Image quality + 10 point checklist

Question 1

What is the purpose of systematic image critique?

Answer 1

-The aim of this method is to ensure all aspects of image quality are adequately assessed
-Reduce the likelihood of missing secondary pathology
-Enables a greater understanding as to whether a repeat examination is justified
-Several methods are recognized as appropriate
-Easier to identify acute pathology

Question 2

Give an example of a 10 point checklist

Answer 2

1- Demographics
2- Markers and Legends
3- AOI/Collimation
4- Projection/Positioning
5- Exposure factors
6- Brightness
7- Contrast
8- Unsharpness
9- Artifacts/anatomical variations
10- Repeats or concerns

Question 3

what are demographics?

Answer 3

-Patient identification
-Legal requirement under IR(ME)R
-Ensure all forms of ID match including hospital number
-Correct name, D.O.B, and date/time of examination

Question 4

what questions should be asked about markers and legends?

Answer 4

-Is there a marker present in the primary beam?
-If not has it been added during post processing?
-Is the marker correct?
-Is it obscuring anatomy?
-What was the patient position?

Question 5

What questions should be asked about collimation?

Answer 5

-Can you identify 4 borders of collimation?
-Has important anatomy been ‘cropped out’ at the post processing stage?
-Can you see the glenohumeral joints?
-Is the image centered correctly?
-Is all necessary anatomy included?
-8-10 POSTERIOR RIBS ON A CHEST X-RAY?

Question 6

what should be asked about projection/positioning?

Answer 6

*Has the correct projection been performed to best answer the clinical question?
*Is the patient positioned appropriately?
* Is there evidence of rotation?
*Are the clavicles equidistant from the spinous process?
*If appropriate is symmetry present?

Question 7

what should be asked about exposure factors?

Answer 7

*Has the correct exposure factors being used for the patient habitus
*kV and mAs
*Is the image under or over penetrated?
*Can you see T4?

Question 8

brightness?

Answer 8

*Is there suitable contrast between bone, air and soft tissues?
*Can you differentiate between structures?
*Refers to the overall brightness, displayed in shades of grey

Question 9

contrast?

Answer 9

*Has sufficient kV been applied to allow tissue differentiation?
*Can be caused by scatter radiation, and is often an issue imaging patient with a large patient habitus
*Density between neighbouring regions on a chest radiograph

Question 10

unsharpness?

Answer 10

*The three factors that affect un-sharpness is source to image distance (SID) source size and object to detector distance
*Can cause a loss of definition in the x-ray
*An example is a loss of trabecular pattern

Question 11

Artefacts/ anatomical variants

Answer 11

*Does the patient have any anatomical variances such accessory ossicles
*When imaging the chest does the patient have Situs inversus or dextrocardia?
*Are there clinical/internal artefacts?
*Are there non-clinical/external artefacts?

Question 12

Repeats or concerns.

Answer 12

*After assessing the previous factors is the image diagnostic and does it answer the clinical question?
*If not, what are you going to change to ensure the repeat improves the image
*Is there any concerning pathology which requires follow up?
*Discuss concerns with referrer
*ALWAYS DOCUMENT

Question 13

Image commenting

Answer 13

*We are expected as qualified radiographers to be able to make comments on radiographs
*A comment is an initial interpretation of an x-ray in order to appreciate important pathology or variants
*Even if there is not an expectation to write a comment all images should still be initially assessed for pathology

Question 14

Common chest pathology

Answer 14

• Pneumothorax
• Pleural Effusion
• Consolidation
• Perforation
• Cardiomegaly