Shape distortion in radiography comes from the geometry of the setup. It happens when the X-ray tube, the part of the patient you’re imaging, and the image receptor are not aligned or are angulated relative to each other. The X-ray beam diverges, so tilting the tube, rotating or misaligning the anatomy, or tilting the image receptor changes how the structures are projected onto the image plane. This causes the shapes to appear stretched or foreshortened, even if the structure’s size is the same. To minimize distortion, aim for the central ray to be perpendicular to both the image receptor and the anatomy and position the patient so the anatomy is in the intended plane. Exposure index and detector type affect exposure and image capture quality, not the geometric projection that creates distortion. So the key factors are the X-ray tube, the anatomy being imaged, and the image receptor.