Troubleshooting Poor-Quality Images in Radiography: A Practical Guide

Radiographic imaging is a blend of technology, technique, and patient cooperation. But even with the best equipment and intentions, poor-quality images can and do happen. Whether it’s a blurry X-ray, an overexposed chest film, or a noisy digital scan, poor image quality can compromise diagnosis, delay treatment, and result in unnecessary repeat exposures.

As a radiographer, your ability to troubleshoot and correct poor image quality on the spot is not just helpful—it’s essential. In this article, we’ll explore common causes of suboptimal images and provide a step-by-step guide to diagnosing and resolving them.

🔍 Why Image Quality Matters

A diagnostic-quality image is one that clearly shows the anatomy of interest with appropriate sharpness, contrast, and density—free from significant artifacts or errors. When quality drops, so does clinical confidence.

Poor-quality images may lead to:

• Missed or incorrect diagnoses
• Additional radiation exposure from repeat exams
• Frustration for patients and staff
• Longer workflows and increased costs

The goal of troubleshooting is to identify what went wrong, fix it, and learn how to prevent it from happening again.

🛠️ Common Image Quality Problems and How to Fix Them

1. Blurry or Unsharp Image

Symptoms: Edges are not well defined; anatomy appears smeared.

Possible Causes:

• Patient motion during exposure
• Tube or cassette movement
• Long exposure time
• Large focal spot size
• Improper SID/OID ratio

Troubleshooting Tips:

• Ensure patient is comfortable and immobilized if needed.
• Use the shortest exposure time possible.
• Check for mechanical vibrations.
• Switch to a smaller focal spot if the situation allows.
• Optimize SID and reduce OID.

2. Underexposed Image (Too Light)

Symptoms: Image appears washed out; insufficient black areas; poor contrast.

Possible Causes:

• Low mAs or kVp
• Incorrect AEC (automatic exposure control) selection
• Improper detector positioning
• Excessive patient thickness without compensation

Troubleshooting Tips:

• Increase mAs or adjust kVp appropriately.
• Recheck AEC chamber alignment and settings.
• Ensure proper detector centering and collimation.
• Use technique charts to match exposure to body part thickness.

3. Overexposed Image (Too Dark)

Symptoms: Structures are overly black; details may be lost.

Possible Causes:

• High mAs or kVp settings
• Wrong AEC selection or failure to terminate exposure
• Delayed processing in film systems

Troubleshooting Tips:

• Adjust exposure settings based on patient size.
• Verify correct AEC chamber and exposure termination.
• For digital systems, remember that the image may look acceptable but still involve unnecessary dose—always review exposure indicators.

4. Excessive Noise or Graininess

Symptoms: Image appears mottled; lacks smooth density gradients.

Possible Causes:

• Inadequate mAs (quantum mottle)
• Low signal-to-noise ratio
• Improper processing or compression artifacts (digital systems)

Troubleshooting Tips:

• Increase mAs to provide more photons.
• Avoid excessive reliance on digital post-processing to "fix" underexposed images.
• Check detector and processing settings.

5. Poor Contrast

Symptoms: Difficult to distinguish between different tissues; image looks flat.

Possible Causes:

• kVp too high (produces low contrast)
• Inadequate beam collimation (increased scatter)
• Lack of a grid for thicker parts
• Improper window/level settings in digital imaging

Troubleshooting Tips:

• Reduce kVp for higher contrast (as appropriate for the body part).
• Use proper collimation and consider adding a grid.
• Adjust window and level to enhance contrast without losing data.

6. Artifacts Present

Symptoms: Unusual lines, shadows, or marks that don’t belong to the anatomy.

Possible Causes:

• Jewelry or clothing left on the patient
• Dirty imaging plate or cassette
• Detector malfunction or calibration issue
• Residual image from previous exposure (ghosting)

Troubleshooting Tips:

• Have the patient remove all external objects.
• Clean imaging equipment regularly.
• Recalibrate or service faulty detectors.
• Ensure imaging plates are erased properly before reuse.

7. Incorrect Anatomy or Positioning

Symptoms: Wrong body part captured; poor visibility of key structures.

Possible Causes:

• Miscommunication about the exam requested
• Poor patient positioning or centering
• Inadequate collimation

Troubleshooting Tips:

• Double-check the requisition and patient identity.
• Review positioning guides and practice techniques.
• Center the anatomy properly and use anatomical landmarks.

🧰 A Radiographer’s Troubleshooting Checklist

1. Patient factors: Motion? Correct positioning?
2. Exposure settings: mAs, kVp, AEC chamber?
3. Distance and alignment: SID, OID, CR alignment?
4. Image processing: Are digital settings optimal?
5. Artifacts: Any external objects or equipment issues?
6. Detector condition: Clean, calibrated, functioning?

👩⚕️ Pro Tips for Consistently Good Images

• Communicate clearly: Patients who understand the process cooperate better.
• Know your equipment: Learn the quirks and settings of your imaging system.
• Practice positioning: It’s an art and a science.
• Use exposure charts: Don't rely on memory—charts ensure consistency.
• Check every image before release: Catch problems before they leave your hands.

📌 Final Thoughts

Producing high-quality radiographic images is about more than pressing a button—it’s about skill, awareness, and attention to detail. By knowing how to identify and correct common image problems, you not only save time and reduce repeat exposures, but also ensure your patients receive the safest and most accurate care possible.

Remember: A great radiographer doesn't just take images—they craft them with purpose and precision.