December 2025
In this VETgirl online veterinary continuing education blog, Julia Bitan, RVT breaks down how to evaluate the quality of thoracic and abdominal radiographs. A bit of rotation, missing anatomy, or a missing marker — we’ve all taken images where we could have done a better job! Ensure every thoracic or abdominal radiograph is diagnostic quality by following these quality control steps!

Is My X-ray Shi*e? Identifying Diagnostic Markers

By Julia Bitan, RVT, Founder, Hands-Free X-Rays

A bit of rotation, missing anatomy, or a marker sitting right over the area of interest — we’ve all taken images that made us pause and question whether they’re diagnostic or need to be repeated before showing them to the DVM.

Improving radiographic quality is easier than it seems. Once the most common errors behind a non-diagnostic image are understood, most issues can be corrected before the exposure is taken — resulting in fewer repeats, cleaner images, and reduced radiation for everyone.
Note: This article focuses primarily on thoracic and abdominal views.

Diagnostic Quality Markers

Straightness

A radiograph can be perfectly exposed and well-collimated, but if the patient is rotated, the image becomes misleading or even non-diagnostic. Rotation changes everything — it alters gas patterns, distorts organ size and shape, shifts the heart, and creates asymmetry that isn’t clinically real. This can lead to misinterpretation, delayed diagnoses, and a frustrated DVM.
Assessing and correcting patient rotation before exposure should always be the first step in ensuring proper alignment. Following this, evaluating straightness using the appropriate post-exposure markers helps confirm that the final image is non-rotated and diagnostic.

Collimation

Collimation is one of the simplest yet most powerful ways to improve radiographic quality. By tightening the X-ray beam to include only the anatomy that truly needs to be imaged, scatter radiation is reduced, contrast is sharpened, and soft-tissue detail becomes much easier to interpret. Good collimation isn’t about aesthetics — it directly impacts diagnostic accuracy. A well-collimated image has less fog, clearer borders, and better visibility of subtle pathology.
Collimation also protects staff by minimizing unnecessary exposure. A wide-open beam (poor or no collimation) produces more scatter, which not only exposes personnel but also degrades image quality. Improving collimation is one of the fastest, easiest habits to fix, and it immediately elevates the clarity, safety, and overall quality of the image.

Inclusion

One of the biggest factors in image quality is simply making sure all the required anatomy is there. A straight, properly exposed radiograph loses its value if part of the target anatomy is missing. Even small omissions can conceal important findings and can alter patient diagnosis.
Good inclusion starts before the exposure: understanding which landmarks must be included, centering accurately, and adjusting the detector to fit the patient rather than relying on guesswork. When the anatomy is deliberately and correctly framed, radiographs are complete, more diagnostic, and less likely to require retakes.

Settings

Selecting the correct exposure settings is essential for a diagnostic radiograph. Incorrect settings can hide lesions, reduce soft-tissue detail, and make the thorax or abdomen difficult to interpret.

Thoracic views generally need higher kVp and lower mAs, while abdominal views benefit from lower kVp and higher mAs for better contrast. Using a proper technique chart and measuring patient thickness helps ensure consistent, high-quality images with fewer repeats.
While digital systems are far more forgiving than film and can correct small exposure mistakes, they aren’t magic. Overreliance on post-processing can still lead to noise, poor contrast, and missed pathology. A good technique chart is important.

Human Anatomy

Figure 1. Canine radiograph with human anatomy exposure. (Image courtesy of Julia Bitan)

Human anatomy should never appear in a radiograph. Lead gloves and other PPE only protect against scatter — they do not stop the primary beam. If a hand or arm is inside the beam, that is direct radiation exposure.

“These kitten legs are just too small to hold with these bulky gloves” – we’ve all been there. But now there are safe, hands-free options for exactly those situations. Elastic extremity straps, sock sandbags, and other positioning aids make restraining small patients easier and far safer than slipping off a glove and using bare hands.

Poor professionalism, such as visible hands, fingers, or arms, instantly signal poor technique and rushed positioning. It reflects badly on the clinic and on the team member who took the image.

Many regions are also restricted by a regulatory component, intentionally exposing any part of a person to the primary beam is considered non-compliant with required radiation-safety practices. These standards are built around ALARA (As Low As Reasonably Achievable), meaning all preventable exposure must be avoided — especially direct exposure.

If manual restraint is absolutely necessary, all available lead PPE must be worn, and all staff body parts kept away from the primary beam. Whenever possible, hands-free positioning techniques should be used instead. It reduces exposure to staff, improves image quality and maintains regulatory compliance.

Hands-Free Positioning

Hands-free positioning is one of the more effective ways to improve radiographic quality while protecting staff from unnecessary radiation. Using appropriate positioning aids—such as loose-weighted sandbags, foam wedges, foam v-troughs, and elastic extremity straps—provides patient comfort, straightness, and stability.

Quick Reference Guide for the Thorax

Lateral Thoracic (R/L) Radiographs

Ventrodorsal (VD) Thoracic Radiographs


Dorsoventral (DV) Thoracic Radiographs


Quick Reference Guide for Abdomen Radiographs

Lateral Abdominal Radiographs

Ventrodorsal (VD) Abdominal Radiographs

Summary

Most non-diagnostic x-rays are preventable. Straightness, inclusion, collimation, and technique fix most issues before exposure. Add hands-free positioning, and the result is consistent, clean, diagnostic images with fewer repeats.
Please note the opinions in this blog are the expressed opinion of the author, and not directly endorsed by VETgirl.

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