IMAGE 1:

INCORRECT DENSITY (AN IMAGE OF HIGH DENSITY)

RADIOGRAPHIC CRITIQUE OF KUB RADIOGRAPH
WITH HIGH DENSITY

PROJECTION
This is a radiograph of a kidney, ureter and bladder (KUB)
projection of the abdomen.
I say so because:
1. The eleventh thoracic vertebra, lumbar vertebra, iliac crest,
pelvic brim and symphysis pubis are included in the
radiograph.
2. Spinous processes aligned with midline of vertebral bodies
and long axis of collimated field.
3. The forth lumbar (L4) is at the center of collimation field.
POSITIONING
The positioning for this projection is correct:
This is because,
1. The distance from the pedicles to the spinous processes is
the same on the both side.
2. Spinous processes are aligned with the midline of the
vertebral bodies and long axis of the vertebral bodies is
aligned with the long axis of the collimated field.
3. The sacrum is centered within the inlet of pelvis and is
aligned with the symphysis pubis.
ALIGNMENT
There are 3 components for alignments:
1. X-ray tube and cassette

The alignment between x-ray tube and cassette is incorrect

because the collimation on the right side is 1.5cm larger than the
left side.
2. Patient / structure and cassette
The alignment between patient and cassette is incorrect because
each distance from the borders of the cassette to the central
structure are not equal and larger on the left side compared to the
right side.
3. X-ray tube and patient / structure
The alignment between the x-ray tube and the patient is
incorrect because each distance from the edges of collimation to
the central structure are not equal and larger on the left side
compared to the right side.

COLLIMATION / RADIATION PROTECTION

Collimation should be done to all four borders of the film and
should include:
At the superior borders, spinous process of T11, both kidneys
At both lateral borders, both lateral abdominal soft tissues,
both iliac crest
At the inferior border, both pelvic brim, pelvic inlet and
symphysis pubis.
There is evidence of radiation protection apparatus seen on the
radiograph which is collimation.

EXPOSURE FACTORS
The kVp used is adequate for penetration and radiographic
contrast.
This is because the bony cortical outline of the thin structure
which is the ilium and psoas muscle can be seen. And the bony

cortical outline of the thick structure which is the head of

femur and sacrum can also be seen.

The mAs used is too much for detail and density.

This is because the bony trabecular pattern of the thin
structure which is the ilium cannot be seen. And the bony
trabecular pattern of the thick structure which is the head of
femur and sacrum can be seen.
Explaination:
Radiographic density (AKA optical, photographic, or film
density) is a measure of the degree of film darkening. It is the
degree of overall blackening from the black metallic silver
deposited in the emulsion. Density is determined by exposure,
exposure is directly proportional to mAs, mAs is used as the
primary controller of radiographic density. mA (tube current )
(number of electrons and quantity of x-rays produced) mA does not
affect
quality
of
x-rays
produced.
The original exposure factors used were too much
(overexposed) . This mean that patient body thickness (tissue) are
less. The bony trabecular pattern of the thin structure which is the
ilium is not visualised compared to the bony trabecular pattern of
the thick structure which is head of femur which can be visualised.
The radiograph demonstrates an excessive radiographic density
(mAs). When a radiograph is overexposed (too much mAs used) it
demonstrated density that is so dark , the bony trabecular pattern
and soft tissue structures of interest are not well visualised. When
the image is too dark, it mean that too many photons had fallen
onto the emulsion, producing high degree of blackening, which
could mean too much information recorded.The physician may
misdiagnosed the radiograph as the thin structure cannot be seen
clearly in the radiograph.

Correction:
Changing the number of photons produced will affect the
blackness of the film but will not affect the film contrast. Methods
used to derive the correct exposure factors: Since this radiograph
is overexposed, as the bony trabecular pattern of the thin structure
is not visualized while the bony trabecular pattern of the thick
structure is visualized in this radiograph, we need to decrease the
opacity by 2 times. To accomplish that, we need to reduce the mAs
by half (50%). Decreasing mAs by half will decrease opacity by two
times.
Density is determined by the amount of silver deposition in
the emulsion. kVp is one of the influencing factor which may alters
the intensity of x-ray beam reaching the film. Increasing the kVp
increases the penetration power of the x-ray beam, hence more xray photons will reach the image receptor. As such, quantity of xray beam will vary significantly with changes in kilovoltage. Hence
when a contrast change is desirable , the 15% rule is a useful
method to maintain density. When only a density change is
desired, (as in this radiograph) the 15% rule should not be used.
The actual exposure factors used is 72 kVp, 44 mAs.
The corrected exposure factors is 72 kVp, 22 mAs.

MARKERS
There is evidence of an anatomical marker shown in the
radiograph, correctly placed on the right, inferior side of the body
and placed appropriately not superimposing any region of interest.

AESTHETIC
1) The film size used 35cm x 43cm which is sufficient to
demonstrate all structures of interest.
2) There is evidence of artifact on the radiograph which
probably the storage artifact.

NAME
The patients name and ID, date of examination, place of
examination are clearly visualized on the radiograph at the
appropriate area, and not superimposed with structures of interest.

DIAGNOSTIC ACCEPTABILITY/ CONCLUSION

The radiograph is unacceptable, because the radiograph is
overexposed and is too dark. The physician will not be able to see
the thin structure which may have pathology to be diagnosed. To
obtain a better image quality, this image should be repeated.