L 5. Pelvic radiograph of a hip prosthesis
process, is also a tailings process. This process shows dark horizontal lines, which represent hesita-
is extremely efficient and can reduce the silver tion marks.
concentration to 1 mg/L or less. However, addi-
tional space is required, and the system needs
periodic testing and “recharging” of the ion ex- silver concentration has been reduced to about
change resins. Most important, the system can 5 mg/L or less.
handle only solutions with low silver coneentra- Electrolytic silver reclamation is the primary
tions such as wash water and fixer in which the method of silver recovery used in most facili-
ties. In this process, silver is plated onto large
plates by means of electrolysis. The silver pro-
duced is extremely pure (on the order of 99%

184 U Imaging & Therapeutic Technology Volume 17 Number 1

 . Silver Recovery from Wash Water
and Film
The concentration of silver in wash water is
relatively low (on the order of 5- 10 mg/L, with
a maximum of approximately 20 mg/L). How-
ever, some countries and states still require that
the silver from photographic processing be re-
covered from the wash water. This recovery is
usually achieved through an ion exchange pro-
cess.
The silver concentration in film is relatively
high; thus, silver recovery can be profitable, es-
pecially with older films. Films that are 10-15
years old or older contain higher levels of silver
than films used today. Consequently, the price
paid for recycled older films should be higher
than that for newer films. As noted, the base
material can also be recycled.

U FILM ARTIFACTS FROM PROCESS-

ING
In the processing of film, artifacts can arise
Figure 6.Abdominal radiograph demonstrates yen- from many sources, including processing pres-
tical line artifacts. The series of vertical lines was sure marks, processing physical damage to film,
caused when the film, which was going through the and chemical problems.
processor with the wide edge leading, stopped in Many films are more susceptible to damage if
the crossover section between the developer and processed improperly. Both the developer and
the fixer tanks. The processor or at least the cross- fixer solutions contain hardeners that harden
over assembly had stopped momentarily, allowing
the emulsion and help protect it from pressure
some areas of the film to continue developing. The
marks and scratches during processing. If the
leading edge (left side) was already in the fixer. Ev-
film is underdeveloped or the fixer is less than
cry place where the crossover rollers touched the
film, little additional development occurred due to optimal, more artifacts may be apparent. Pro-
that contact; the areas in between developed fur- cessing film at high temperatures can also cause
ther. The trailing edge (right side) was still in the de- processor artifacts because the emulsion will be
veloper and developed even more. softer if the processing temperature is above
that recommended by the manufacturer.
Inadequate fixing results in a loss in image
purity or better), and the silver concentration quality and staining of the images within a few
can be reduced to approximately 50 mg/L or months to a year or so after development. Simi-
less by using batch electrolytic silver recovery. lar staining and fading may result if the film is
After the silver is removed from the fixer, the inadequately washed. Inadequate washing may
remaining fixer may be recycled. The eleetro- result from wash water temperatures that are
lytic process is the method of choice for in- too low and from less than optimal water flow
house recovery of silver from fixer solutions. rates.
There are two types of electrolytic silver re- Many artifacts associated with processing are
covery: flow-through and batch processes. In caused by human error. Such artifacts may re-
the flow-through process, the used fixer flows sult from improper handling of the film or im-
into an electrolytic recovery cell continuously. proper maintenance of the processor. These an-
Because the solution is continuously flowing in, tifacts may take the form of dark streaks from
it is also continuously flowing out. Conse- developer solution on the crossover rollers (Fig
quently, a substantially higher level of silver 4), hesitation marks from film being temporarily
goes to the sanitary sewer system with this pro- stopped in the processor (Fig 5), vertical lines
cess. In batch processing, the silver recovery is from film stopping in the crossover rollers (Fig
maximized because the electrolytic process re- 6), dark and light halves of an image due to a
moves the silver from a fixed amount of solu-
tion at one time before any of the solution is re-
used or discarded.

January-February 1997 Gray U RadioGraphics U 185

 Figure 7. Radiograph of the lumbar spine reveals Figure 8. Close-up of a chest radiograph shows
multiple artifacts. The left side is darker than the static artifacts. The black marks on the left side are
right side; in fact, the dividing line between light caused by the discharge of static electricity. When
arid dark is aligned with the lumbar spine. making the discharge occurs, light is created in a pattern, as
the increased density less apparent. It appears as if seen here. The dark vertical line is also static dis-
this film was partially submerged in the developer charge. This discharge probably occurred when the
when a probleni occurred. It is suspected that the film was in contact with a roller, perhaps in a chest
technologist, realizing that there was a film jam, changer. (Although it is not clear whether the verti-
pulled the tllni backward. causing the fine horizon- cal line is due to static, if one looks at it with a mag-
tal scratch marks that occur when film is forced nifying glass, a pattern similar to the larger static pat-
OVer the guide shoes. tern on the left is apparent.)

film jam (Fig 7), fine horizontal scratch marks

from film being forced over the guide shoes
(Fig 7), static marks (Fig 8), dark spots caused
by foam or air bubbles in the fIxer solution
(Figs 9, 10), and nonuniformity of density due
to poor squeegee removal of developer solution
(Fig II).

U SUMMARY
A good photographic processing QC program is
essential for quality radiography. It is essential
to consider the screen, film, chemical solutions,
and processor as a system and to use the com-
ponents recommended by the film manufac-
tuner that are designed to provide optimal re-
51.llts. Part of a good QC program includes envi-
ronmental considerations such as minimizing
chemical wastes, recovery of silver, and recy- Figure 9. Uniformly exposed radiograph demon-
cling the polyester film base material. Artifact strates dank marks similar to ones that were show-
ing up on a substantial number of films coming from
one processor. Investigation proved that the marks
were caused by foam in the fixer. The marks occur
because the bubbles in the foam attach themselves
to the film and prevent the fixer from getting to the
film as quickly as necessary to stop the development
process. Consequently, the film develops further
wherever a bubble is located.

186 U Imaging & Therapeutic Technology Volume 17 Number 1

 Figure 10. Slot radiograph from a gastrointestinal Figure 11. Image of a mammography phantom
examination demonstrates a metallic object, which shows nonuniform density, especially in the lower
is part of a palpation spoon, and a dark area in the half of the image. It is clear that development was
barium that could very well be diagnosed as a not uniform because the squeegee roller (at the exit
P#{176}1YPHowever, this artifact was caused by an air side of the developer tank) was not sufficiently tight.
bubble in the fixer solution, similar to those demon- Some developer was removed from the film hut in a
strtted ill Figure 9. Such an artifact could clearly nonuniform manner, allowing development to con-
lead to additional and needless examinations and tinue nonuniformly.
CtUSe the l)atieflt worry.

analysis is a skill required in QC to be able to Physics Monograph no. 20. New York, NY:
determine the processor problems that cause American Institute of Physics, 1994.
the artifacts. 4. Haus AG, ed. Film processing in medical imag-
ing. Madison, Wis: Medical Physics, 1993.
5. GrayjE, Winkler NT, StearsJ, Frank ED. Qual-
U REFERENCES
ity control in diagnostic imaging. Frederick, Md:
1 . Artifact identification program: a self teaching
Aspen, 1983.
guide, part no. 668066. Rochester, NY: East-
6. Quality assurance in diagnostic imaging. NCRP
man Kodak, 1977.
report no. 99. Bethesda, Md: National Council
2. Recommended specifications for new mam-
on Radiation Protection and Measurements,
mography equipment: screen-film x-ray sys-
1988.
tenTh, image receptors, and film processors.
Reston, Va: Anierican College of Radiology,
1995.
3. Seihert JA, Barnes (T, Gould RG. SpecitIca-
tion, tcceptince testing, and quality control of
diagm)stic x-ray imaging equipment . American
Association of Plwsicists in Medicine, Medical

This article meets the criteriafcr 1. 0 credit hour in category 1 of the AMA Physician ‘s Recognition
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January-February 1997 Gray U RadioGrapbics U 187