Mandatory Medico-legal considerations;
- Does it match the request card?
- Is there enough information there to uniquely identify this patient?
- Has it been removed for confidentiality purposes?
- Is an anatomical marker clearly visible?
- Is the anatomical marker correct?
- Is the anatomical marker in the primary or secondary beam, or has it been added?
- Does this raise any issues?
- Does the marker match the request e.g. has the correct limb been imaged etc
- Are there any legends?
- If so, what do these legends tell you?
- are you looking for fluid levels,
- was the patient in extreme pain, very ill,
- does the choice of projection affect the image appearances?
Area of interest
- What should be included superiorly, inferiorly, medially and laterally?
- Is the correct anatomy visible on the image? How do you know?
- What is the correct centring point?
- How can you assess whether the correct centring point has been selected?
Is the collimation adequate?
- Is it over- or under- collimated?
- How do you assess this?
- Have all the relevant anatomical features been shown?
Why do we collimate?
- What about patient dose?
- Effect on image quality?
Is the patient positioned correctly?
- How do you know?
Are there any other considerations that you should make?
- e.g. position of the neck of femur on an AP pelvis projection,
- position of scapulae on a PA chest image etc.
Radiographic image quality
- How much bony detail do you expect to see and where?
- How much soft-tissue detail to you expect to see and where?
- Is there sufficient contrast to demonstrate differences between tissue densities in respect to the body part being imaged? What evidence is there to support your answer?
- Is there sufficient brightness on the image? How can you tell? What evidence is there to support your answer?
- Does the image need manipulating?
- What informs the practitioner that the detector has received sufficient exposure to manipulate the image? What indicative signs are there that a detector has received too much or too little? Are these evident on the image? If so, do they interfere with your image evaluation?
- Is there any evidence of voluntary movement unsharpness on the image?
- Is there any evidence of involuntary movement unsharpness on the image?
For every image that you undertake you should be able to:
- Name all the bones that are visible on the image
- Name regions of those bones
- Name the joints that are visible on the image
- Name soft tissue structures that are visible on the image
- Describe any identified abnormalities using appropriate medical terminology
- Are there any unavoidable artefacts on the image?
- Are there any avoidable artefacts on the image?
- Are these artefacts obscuring important anatomy?
Overall diagnostic quality
Need for further projections / repeat images
- Is there the suggestion of a pathology / abnormality that would only be adequately identified if an additional, supplementary projection was taken?
- Is the image undiagnostic e.g. due to inadequate positioning, collimation, exposure, artefacts etc and needs to be repeated?
- Is the image sufficient to answer the clinical question raised by the request?
Within the clinical department
- Was the correct body part and projection selected?
- What does this selection usually dictate in regard to image processing?
- Why is this selection important from a medico-legal and data manipulation aspect?
- Is it within the recommended range for the body part imaged?
- Is this appropriate to allow post processing of the image?
- Are the differences in grey scale well demonstrated?
- Is there adequate demonstration of the bony trabeculae patterns, yet still demonstrating the soft tissue structures?