653

Pictorial Essay

Artifacts In Chest Radiographs With A Third-Generation

Computed Radiography System
American Journal of Roentgenology 1996.166:653-657.

John P. Volpe1’2, Maria L. Storto3’4, Katherine P. Andniole1 , Gordon Gamsu1

Photostimulable phosphor computed radiography (CR) is a addition of a third-generation system (FCR9000; Fuji Medical
developing and increasingly widespread technology. The pur- Systems) in September 1994. A mean of 24,000 studies is
pose of this pictorial essay is to familiarize readers with the performed per year, largely bedside and intensive care unit
appearance and cause of image artifacts that can occur in a
examinations. The updated CR system incorporates hard-
third-generation computed radiographic system. Artifacts are
ware and software modifications including a new imaging
described that relate to imaging plates, image readers, image
plate, image reader, and image-processing algorithm [5].
processing, and film processing.
Although this system has eliminated many artifacts
observed with the earlier CR systems [6, 7], we have observed
Oven 150 storage phosphor on computed radiography sys- others specifically related to design modifications. We also
tems are in use in the United States. Systems are offered by continue to encounter artifacts common to both screen-film
several manufacturers including Fuji, Eastman Kodak, Phil- and digital systems. These artifacts may degrade image quality
ips, Siemens, and Toshiba [1]; others, sold under license by and simulate or conceal significant disease. In this essay, we
Philips, Siemens, and Toshiba, are essentially Fuji systems. present clinical examples of artifacts along with demonstra-
A recent survey of academic radiology departments showed tions of others, using an anthropomorphic chest phantom. We
that digital imaging systems, including storage phosphor verified clinical case artifacts by repeat processing of images,
technology, were used by 27% (47/i7i) of these depart- by comparison with repeat examinations obtained within 24 hr,
ments, and 43% (74/i7i) indicated plans for such systems on by experimental reproduction. Examinations of the chest
[2]. CR has been shown to be well-suited to all aspects of phantom were exposed at 80 kVp and 1 .5 mAs. CR films were
general body radiography [3]. Its benefits in thoracic imaging printed on a Fuji LP414 laser printer (Fuji Medical Systems).
include significantly reducing the numbers of repeated porta- Comparisons were read by two chest radiologists.
ble examinations, with concomitant reduction in radiation
exposure to patients and staff as well as cost savings [3]. CR
allows readers to tailor images to suit individual on institu- Imaging Plate
tional preferences, to generate multiple images for rapid use
at remote sites, and to digitally acquire and archive, which Lead backing added to the aluminum-framed, carbon-fiber
allows remote viewing station retrieval and virtual elimination cassettes has eliminated backscattered radiation from a
of lost studies [4]. patient’s bed, the so-called light-bulb effect [6]. Use of older
Our department has used a storage phosphor CR system cassettes without lead backing may produce this artifact (Fig.
(Fuji AC2; Fuji Photo Film, Tokyo, Japan) for 3 years, with the 1) in which outer portions of a film might appear darkened

Received July 21, 1995; accepted after revision October 25, 1995.
1 Department of Radiology, University of Califomia, 505 Parnassus Ave., San Francisco, CA 94143-0628. Address correspondence to G. Gamsu.
2Present address: Department of Radiology, Westchester County Medical Center, Valhalla, NY 10595.
3Department of Radiology, Ospedale 55. Annunziata, Chieti, Italy.
4Present address: Department of Radiology, University of California, San Francisco, CA 94143-0628.
AJR 1996;166:653-657 0361-803)(/96/i663-653 © American Roentgen Ray Society
 654 VOLPE ET AL. AJR:166, March 1996

and simulate a pneumothonax or a pneumopenitoneum in a cassettes for screen-film systems, storage phosphor plates are
supine patient on might potentially obscure abnormal find- often kept in service longer because of their high cost [8].
ings. The highly sensitive CR plates remain extremely sus- Oven time, the latent image information stoned on an
ceptible to scattered radiation or inadvertent exposure (Figs. exposed imaging plate decays. This phenomenon is called
2 and 3). We therefore recommend routine erasure of all CR fading. In technical studies, fading is more pronounced with
plates on the day they are to be used. Depending on the image reading at the longer wavelength of light emitted by
severity of the inadvertent exposure, images may need to be the new photoluminescent plates [5]. New phosphor technol-
reprocessed or studies repeated. ogy has increased the stability of X-ray energy storage, and
Higher spatial resolution and decreased noise have been a clinically significant reduction in image quality has not
achieved in the new Standard-Version V (ST-V; Fuji Photo Film) been shown with delayed processing (Fig. 5).
phosphor plates by reducing phosphor grain size and applying After a laser scanning of the latent image generated by X-
a thinner phosphor and a thinner surface-protection layer, ray exposure, imaging plates must be erased by exposure to
which serves to moderate broadening of the incident laser light. However, increased image stability also increases the
beam. However, these plates are more susceptible to damage likelihood of persistent latent images that have been
from vigorous on improper cleaning (e.g., with a water-based reported after exposure to high levels of radiation and after a
solution). Besides typical use artifacts, plates crack despite a prolonged lapse between plate erasure and reuse [6, 7].
change from roller- to belt-plate transport (Fig. 4). Although Because the erasure unit in our updated CR system uses a
storage phosphor plates have a shorten life expectancy than two-stage method of exposing plates first to visible light, then
American Journal of Roentgenology 1996.166:653-657.

.. ..-.

.. ,., .

. ..

. . . #{231}
. ..

Fig. i.-Light-bulb effect. Created for refer- Fig. 2.-Scattered radiation. Storage Fig. 3.-Inadvertent exposure. Computed
ence using older cassette without lead backing phosphor plate exposed to fluorescent radlographs in 40-year-old woman with renal
and relatively high exposure, poorly collimated lighting for 24 hr shows radiopaque failure show artifacts resulting from insufficient
image of anthropomorphic pelvic phantom. elements on cassette back. Distance shielding of cassettes during portable radio-
between plate and light source was 41 graph rounds in intensive care unit.
inches. Plate has not been exposed to
radiation. Erasure of all plates the day
they are used and storage of plates
placed on end In appropriate cabinets
will reduce incidence of this artifact.

Fig. 4.-Plate cracking In computed radio-

graphs.
A, Radiograph shows artifacts misinterpreted
as surgical clips in mediastinum of 23-year-old
man with acute myeloblastic leukemia (arrows).
B, Radiograph shows right upper quadrant of
78-year-old man following radical neck dissec-
tion for squamous cell carcinoma (black arrow).
Similar artifacts on muftipie plates led to discov-
cry of unobserved damage to housing of corn-
puted radiography unit that scratched image
plates during belt transport to image erasure
unit and resulted in cracks. Linear artifact (white
arrows), related to dust particles on light source
of scanning laser, is also seen.
 AJR:166, March 1996 ARTIFACTS IN CHEST RADIOGRAPHS 655

to light containing an ultraviolet component-which improves Image Reader

the efficiency of the erasure process-we were unable to
generate a persistent latent image with exposure intensities Our updated CR system, the FCR9000, employs a visible-
up to 1000 times the normal intensity (Fig. 6). light semiconductor laser that has a reading light wavelength
Inadvertent double exposures do occur with our updated of 680 nm. By decreasing scan time, these lasers have
CR system and are more difficult to detect than in screen- improved processing capacity with more rapid throughput.
film systems because of the linear frequency-processing New imaging plates contain a europium-activated barium flu-
response of the CR system, which optimizes image intensity oro-halide-halide (bromide and iodide) phosphor. The peak
over a wide range of exposures. Such double exposures photostimuable luminescence intensity generated by these
may lead to errors in interpreting the position of lines and plates is shifted to a wavelength (680 nm) longer than that of
catheters. Double exposure may also mask low-density find- the older europium-activated barium fluonobromide phos-
ings such as regions of parenchymal consolidation (Figs. 7 phor plates (633 nm) and is therefore more compatible with
and 8). Review of the Fuji “S” number in the data field, which solid-state lasers. Processing of a barium fluorobromide-
provides quality assurance by relating actual exposure to the iodide plate in a system designed to read barium fluorobro-
optimal range of the storage phosphor plate, has not proven mide plates, which function most efficiently at the shorter
a reliable method of detecting this type of double exposure 633-nm wavelength, will theoretically result in a relative
artifact in either clinical or phantom studies. This lack of neli- decrease in photostimuable luminescence intensity and thus
ability is probably due to a wide variation in initial X-ray expo- will degrade images. We were unable to show this artifact
sure settings and in patient morphology. (Fig. 9). Nonetheless, scanning artifacts still occur (Fig. iO)
American Journal of Roentgenology 1996.166:653-657.

Fig. 5.-Fading of latent Image.

A and B, Computed radiographs of chest
phantom with immediate processing of plate
(A) and processing delayed 48 hr (B). Diag-
nostic quality image Is produced with no dis-
cemibie loss of Information wIth delayed
processing.

Fig. 6.-Erasure of latent image. Chest Fig. 7.-Double exposure. Computed radio- Fig. 8.-Double exposure.Computed
phantom exposed at 80 kVp, 1500 mAs (1000 graph of 62-year-old man recovering from myocar- radiograph of 75-year-old woman
with gas-
x normal exposure). Computed radiograph dial infarction. Duplicated ribs (arrowheads) and trointestinal bleeding, misdiagnosed as hay-
is of diagnostic quality (compare with Fig. right hernldiaphragm (black arrows) reveal double ing pulmonary edema. Left shoulder girdle
5A). Repeat processing of plate showed no exposure. shows two humeri (arrows), indicating sub-
latent image. tie artifact.
 656 VOLPE ET AL. AJR:166, March 1996

Fig. 9.-Compatibility of CR systems. Bar- Fig. 10.-Laser scanning artifacts.

lurn fluorobromide-lodide plate processed A, Reprogramming of processing parameters during image readout results in premature termina-
through helium-neon laser reader of second- tion of laser scanning with linear and star burst effect.
generation unit shows no loss of diagnostic B, Computed radiograph of 85-year-old woman shows linear artifact of dust on light source of scan-
Information (compare with Fig. 5A). ning laser.
American Journal of Roentgenology 1996.166:653-657.

Fig. 11.-Incorrect diagnostic specifier.

Computed radiographs of42-year-old woman.
A, This study was erroneously processed
with parameters reserved for studies of
shoulder. Image reveals poor contrast in low
density regions of lung parenchyma.
B, Postprocessing of archived study with
appropriate parameters for chest corrected
this problem.

that cannot be removed on circumvented by postpnocessing ton chooses an incorrect diagnostic specifier or wrong
and may necessitate a repeat study. anatomic region, the results will be an image readout with
incorrect frequency and gradation processing parameters as
well as unacceptable image quality (Fig. ii). Such an error
Image Processing
may be easily recognized on the data field beneath the
The ability of CR to produce diagnostic quality images image and is connected with repeat processing of the
oven a wide range of exposures is dependent on the effec- archived image.
tiveness of the image analysis program in the exposure data When earlier readers failed to recognize the appropriate
recognizer. This analysis should include laser prescanning, collimation pattern, the result was an incorrect density his-
histogram analysis, maximum-minimum signal levels, high- togram after prescan and suboptimal readout. As little as a
density object thresholding (for wines, clips, and so forth) and 30 off-angle collimation can produce significant image deg-
knowledge of the anatomic region under examination [3]. An radation when an operator processes in the automatic
operator applies gradation processing, which is the digital mode [6]. Neural network processing in our FCR9000 sys-
equivalent of the screen-film Hurter and Dniffeld charactenis- tem, with its improved pattern recognition of image data,
tic curve, and frequency processing, which uses an unshanp allows varied collimation fields that, in turn, improve histo-
mask to generate edge enhancement, according to refer- gram analysis of the imaged region (Fig. 12). Neural net-
ence standards based on the examination type. If an opera- work processing allows flexibility in the performance of
 AJR:166, March 1996 ARTIFACTS IN CHEST RADIOGRAPHS 657

Fig. 12.-Varied collimation fields. Computed

radiograph of chest phantom with collimation
altered to 20#{176}
from parallel results in no loss of
contrast (compare with Fig. 5A).

Fig. 13.-Fixer contamination. Computed

radiograph of 6-month-old girl with unexplained
neutropenia. During film processing developer
solution was contaminated by overflow of fixer
solution from too-full reservoir. This produces
low-contrast image of characteristic brown hue.
This problem was corrected by establishing
continual runoff of replenished fixer solution.
12 13
American Journal of Roentgenology 1996.166:653-657.

bedside radiography while maintaining consistent image quality control remains of paramount importance to ensure a
quality. We have found no significant artifacts related to fre- hard-copy film true to the acquired and processed image.
quency processing for edge enhancement, specifically, loss
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