148 Veterinary Ireland Journal Volume 64 Number 3 Veterinary Ireland Journal Volume 64 Number 3

I NURSING
In this article, Orla OReilly RVN offers a recap on the principals of producing
good quality radiographs using traditional ionising radiation methods. The
article provides refresher points on radiographic principals, and explores
what can go wrong during the process and how to correct these problems.
How to: produce a
good quality diagnostic
radiograph
Key prINCIpALS
In order to be of diagnostic value, radiographs have to be
of good technical quality. A good radiograph should show
accurately the structure under examination, the quality of
both contrast and detail should be good and there should
be no misleading artefacts on the film. Many factors
influence the formation of the image:
Positioning;
Screen and film combinations;
Exposure factors; and,
Processing.
X-rays are a form of ionising radiation and they can be
potentially harmful to living tissue, so personal protection
is very important. A radiograph is the picture produced on
film when an object/patient is exposed to this radiation.
The varying levels of absorption of x-rays by different
tissue types produces five radiographic opacities:
Black - gas;
Dark grey fat;
Light grey soft tissue and fluid;
Nearly white bone; and,
White metal.
Kilovoltage (kV) refers to the penetrating power of the
beam and the speed of the x-rays. Thicker tissues and
those with a higher specific gravity will require a higher kV
setting. The normal range of kV settings on a veterinary
x-ray machine is 40 125kV with 50 70kV being
adequate for most small animal radiography.
Milliamperes (mAs) refers to the exposure time in
seconds. This dictates the number of x-rays and affects
the density, or the degree of blackening of the film.
NB: If kV is increased by 10, the mAs can be
halved (and vice versa) to produce the same quality
radiograph. This can be important when performing
thoracic radiographs when there is a need to keep
mAs low in order to minimise movement blur from
respiration.
All exposures should be recorded in an exposure book
which should be referred to prior to any radiographic
investigation to compare with previous exposures. Keeping
such a record should minimise the need for repeat
radiographs due to poor choice of exposure factors, thus
reducing unnecessary radiation exposure to staff and the
patient.
Film-focal distance (FFD) is the distance between the
x-ray tube and the cassette. This should be either 70cm
(small animal) or 100cm (large animal) depending on
model. Distance should be kept constant for all x-rays in
order to minimise variables.
Object-film distance (OFD) is the distance between the
part of the patient being radiographed and the cassette.
This should be kept to a minimum (directly on plate as
much as possible) to avoid magnification and distortion of
the image also know as the penumbra effect.
Film/screen Combination (Fast/slow). Cassettes with
intensifying screens contain crystals that emit light when
exposed to radiation. Fast screens produce more light for
a set exposure level then slow screens but have larger
crystals. This means that fast screens cause higher
density but poorer detail compared with slow screens
(similar to the pixels of a television; the smaller the pixels
the finer the detail).
light Beam Diaphragm (lBD) refers to an area of light
which directly corresponds to the area or beam of direct
radiation. This allows tight collimation over the specific
area of interest.
NB: To test that the LBD is working effectively, place
metal paperclips on a cassette at the corners of the
light beam. When a radiograph is exposed the clips
should appear white at the corners of the image.
scatter radiation is the term used to describe secondary
radiation. This is a form of radiation with lower energy
than direct or primary radiation. It is produced when the
primary radiation interacts with the object and is reflected
in infinite directions. This can adversely affect the quality
of the radiograph by causing a general blackening of the
film and reduced contrast or fogging. Scatter radiation is
March VJrnl.indd 148 23/02/2011 12:12:12
Veterinary Ireland Journal Volume 64 Number 3
NURSING I
149 Veterinary Ireland Journal Volume 64 Number 3
an important health and safety concern and so protective
lead clothing and screens are essential to protect
personnel from repeated exposure to scatter radiation. The
amount of scatter increases as both patient size and area
of collimation increases. A grid should be used to absorb
scatter radiation when the area being radiographed is
thicker than 10cm.
NB: Lead clothing only protects against scatter
radiation and not against primary radiation. For this
reason, personnel should never hold an animal for a
radiograph in the primary beam.
Manual Processing involves chemicals (developer and
fixer) in either horizontal or vertical tanks. Developing
stage takes 5 minutes at 20C, fixing approximately 10
minutes and then the film is washed in cold running water
for 1530 minutes. This method is very time consuming
and labour intensive and requires good management of
chemicals in order to avoid significant processing film
faults.
Automatic Processing uses the same chemicals but
the film is loaded into an automatic processor. The
temperature is higher and consequently processing is time
reduced. This method requires machine and chemical
maintenance.
Digital Processing is the quickest and cleanest method
of processing. The contrast of the image can be altered, a
specific area magnified for examination and images saved
to computerised files to avoid multiple storage boxes. The
fact that the image can be edited post processing means
that it reduces the number of repeat radiographs being
carried out which saves on time and personal exposure to
radiation.
reCAp:
Sedate/anaesthetise patient as necessary.
Know exactly what area of the patient is to be
radiographed and what views are required.
Have good knowledge of the anatomy of the relevant
area.
Have equipment ready e.g. cassettes, positioning aids,
markers and grid if applicable.
Wear protective clothing and a personal
thermoluminescent dosimeter.
Ensure automatic/digital processor switched on
(automatic processing).
Ensure chemicals are not exhausted and are at the
correct temperature (manual processing).
Check exposure chart for appropriate settings.
Ensure access to room by other staff and clients is
restricted and that safety light is working.
March VJrnl.indd 149 23/02/2011 12:12:14
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I NURSING
150 Veterinary Ireland Journal Volume 64 Number 3
Troubleshooting - What can go wrong and how to correct it:
Exposure and processing faults
Problem Cause Solution
Dark flm Over exposure
Over developed
Developer temperature too high
Excessive fogging
Reduce exposure factors
Use automatic timer
Use thermometer in tank
Use automatic timer
Pale flm Under exposed
Developing time too short
Developer temprtature too cold
Exhausted developer
Developer too dilute
Incorrect flm-screen combination
Increase exposure factors
Use automatic timer
Use insulating temperature jacket and thermometer in tank
Keep developer covered to prevent oxidation and water
contamination
Keep record of flm-screen combinations
Poor detail FFD too short
OFD too long
Uneven screen contact
Increase FFD
Reduce OFD
Check screens regularly
High contrast
Low contrast
Insuffcient kV
High kV
Incorrect processing
Excessive fog
Increase kV/grid
Reduce kV
Review processing procedures
Blurring Movement
Poor flm/screen contact
Use sedation/GA as required
Take exposure at expiratory pause except when radiographing
lungs when it should be done at peak inspiration
Keep mAs low and increase kV when imaging the thorax to
avoid movement blur from respiration
Use new cassette and/or repair
Edge of flm underex-
posed
Grid cut off Correct FFD
Lines on flm when using
grid
Primary beam not perpendicular to cassette/grid or grid is
upside down
Ensure 90 angle
Ensure correct way up
General fog
Chemical fog
Radiation fog
Localised fog
Prolonged storage of flms
Developer time too long, temperature too high or developer
exhausted
Pre-exposure to radiation
Excessive secondary radiation
Exposure to white light
Incorrect safelight
Prolonged inspection during development
Damaged cassette
Rotate stock
Use automatic timer, thermometer and replace or replenish
developer solution.
Review storage facilities
Reduce exposure factors
Ensure darkroom light proof
Refer to flm type
Review manual processing
Check cassettes regularly
Stains and artefacts
Problem Cause Solution
Yellow stains Prolonged development in exhausted solutions
Developer temp. too high
Films stuck together
Change or replenish developer solution
Use thermometer in tank
Agitate in developer
Brown stains Deposits of oxidised developer
Deposits of silver sulphide
Replace developer solution and wash properly
Wash for appropriate times
Blue-green stains Exhausted chrome alum. fxer Replace fxer solution
Streaking Lack of agitation
Dirty processing hangers
Insuffcient rinsing
Drying marks
Agitate in developer and fxer
Clean regularly
Review processing protocols
White splashes
Black splashes
Fixer
Developer
Review processing protocols
White specks and marks Dirt, dust or stains on intensifying screens
Finger prints
Crimp marks
Clear marks surrounded by a ring
Lightening static marks
Metal tag on collar
Microchip
Clean regularly with proprietary cleaner
Work with clean dry hands
Hold by edges only
Bubble marks- agitate flm during processing
Remove flm slowly from box and place in cassette without
dragging across surface
Remove collar
Scan
Scratching Emulsion sensitive when wet Care with adjacent hangers
Drips and stains Contrast media, urine, blood or water on cassette surfaces Clean cassette surfaces if soiled or use protective radiolucent
covers
March VJrnl.indd 150 23/02/2011 12:12:16