Presentation
Screening chest x-ray
Patient Data
While the laterolateral radiograph appears to be of sufficient quality, the lung zones are lacking contrast due to overexposure in the PA x-ray - highly suggestive of a kV or mAs error. The DICOM header of the exams contains these pieces of information, which in this case revealed that the kV (120) was appropriate, however, the PA radiograph was also inappropriately taken with a preset designed LL ones, resulting in overexposure due to the higher mAs setting of the latter. For comparison the mAs of the PA radiograph was 6.5 while, a the previous similar x-ray was obtained with a much lower value (2 mAs)
Case Discussion
Profound over or underexposure is much more rare in the era of digital radiography, but even with automated exposure control it can occur, if the presets designed for a different exam are accidentally used. If such error is suspected while reading and exam, the DICOM header can often provide a clue, and reveal the culprit behind the problem
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