Taking the Perfect Radiograph: Troubleshooting Common Errors & Artifacts

Author: Adam Yoskowitz, VMD, DACVR

Radiography is a powerful and readily available diagnostic tool that is often used as part of a work up or as a screening test. The conversion to digital radiography and accessibility of teleradiology have greatly improved the ease of use and the time needed to acquire images and get expert advice when needed. Even though acquisition is much easier with digital systems, errors in radiographic technique can lead to poor image quality, making diagnosis difficult or even leading to misinterpretation. Understanding the most common errors and their solutions helps ensure accurate imaging and effective patient care. Here are some of the most common errors and artifacts I encounter, and how to fix them or avoid them all together.
 

Taking the perfect radiograph: troubleshooting common errors and artifacts

Radiography is a powerful and readily available diagnostic tool that is often used as part of a work up or as a screening test. The conversion to digital radiography and accessibility of teleradiology have greatly improved the ease of use and the time needed to acquire images and get expert advice when needed. Even though acquisition is much easier with digital systems, errors in radiographic technique can lead to poor image quality, making diagnosis difficult or even leading to misinterpretation. Understanding the most common errors and their solutions helps ensure accurate imaging and effective patient care. Here are some of the most common errors and artifacts I encounter, and how to fix them or avoid them all together.
 

Poor Patient Positioning:

One of the most frequent mistakes in veterinary radiography is incorrect patient positioning. Improper positioning can lead to overlapping structures, misalignment, or distortion, making it difficult to assess abnormalities accurately. This is particularly common in thoracic and abdominal radiographs, where incorrect positioning can obscure key structures like the heart, lungs, or intestines.
 

Correction:

The most important way to optimize positioning is to ensure appropriate education, training, and support for the team members acquiring the images. I recommend providing access to positioning guides and resources in the X-ray room itself (sometimes even posted on the walls). To aid in appropriate positioning I recommend having access to positioning aids such as foam pads, sandbags, tape, and sedation when indicated, to keep the patient in the correct alignment. Above all, the most critical positioning aid is real-time feedback and open communication, which is the best way to help team members learn how to take perfect images every time.
 

Inappropriate Collimation/ Field of View:

Tight collimation improves both spatial and contrast resolution, resulting in crisp images focused on the region of interest. The wider the field of collimation the less detailed the image will be. This is why it is important to center your field of view on the anatomy you are interested in. The more anatomy you try to cover in one image, the less optimized it will be.
 

Correction:

plan ahead and select a field of collimation that contains only the body region of interest and minimizes dead space. Sometimes splitting a study into multiple tightly collimated images is better than trying to squeeze multiple body parts into a single image. For example, dedicated thoracic radiographs will always have better detail and resolution than wider field of view thoracoabdominal /whole body studies.
 

Motion Blur:

Motion blur occurs when the patient moves during the exposure, leading to a blurry image that lacks sharpness. This can happen due to voluntary movement, breathing, or even tremors in nervous or painful animals. Motion blur makes it difficult to distinguish fine details, reducing the diagnostic value of the radiograph.
 

Correction:

Images that have motion blur should be repeated. Using appropriate restraint techniques, sedation, or even anesthesia can help minimize movement, especially in anxious or uncooperative patients. Additionally, selecting the shortest possible exposure time (low mAs, high kVp settings) reduces the risk of motion artifacts while maintaining image quality. This is one of the reasons most technique charts have lower mAs for thoracic protocols compared to abdominal protocols.
 

Incorrect Exposure Settings:

Choosing the wrong exposure settings—kVp (kilovolt peak) and mAs (milliampere-seconds)—can result in images that are too dark (overexposed) or too light (underexposed). Overexposure may cause loss of detail or “clipping” of soft tissues, while underexposure can make structures difficult to differentiate. Digital images have a wide exposure latitude meaning that you can mildly over or under expose the image, and you can still get a useful image. If the over or under exposure is bad enough to recognize, the image should be re-acquired.
 

Correction:

Refer to the technique chart provided by the manufacturer of the system. Technique charts may be weight or thickness based. Several digital systems have a built-in technique chart. Make sure that the chart you are using is for the correct weight/thickness and body part you are acquiring an image of.