The application of anatomical side markers during abdominal and IVU examinations: An investigation of practice prior to and post-installation of computed radiography (CR)

Platt, Jane M.; Strudwick, Ruth

doi:10.1016/j.radi.2008.11.006

Cited by 10 publications

(36 citation statements)

References 7 publications

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“…It was equally noted that an abnormally high density, which is likely in the primary radiation field, often masked markers, hence making the theory of Bontrager and Lampignano [4] not fool-proof. The work of Platt et al [5] however, is in tandem with our ambivalence on marker placement positions. Our findings also revealed that markers placed in the secondary radiation field, very close to the collimation line, were clear and aesthetic like those in the primary field placed over non-essential anatomy.…”

Section: Discussionmentioning

confidence: 87%

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Radiation Field Preference for Radiographic Anatomical Markers by Radiographers in a University Teaching Hospital in Nigeria

Adejoh¹,

Onwuzu²,

Nkubli³

et al. 2014

OJRad

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Objective: The work aims to determine the radiographers' preference between primary and secondary radiation fields for imprinting anatomical markers on radiographs. Methodology: Processed radiographs from the darkroom with evidence of radiographic anatomical markings were selected randomly and reviewed using a viewing box, within a 4-week period. The radiation field in which markers were placed was noted for each radiograph. Faintly-appearing and partly conedoff markers were excluded. Simple statistical tools were used to derive central tendency. Result: 623 radiographs were assessed. 89.0% (n = 555) had markers in the primary radiation field while 11.0% (n = 68) were in the secondary radiation field. 98% (n = 611) of markers did not obstruct essential anatomy while 2% (n = 12) did, but the radiographs were neither repeated nor rejected because of the twin reason of reportability and the need to avoid additional radiation dose to patients. Conclusion: Radiographers in the centre preferred the primary radiation field for marker placement to avoid cone-off, cutoff and illegibility which leads to repeat. This, however, does not offer superior advantage to markers placed in secondary radiation field. It is recommended that marker placement preference should be guided by the need for legibility, aesthetics and avoidance of essential anatomy.

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Section: Discussionmentioning

confidence: 87%

“…It is advocated that radiopaque markers should be within the collimation field and should not cover essential anatomy [4]. However, in a work carried out in East Anglia, the authors concluded that there was a conflict of opinion about the necessity for anatomical side markers to be used within the primary beam [5].…”

Section: Introductionmentioning

confidence: 99%

Radiation Field Preference for Radiographic Anatomical Markers by Radiographers in a University Teaching Hospital in Nigeria

Adejoh¹,

Onwuzu²,

Nkubli³

et al. 2014

OJRad

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“…It is globally accepted best practice that all radiographic images must display a correct anatomical side marker . Anatomical side markers are defined as annotations of ‘right’ or ‘left’ on the image .…”

Section: Introductionmentioning

confidence: 99%

“…Best practice has always been to apply radiopaque anatomical side markers in the primary beam pre‐exposure . Recent technological innovations and change within radiology processes have had far‐reaching implications.…”

Section: Introductionmentioning

confidence: 99%

A clinical audit of anatomical side marker use in a paediatric medical imaging department

Barry

Kumar

Linke

et al. 2016

J of Medical Radiation Sci

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IntroductionThe gold standard in general radiography is to place a radiopaque anatomical side marker in the field of view for each radiographic image prior to exposure. The advent of digital radiography has allowed for anatomical side markers to be digitally added to films as part of post‐processing. The aim of this audit was to identify whether general X‐ray images performed in a tertiary Women's and Children's Hospital were being appropriately annotated with a definitive side marker, and to identify factors that may contribute to inappropriately labelled images.MethodsFour hundred images from 201 patients’ examinations occurring within a randomly selected time period were assessed to ascertain whether radiographic anatomical side markers were visible when images were viewed via the hospitals main viewing platform. The audit occurred in January 2014. The scope included both mobile and in‐department general X‐ray examinations, with the patient age range extending from 1 day to 18 years.ResultsOf the 400 images evaluated, 88 (22%) were found to have a lead marker that matched the anatomy being imaged within the primary beam; 289 (72.3%) images contained a correct digital marker inserted as part of the post‐processing of the image. In total, 377 (94.2%) images were appropriately marked. Of the 23 (5.8%) images not marked correctly, 22 images had no marker and 1 was incorrectly marked with a digital marker. There was a noticeable relationship between absent anatomical markers and chest X‐rays performed outside of the medical imaging department.ConclusionsWhile it is encouraging that the majority of the images assessed were correctly annotated, with only a small number of missing markers, there are opportunities for further improvement. The audit findings suggest that reduced access to lead markers influences marker use. Strategies that may improve compliance at an individual level include distribution of personalised anatomical side markers, and targeted staff education sessions. At a department level, regular audits and monitoring should be encouraged.

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“…Radiographic image annotation is a core skill inculcated in every radiographer from the classroom to the clinic. It is a fundamental evidence of acceptable technique [1]. In abnormality detection on radiographs by radiographers, image annotation is a core feature to watch out for [2].…”

Section: Introductionmentioning

confidence: 99%

An audit of radiographers’ practice of left-right image annotation in film-screen radiography and after installation of computed radiography in a tertiary hospital in Africa

Adejoh

Elugwu

Sidi

et al. 2020

Egypt J Radiol Nucl Med

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Background Errors in radiographic image annotation by radiographers could potentially lead to misdiagnoses by radiologists and wrong side surgery by surgeons. Such medical negligence has dire medico-legal consequences. It was hypothesized that newer technology of computed radiography (CR) and direct digital radiography (DDR) image annotation would potentially lead to a change in practice with subsequent reduction in annotation errors. Following installation of computed radiography, a modality with electronic, post-processing image annotation, the hypothesis was investigated in our study centre. Results A total of 72,602 and 126,482 images were documented for film-screen radiography (FSR) and computed radiography (CR), respectively in the department. From these, a sample size of 9452 made up of 4726 each for FSR and CR was drawn. Anatomical side marker errors were common in every anatomy imaged, with more errors seen in FSR (4.6%) than CR (0.6%). Collectively, an error rate of 3.0% was observed. Errors noticed were as a result of marker burnout due to over-exposure as well as marker cone off due to tight beam collimation. Conclusion Error rates were considerably reduced following a change from film-screen radiography (FSR) to computed radiography (CR) at the study centre. This change was, however, influenced more by a team of quality control radiographers stationed at CR workstation than by actual practice in x-ray imaging suite. Presence of anthropomorphic phantom in the teaching laboratories in the universities for demonstrations will significantly inculcate the skill needed to completely eliminate anatomical side marker (ASM) error in practice.

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The application of anatomical side markers during abdominal and IVU examinations: An investigation of practice prior to and post-installation of computed radiography (CR)

Cited by 10 publications

References 7 publications

Radiation Field Preference for Radiographic Anatomical Markers by Radiographers in a University Teaching Hospital in Nigeria

Radiation Field Preference for Radiographic Anatomical Markers by Radiographers in a University Teaching Hospital in Nigeria

A clinical audit of anatomical side marker use in a paediatric medical imaging department

An audit of radiographers’ practice of left-right image annotation in film-screen radiography and after installation of computed radiography in a tertiary hospital in Africa

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