Faulty Radiographs

faults during management and processing of x-ray films.

1. Department of :- Oral medicine and radiology KALKA DENTAL COLLEGE

2. FAULTY RADIOGRAPH SUBMITTED BY:- Dr. NIKESH ROSHAN

3. Causes of FAULTY RADIOGRAPHS can be broadly classified into:- PROJECTION ERRORS EXPOSURE AND PROCESSING ERRORS AUTOMATIC PROCESSING ERRORS MISCELLANEOUS TECHNIQUE ERRORS

4. PROJECTION ERRORS Apical ends of the teeth cut off REASON :- Film is placed too close to the teeth in the maxillary arch when using paralleling technique. RECTIFICATION :- Place the film away from the teeth. Lighter Radiographs (Underexposed/ Underdeveloped Radiographs) REASON :- Radiograph with low density. Radiograph exposed for less than optimum time or with less than optimum kVp . RECTIFICATION :- Developing time should be increased

5. Darker Film (Overexposed/ Overdeveloped/ High Density Radiology) REASON :- Radiograph with high density. Radiograph exposed for more than optimum time or with more than optimum kVp . RECTIFICATION :- Developing time should be decreased Cone-cut/ Partial Image REASON :- Improper alignment of the tube, the object and the film. RECTIFICATION :- X-ray tube should be aligned properly with the object and the film.

6. Blurring REASON :- Movement of the film, the patient or the X-ray tube during exposure RECTIFICATION :- Patient should be instructed not to do any movement either of the film or of himself during the radiograph. Ensure the stability of the X-ray tube. Image Shape Distortion REASON :- Excessive pressure is applied over the film. RECTIFICATION :- Film should be supported very gently.

7. Tyre Track Appearance / Herring Bone Effect REASON :- Reverse film position. RECTIFICATION :- Always ensure that convexity of embossed dot should face the X-ray tube. Overlapped Image REASON :- Incorrect horizontal angulation of the cone. RECTIFICATION :- Central rays of the X-ray beam should be directed perpendicular to the facial surface of the teeth.

8. Crowns of teeth not showing REASON :- Not enough film showing below or above the crowns of teeth. RECTIFICATION :- Approximately 1/8 th of the film should extend below or above the crown. REASON :- Decreased vertical angulation causing elongation. RECTIFICATION :- Increased vertical angulation. Magnification REASON :- Film to object distance increased. RECTIFICATION :- Use the recommended film to the object distance. REASON :- A cone pointed cone is used which produces a divergent beam. RECTIFICATION :- Use open ended lead lined cones.

9. Black Lines on the radiograph REASON :- Bending of the film prior to it’s placement inside the patient’s mouth. RECTIFICATION :- Avoid bending of the film. Doubled Images on the radiograph REASON :- Film exposed twice to radiation. RECTIFICATION :- Place exposed film in separate labeled compartments.

10. Random artifacts on film REASON :- Contaminants (paper, dust, etc.) will prevent the X-ray from reaching the film RECTIFICATION :- Check and clean screens inside the cassettes for contaminants. Radiopaque artifacts on the radiographs REASON :- Dental appliance in the mouth, presence of foreign bodies in and around the area of radiographed. RECTIFICATION :- Instruct the patient to remove all the removable dental appliances and any other foreign bodies like eye glasses, nose ring, ear ring etc.

11. Black Dot in the apical area . REASON :- Identifying mark on the film placed towards the apical area of the teeth. RECTIFICATION :- Placed the raised dot on the film towards the occlusal surface or the incisal surface of the teeth. Adumbration (Cervical burn out) REASON :- Horizontal angle of the beam is not directed through the contact area of the teeth. RECTIFICATION :- This is relative radiolucency that may be mistaken for cervical caries or root caries.

12. EXPOSURE AND PROCESSING ERRORS High Contrast REASON :- Insufficient penetration RECTIFICATION :- Increase kilo voltage. REASON :- Over development RECTIFICATION :- Use temp. method with a darkroom timer, lower temp. to 70˚ F Light Contrast REASON :- Excessive penetration RECTIFICATION :- Decreased kilo voltage REASON :- Under development RECTIFICATION :- Set darkroom timer correct, rise temp. to 70˚ F REASON :- Scattered radiation RECTIFICATION :- Check diaphragm size and use suitable cone.

13. Reticulation ( Orange Peel Appearance) REASON :- Sudden extreme temp. Changes during processing RECTIFICATION :- Maintain uniform processing temp. REASON :- Weakened fixer solution RECTIFICATION :- Replenish or replace fixer solution Air Bells REASON :- Air bubbles trapped on the film surfaces preventing uniform reduction of the emulsion RECTIFICATION :- Agitate film upon immersions into developer

14. White Spots and Lines on Film REASON :- Grit or dust present on the film or upon the screens RECTIFICATION :- Keep darkroom clean to prevent dust and dirt particles from settling on films Periodically clean the screens with commercial screen cleanser REASON :- Emulsion tear from rough handling of films in processing tanks RECTIFICATION :- Do not rub films up against the sides of tanks or other film hangers REASON :- Film contamination with the fixer before processing RECTIFICATION :- Keep the dark room clean and dry REASON :- Excessive bending of films REASON :- Cracks in the intensifying screens REASON :- Finger contamination, where the contaminant is the fixer REASON :- Films handled roughly while being mounted in the hanger

15. Artifacts on processing 1. Black Crescents REASON :- Rough handling of films RECTIFICATION :- Handle films by edges only 2. Black smudge marks REASON :- Finger prints or finger abrasions RECTIFICATION :- Have dry fingers while handling film 3. Black lines REASON :- Static electricity (naked tree, lightening marks). These are caused by electric discharges that produce no visible light, but occurs on the surface of emulsion. - Rapid movement in removing film from the box. - Film is removed rapidly from the interleaving. - Paper. - Film is touched by the fingers of the person. - Processing the film.

16. Yellow or Brown stains on film REASON :- Exhausted or oxidized or contaminated developer or prolonged development. RECTIFICATION :- Use fresh developing solution and use recommended developing time. REASON :- Insufficient rinsing. RECTIFICATION :- Rinse films for 15-20 sec. in fresh running water Vertical white line on panoramic radiograph REASON :- The push button on the exposure switch is accidently released and then pressed down for the reminder of the excursion, a blank space on the panoramic radiograph will result, as the radiation to film is cut off. RECTIFICATION :- Keep the exposure button properly pressed till the entire exposure cycle is through.

17. Clear film ( Film not exposed) REASON :- Failure to switch on the X-ray machine, electrical failure, malfunction of machine RECTIFICATION :- Ensure that the X-ray machine in working properly. REASON :- Exposed film is first put in the fixing solution RECTIFICATION :- The position of the tank containing the solutions should be fixed, as per the requirement of the darkroom. Black film REASON :- Film exposed to light. RECTIFICATION :- Handling of the exposed or unexposed film should be done carefully

18. Frilling REASON :- Hot processing solution RECTIFICATION :- Maintain proper processing temp. (70˚ F) Emulsion Peel REASON :- Abrasion of image during processing or excessive time in water bath. Grainy Appearance REASON :- Developer solution too warm

19. AUTOMATIC PROCESSING ERRORS Improper drying REASON :- If a drop of water remains on the film and the film dries with that, it produces the stains on the film. RECTIFICATION :- Should be dried well in the specially designed X-ray dryer. Streaking (Uneven density) REASON :- Developer and fixer replenishment low, unclean rinsing water. REASON :- Rollers and crossovers encrusted with chemical deposits. REASON :- Improper chemicals and/or films used. REASON :- Films not hardened properly by chemicals.

20. Increased film density ( overall dark film ) REASON :- Developer temp. too high RECTIFICATION :- Check that the water is not turned off. Check temp. of the incoming water supply and adjust between 75˚ - 80˚ F. Decrease the heat in the developing solution. REASON :- Light leaks in processor cover REASON :- too much replenisher Decreased film density ( overall light film ) REASON :- Low developer temp. , exhausted or contaminated developer , no agitation in developer tank. RECTIFICATION :- Drain and thoroughly clean tank, install new developer. Be sure that the agitator paddle drive belt is in the proper position in the pulley. REASON :- Processing too fast.

21. White cloudy appearance over film surface REASON :- No water in water tank. RECTIFICATION :- Check incoming controls and lines. Drying pattern on film surface REASON :- Dryer too hot. RECTIFICATION :- Reduce dryer temp. REASON :- Characteristic of film. RECTIFICATION :- Process film of the same box through other processor and chemicals to determine consistency of pattern Broad horizontal white line REASON :- Irregularities on the surface of the rollers.

22. Pressure marks REASON :- Foreign material or rough spot on roller RECTIFICATION :- Clean rollers and/ or remove rough area on roller REASON :- Rough handling or excessive hand pressure on film before processing. RECTIFICATION :- Film emulsions are extremely sensitive, after exposure and before the processing. Good habits in gentle handling of film must be practiced

23. MISCELLANEOUS TECHNIQUE ERRORS Phalangioma (Patient’s Finger on the Film) REASON :- The patient’s finger was incorrectly positioned in front of the film instead of behind the film. RECTIFICATION :- Patient should advised to put the finger behind the film.

24. REFERENCES :- FERRY R. KARJODKAR (FIRST EDITION) ANIL GOVINDRAO GHOM (FIRST EDITION) STUART C. WHITE • MICHAEL J. PHAROAH ( FIRST SOUTH ASIA EDITION)

25. THANK YOU