Revalidating the importance of anatomical side markers and annotations on radiographic images

Transcription

1 Revalidating the importance of anatomical side markers and annotations on radiographic images Poster No.: C-2464 Congress: ECR 2015 Type: Authors: Keywords: DOI: Educational Exhibit H. Khosa, C. Thomas, N. Ramesh; Portlaoise/IE Anatomy, Management, Respiratory system, Conventional radiography, Digital radiography, Audit and standards, Safety, Education and training, Image registration /ecr2015/C-2464 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 23

2 Learning objectives Revalidating the importance of anatomical side markers and annotations on radiographic images, particularly the chest Radiographs Background Despite the rapid advances technology in Radiology, plain radiographs still remain the first and foremost imaging modality used for evaluation The use of anatomical side markers is of paramount importance while imaging a patient and should be placed during the exposure and not electronically during the post processing. Inappropriate use of the side markers has several implications including medico-legal. Radiographic images must not show ambiguous side markers, after a brief audit and several local meetings we revalidated the importance of anatomical side markers and annotations at our institute. Some of the points included -placement of side markers prior to exposure, placement of markers so that they do not obscure anatomy. For Chest examinations, the markers should ideally placed on the left side above the shoulder, it may be placed between the chest and the humerus. Electronic markers to be used if the lead marker is incorrect, all electronic annotations to be entered and positioned so that anatomical structures are not obscured Findings and procedure details Anatomical side markers are essential procedure for all plain radiographs for identification of the correct anatomical side and prevent clinical and radiological confusion, medicolegal issues. All radiographs should be exposed with appropriate clip on side markers. They should be appropriately placed so that they do not obscure anatomy. Page 2 of 23

3 Ideally, the side markers are placed on the left side above the left shoulder.{ Fig 18} If this is anticipated to cause problems, the side marker can be placed below the level of the left axilla.{ Fig 16} Changes in practice since the introduction of computed radiography and digital radiography Electronic/digital side markers placed after exposure carry risk of error and should be avoided {e.g. dextrocardia{ Fig 13}, pneumothorax, pleural effusion.} Electronic side markers should only be used if original marker has been placed incorrectly. Post processing annotations should be typed and placed appropriately again avoiding obscuring anatomy.{ Fig 18} Examples of post processing annotations- Body Position: Erect, decubitus, prone, weight bearing, flexion, extension, oblique { nonstandard pronections} Views: inspiration, expiration, tube angulations Timed: Gastrointestinal studies { time since first exposure} Alerts: Red dot {fractures}artefacts, problems during exposure. Images for this section: Page 3 of 23

4 Fig. 1 Page 4 of 23

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20 Fig. 17: Right and left side markers Page 20 of 23

21 Fig. 18 Page 21 of 23

22 Conclusion Accurate placement of anatomical side markers and labeling is paramount and every department should develop standard local guidelines. Standard and best Practice is --- CORRECT PATIENT CORRECT SIDE MARKER/ANNOTATION CORRECT PROCEDURE Regular audits, reject analysis should be conducted to ensure the best practice of appropriate placement of side markers is maintained Personal information Claudia Thomas Radiographer, Midland Regional Hospital, Portlaoise, Ireland Huma Khosa Consultant Radiologist, Midland Regional Hospital, Portlaoise, Ireland Nagabathula Ramesh Consultant Radiologist, Midland Regional Hospital, Portlaoise, Ireland Page 22 of 23

23 References 1. Radiographer use of anatomical side markers and the latent conditions affecting their use in practice; Titley AG, Cosson P: DOI: 2. Radiation field preference for Radiographic anatomical markers by Radiographers in an University Teaching hospital in Nigeria: Adejoh T et al. Open Journal of Radiology, 2014, 4, Published Online September 2014 in SciRes dx.doi.org/ /ojrad Plain-Radiographic Image Labeling: A Process to Improve Clinical Outcomes. Aakre, K.T. and Johnson, C.D. (2006) Journal of American College of Radiologists, 3, Page 23 of 23