Over exposure artifact
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Loss of bony detail in the first projection due to overexposure.
The second image shows the same patient, with an adjusted exposure.
The first projection (swimmers lateral) often requires high exposures to penetrate through large quantities of soft tissue, in this case, an exposure of 80 kVp over 80 mAs (EI 2611) has resulted in an oversaturated (overly dark) 'burnt out image'. If one cannot window the soft tissue and boney detail into focus, overexposure should be considered before concluding anything more sinister. The radiographer should be consulted for further clarification.
In the case of swimmers lateral projections, a filter can alleviate over penetration of lower density areas.
In comparison, the second image has a KVP of 80, mAs of 32, and a relative exposure of 145.
The case made with the help of Dr Jayanth Keshavamurthy, Medical College of Georgia, Augusta.