2. Is the image HIPAA compliant?
• The image is HIPAA
compliant as it does
not display any type of
information that
violates HIPAA
compliancy.
3. Marker and Patient ID
• The correct anatomical side marker is visible
in the image & includes Left ID, however, the
marker does not include the radiographers
identification
• The marker was placed on the anterior
surface of the patient
• The marker correctly marks the side being
imaged
• The marker is placed close to the soft tissue
and does not super impose over any
pertinent anatomy
• Additional markers are not needed/used for
this image
• An arrow marker could be placed
pointing to the site of pain/injury
• Based on the marker placement, the image is
correctly displayed
4. Radiation Hygiene
• Proper beam restriction requires the
presence of at least three sides of
collimation on the image
• There is no clear evidence that shows
beam restriction. There are no sides of
beam restriction present
• There is no evidence that indicates
whether or not there was appropriate
use of shielding
• Primary shielding should be present
closest to the gonads
• If it were present it would be right here
• The rule for gonadal shielding says
shielding must be provided if the
gonads are within 5 cm of the primary
beam
5. Routine Radiographic Projections
Performed:
• PA
• 45 ̊ PA Oblique Lateral
Rotation
• 45 ̊ AP Oblique Medial
Rotation
• Lateral
* Projections may differ based on
institutional/department protocol *
6. Image Compliance
• This image does comply
with routine position(s)
/projection(s)
• All anatomical parts are
correctly visualized in the
image
7. Artifact Identification
• Yes, there is a preventable physical
artifact visible in this image.
However, I am unsure of what exactly
it is.
• There are no body parts
superimposed that should not be
• I don’t believe hospital paraphernalia
is visible in this image. I do not think
the unknown object is a shield.
• My best guess would be that the
unknown object could possibly be
part of the patients clothing or one of
their belongings.
• There appears to be no indwelling
artifacts/foreign bodies in this image????
8. Artifact Identification/Image
Sharpness
• There does not appear to be excess
fog that could degrade overall image
contrast/visibility & there are no
visible CR/DR artifacts
• There appears to be no “gross”
voluntary motion visible
• There is no excessive quantum mottle
(or image noise) visible
• There is no evidence of double
exposure
• There are no grid lines, grid artifacts
&/or gird cutoff visible
• Because a grid is not likely used for
this body part
9. Image Sharpness
• Size distortion does not appear
greater than expected
• Shape distortion is not being
caused by poor CR/IR/part
alignment
• The CR should be perpendicular to
the wrist joint
• Off-centering is < 1cm
* Correct centering, alignment, and CR
location are extremely important to
help avoid size/shape distortion *
10. Accurate Part Positioning
• The part is adequately aligned to the
longitudinal axis of the imaging media
(green line), however, the metacarpals are
not aligned
• The part is centered to the image media
(blue line)
• The CR is centered within 1cm of the
anatomical part (purple star)
• The CR is adequately centered aligned with
the image media
• The CR’s alignment does not conform to an
accepted IR exposure field recognition
template/field
• Due to not having evidence of proper
collimation
11. Positioning
• IR Size: 8 x 10 inch or 10 x 12 inch
lengthwise, table top with 40’’ SID
• Seat patient at end of table and have then
rest the arm and forearm on the table
• Have patient flex elbow 90 degrees to
rotate the ulna to lateral position
• Adjust forearm and hand so that wrist is in
true lateral position
• Center CR perpendicular to wrist joint
• Collimate 2.5 inches proximal and distal to
the wrist joint and 1 inch on the palmer and
dorsal surfaces
12. Evaluation Criteria
• The following should be clearly
shown:
• Evidence of proper
collimation
• Distal radius and ulna,
carpals, and proximal half
of metacarpals
• Superimposed distal radius
and ulna
• Superimposed metacarpals
• Soft tissue and bony
trabecular detail
13. Image Evaluation
• Proper Collimation
• Distal radius and ulna,
carpals, and proximal half
of metacarpals
• Superimposed distal radius
and ulna
• Superimposed
metacarpals
• Soft tissue and bony
trabecular detail
* Is the anatomical part
correctly positioned? Yes, the
wrist is positioned correctly,
however, the hand is
extended beyond lateral *
14. Exposure Technique
• The most radiolucent structure is the
soft tissue margins
• The most radiopaque structure is the
bony cortex
• Image contrast appears adequate
• Short scale contrast
• The image brightness is adequate to
visualize all anatomical structures
present
• Given that there is no EI value, it is
difficult to determine whether or not
the image is underexposed,
overexposed, or adequately exposed
• However, I do believe that the image
was properly exposed
15. Accept/Reject
• This image meets the
standards for acceptance
criteria
• It is of diagnostic quality
• I would accept this image
• No repeat necessary, however I
would change a few things…
16. Corrections
• I would keep the wrist where it
is, but I would decrease flexion
in the hand to be in a lateral
position
• I would improve the
collimation to having 4 sides or
at least the acceptable 3
• I would also adjust my
centering a little bit so the CR
was going directly through the
wrist joint
• I would also move the
unknown artifact so there
would be no chance of it
ending up in the x-ray
