Quality Assurance in Mammography: Artifact Analysis
Jacquelyn P. Hogge, MD1,
Carolyn H. Palmer, RTR(M)1,
Caroline C. Muller, RTR(M)1,
Sherrill T. Little, MD1,
Deborah C. Smith, RTR(M)2,
Panos P. Fatouros, PhD1 and
Ellen Shaw de Paredes, MD1
1 Department of Radiology, Medical College of Virginia of Virginia Commonwealth University, 1101 E Marshall St, Box 980615, Richmond, VA 23298 (J.P.H., C.P., C.M., S.T.L., P.F., E.S.D.)
2 Department of Radiology, University of Virginia Medical Center, Charlottesville, Va (D.S.)
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Figure 1a. Static artifact. This artifact may have a "ladybug" (a) or dramatic lightning-like (b) appearance.
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Figure 1b. Static artifact. This artifact may have a "ladybug" (a) or dramatic lightning-like (b) appearance.
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Figure 2a. Processor-related plus-density (dark) linear artifacts include entrance roller marks (a) and artifacts caused by inadequate film washing due to improper spring tension in the wash transporter rack (b). Arrows indicate direction of film travel.
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Figure 2b. Processor-related plus-density (dark) linear artifacts include entrance roller marks (a) and artifacts caused by inadequate film washing due to improper spring tension in the wash transporter rack (b). Arrows indicate direction of film travel.
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Figure 3. Wet roller or surface drying marks. This wide, irregular and blotchy linear artifact (arrowheads) may be due to a variety of causes (arrow indicates direction of film travel).
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Figure 4a. Water spots with clumping of silver halide granules (arrow).
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Figure 4b. Water spots with clumping of silver halide granules (arrow).
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Figure 5. Figures 5, 6. (5) Severe emulsion "pick-off" artifact caused by dirty rollers. (6) Scratches (black arrows) caused by misaligned guide shoes (white arrow indicates direction of film travel).
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Figure 6. Figures 5, 6. (5) Severe emulsion "pick-off" artifact caused by dirty rollers. (6) Scratches (black arrows) caused by misaligned guide shoes (white arrow indicates direction of film travel).
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Figure 7. Figures 7–9. (7) Fading and brownish discoloration caused by improper developer fixation. (8) Plus-density linear artifacts resulting from power failure. (9) Plus-density linear artifacts and film mottle caused by contaminated developer.
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Figure 8. Figures 7–9. (7) Fading and brownish discoloration caused by improper developer fixation. (8) Plus-density linear artifacts resulting from power failure. (9) Plus-density linear artifacts and film mottle caused by contaminated developer.
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Figure 9. Figures 7–9. (7) Fading and brownish discoloration caused by improper developer fixation. (8) Plus-density linear artifacts resulting from power failure. (9) Plus-density linear artifacts and film mottle caused by contaminated developer.
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Figure 10a. Fingerprints left prior to exposure (arrows in a) and after exposure (b).
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Figure 10b. Fingerprints left prior to exposure (arrows in a) and after exposure (b).
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Figure 11a. Fingertip pressure artifact. (a) Craniocaudal mammogram of the medial left breast shows an ill-defined, oval nodular density in the subcutaneous tissues (arrow). The artifact was seen only on this view; spot compression mammograms of this area (not shown) were negative. (b) Repeat craniocaudal mammogram of the left breast shows no abnormality.
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Figure 11b. Fingertip pressure artifact. (a) Craniocaudal mammogram of the medial left breast shows an ill-defined, oval nodular density in the subcutaneous tissues (arrow). The artifact was seen only on this view; spot compression mammograms of this area (not shown) were negative. (b) Repeat craniocaudal mammogram of the left breast shows no abnormality.
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Figure 12. Pressure artifacts caused by improper film storage. Curvilinear minus-density artifacts (arrows) appeared in the same location on every film from the same box.
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Figure 13a. Poor screen-film contact caused by air trapped between the film and the intensifying screen (arrows in a), improper seating of the film in the cassette (arrowheads in b), and lint (c).
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Figure 13b. Poor screen-film contact caused by air trapped between the film and the intensifying screen (arrows in a), improper seating of the film in the cassette (arrowheads in b), and lint (c).
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Figure 13c. Poor screen-film contact caused by air trapped between the film and the intensifying screen (arrows in a), improper seating of the film in the cassette (arrowheads in b), and lint (c).
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Figure 14a. Artifacts caused by dirty screens. (a) Minus-density linear artifact caused by fingernail polish on the intensifying screen. (b) Dust artifact simulating microcalcifications (arrows).
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Figure 14b. Artifacts caused by dirty screens. (a) Minus-density linear artifact caused by fingernail polish on the intensifying screen. (b) Dust artifact simulating microcalcifications (arrows).
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Figure 15a. Underexposure caused by improper loading of film into the cassette. The films in a and b were exposed with the same technique (112 mAs, 25 kVp); however, the film in a was correctly loaded with the emulsion side in contact with the intensifying screen, whereas the film in b was incorrectly loaded and is underexposed.
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Figure 15b. Underexposure caused by improper loading of film into the cassette. The films in a and b were exposed with the same technique (112 mAs, 25 kVp); however, the film in a was correctly loaded with the emulsion side in contact with the intensifying screen, whereas the film in b was incorrectly loaded and is underexposed.
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Figure 16. Figures 16–18. (16) Grossly underexposed silhouette of the breast caused by accidental loading of two films into the cassette. (17) Artifact caused by improperly loaded film. The film became folded upon itself when it was loaded, resulting in a nonexposed area ("cutoff"), poor screen-film contact, and a linear crease. (18) Artifact caused by improperly loaded film. An irregular light leak (arrows) was produced when the edge of the film was closed in the cassette hinge during loading.
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Figure 17. Figures 16–18. (16) Grossly underexposed silhouette of the breast caused by accidental loading of two films into the cassette. (17) Artifact caused by improperly loaded film. The film became folded upon itself when it was loaded, resulting in a nonexposed area ("cutoff"), poor screen-film contact, and a linear crease. (18) Artifact caused by improperly loaded film. An irregular light leak (arrows) was produced when the edge of the film was closed in the cassette hinge during loading.
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Figure 18. Figures 16–18. (16) Grossly underexposed silhouette of the breast caused by accidental loading of two films into the cassette. (17) Artifact caused by improperly loaded film. The film became folded upon itself when it was loaded, resulting in a nonexposed area ("cutoff"), poor screen-film contact, and a linear crease. (18) Artifact caused by improperly loaded film. An irregular light leak (arrows) was produced when the edge of the film was closed in the cassette hinge during loading.
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Figure 19. Artifact caused by improper loading of film into a cassette that was still damp from cleaning. Bizarre clumping of silver halide granules and corresponding areas of white pick-off artifact are seen (arrows).
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Figure 20a. Figures 20, 21. (20) Artifact resulting from failure to use a grid. The film in a was exposed with use of a proper grid, whereas the film in b was exposed without the grid in place. Note the degradation of contrast due to increased scatter in b. (21) Double exposure. This error requires that both images be repeated. Many of the new mammography units have built-in safeguard mechanisms to prevent such an error.
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Figure 20b. Figures 20, 21. (20) Artifact resulting from failure to use a grid. The film in a was exposed with use of a proper grid, whereas the film in b was exposed without the grid in place. Note the degradation of contrast due to increased scatter in b. (21) Double exposure. This error requires that both images be repeated. Many of the new mammography units have built-in safeguard mechanisms to prevent such an error.
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Figure 21. Figures 20, 21. (20) Artifact resulting from failure to use a grid. The film in a was exposed with use of a proper grid, whereas the film in b was exposed without the grid in place. Note the degradation of contrast due to increased scatter in b. (21) Double exposure. This error requires that both images be repeated. Many of the new mammography units have built-in safeguard mechanisms to prevent such an error.
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Figure 22. Figures 22, 23. (22) Artifact caused by improper (upside-down) loading of the cassette into the Bucky tray. The internal structure of the cassette is superimposed on the image. (23) Artifact caused by improper (front-back reversed) loading of the cassette into the Bucky tray. The identification flash is superimposed over breast tissue.
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Figure 23. Figures 22, 23. (22) Artifact caused by improper (upside-down) loading of the cassette into the Bucky tray. The internal structure of the cassette is superimposed on the image. (23) Artifact caused by improper (front-back reversed) loading of the cassette into the Bucky tray. The identification flash is superimposed over breast tissue.
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Figure 24. Artifact caused by running films too close together through the processor. The two films were ruined when they became completely overlapped and stuck together.
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Figure 25. Film fog artifact (arrows) caused when the technologist briefly turned on the darkroom overhead light before the film had entered the processor completely.
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Figure 26. Figures 26–29. (26) Light leak artifact (arrow) caused by a cracked cassette frame. (27) Unusual light leak artifact (arrows) caused by the cassette being incompletely latched before it was brought out of the darkroom. (28) Film fog artifact (arrows) on a test strip caused by fluorescent fingernail polish worn by the technologist. (29) Film fog artifact caused by a fluorescent bandage worn by the technologist. Note the word "RAD" exposed on the phantom image.
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Figure 27. Figures 26–29. (26) Light leak artifact (arrow) caused by a cracked cassette frame. (27) Unusual light leak artifact (arrows) caused by the cassette being incompletely latched before it was brought out of the darkroom. (28) Film fog artifact (arrows) on a test strip caused by fluorescent fingernail polish worn by the technologist. (29) Film fog artifact caused by a fluorescent bandage worn by the technologist. Note the word "RAD" exposed on the phantom image.
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Figure 28. Figures 26–29. (26) Light leak artifact (arrow) caused by a cracked cassette frame. (27) Unusual light leak artifact (arrows) caused by the cassette being incompletely latched before it was brought out of the darkroom. (28) Film fog artifact (arrows) on a test strip caused by fluorescent fingernail polish worn by the technologist. (29) Film fog artifact caused by a fluorescent bandage worn by the technologist. Note the word "RAD" exposed on the phantom image.
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Figure 29. Figures 26–29. (26) Light leak artifact (arrow) caused by a cracked cassette frame. (27) Unusual light leak artifact (arrows) caused by the cassette being incompletely latched before it was brought out of the darkroom. (28) Film fog artifact (arrows) on a test strip caused by fluorescent fingernail polish worn by the technologist. (29) Film fog artifact caused by a fluorescent bandage worn by the technologist. Note the word "RAD" exposed on the phantom image.
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Figure 30. Large, well-circumscribed oval artifact resulting from failure of the collimation mirror to rotate out of the path of the x-ray beam during exposure.
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Figure 31. Figures 31, 32. (31) Inhomogeneous white and black lines owing to failure of the reciprocating grid to move. (32) Faint regular grid lines caused by an unusually short exposure. March-April 1999 Hogge et alnRadioGraphicsn
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Figure 32. Figures 31, 32. (31) Inhomogeneous white and black lines owing to failure of the reciprocating grid to move. (32) Faint regular grid lines caused by an unusually short exposure. March-April 1999 Hogge et alnRadioGraphicsn
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Figure 33. Artifact caused by an improperly aligned compression paddle. Improper alignment of the compression paddle with the Bucky tray causes the posterior lip of the paddle to be superimposed on the mammogram, creating a linear area of cutoff (arrows). This situation may also be caused by a compression paddle that is either broken or too flexible, and bends with compression.
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Figure 34. Deodorant artifact (arrows).
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Figure 35. Figures 35, 36. (35) Powder artifacts. The patient presented with new bilateral "calcification clusters" for which she had been encouraged to undergo biopsy at another institution, although no magnification views had been obtained. On magnification views obtained at our institution, the "calcifications" proved to be powder artifacts (arrows). (36) Artifact caused by ointment (arrows).
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Figure 36. Figures 35, 36. (35) Powder artifacts. The patient presented with new bilateral "calcification clusters" for which she had been encouraged to undergo biopsy at another institution, although no magnification views had been obtained. On magnification views obtained at our institution, the "calcifications" proved to be powder artifacts (arrows). (36) Artifact caused by ointment (arrows).
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Figure 37. Artifact caused by a pharmaceutical patch (arrowheads). Note the bubble of air trapped under the patch.
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Figure 38. Severe motion artifact. Repeat mammography was performed because calcifications and masses would have been obscured.
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Figure 39. Figures 39–41. (39) Artifact caused by superimposition of the patient's opposite breast and clothing. (40) Artifact caused by superimposition of the patient's nose. (41) Artifact caused by superimposition of the patient's fingers.
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Figure 40. Figures 39–41. (39) Artifact caused by superimposition of the patient's opposite breast and clothing. (40) Artifact caused by superimposition of the patient's nose. (41) Artifact caused by superimposition of the patient's fingers.
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Figure 41. Figures 39–41. (39) Artifact caused by superimposition of the patient's opposite breast and clothing. (40) Artifact caused by superimposition of the patient's nose. (41) Artifact caused by superimposition of the patient's fingers.
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Figure 42a. Hair artifact. (a) Curvilinear white lines (arrowheads). (b) Tiny minus-density artifacts (arrowheads) simulating microcalcifications posteriorly on craniocaudal mammograms. The tip of a hair braid was responsible for this artifact.
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Figure 42b. Hair artifact. (a) Curvilinear white lines (arrowheads). (b) Tiny minus-density artifacts (arrowheads) simulating microcalcifications posteriorly on craniocaudal mammograms. The tip of a hair braid was responsible for this artifact.
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Figure 43. Figures 43, 44. (43) Artifact caused by clothing (arrowheads) simulates a ruptured saline breast implant. (44) Artifact caused by a pacemaker.
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Figure 44. Figures 43, 44. (43) Artifact caused by clothing (arrowheads) simulates a ruptured saline breast implant. (44) Artifact caused by a pacemaker.
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Figure 45. Figures 45, 46. (45) Artifact caused by a retained Dacron cuff from a Hickman catheter (marked with a metallic BB). The patient presented with a palpable lump that represented the cuff from a previously removed catheter. (46) Artifact caused by bilateral axillary-femoral grafts.
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Figure 46. Figures 45, 46. (45) Artifact caused by a retained Dacron cuff from a Hickman catheter (marked with a metallic BB). The patient presented with a palpable lump that represented the cuff from a previously removed catheter. (46) Artifact caused by bilateral axillary-femoral grafts.
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Figure 47. Artifact caused by a fishhook.
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Figure 48. Figures 48–50. (48) Artifact caused by residual silicone from previous implant rupture (arrow). (49) Artifact caused by metallic fragments from a gunshot wound (arrows). (50) Artifact caused by lymphatic intravasation of dye used in creating a tattoo (arrows). The tattoo itself was not visible mammographically.
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Figure 49. Figures 48–50. (48) Artifact caused by residual silicone from previous implant rupture (arrow). (49) Artifact caused by metallic fragments from a gunshot wound (arrows). (50) Artifact caused by lymphatic intravasation of dye used in creating a tattoo (arrows). The tattoo itself was not visible mammographically.
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Figure 50. Figures 48–50. (48) Artifact caused by residual silicone from previous implant rupture (arrow). (49) Artifact caused by metallic fragments from a gunshot wound (arrows). (50) Artifact caused by lymphatic intravasation of dye used in creating a tattoo (arrows). The tattoo itself was not visible mammographically.
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Copyright © 1999 by the Radiological Society of North America.
