This document provides an evaluation of an AP thoracic spine x-ray image based on several criteria: 1. The image meets HIPAA compliance standards but is missing patient and facility information. 2. The anatomical marker is correctly placed but post-processing was likely used. 3. Radiation hygiene standards for beam restriction and shielding are not met. 4. The image shows the correct position/projection for a thoracic spine x-ray. 5. There are no artifacts but the part is slightly rotated and not optimally centered. 6. Image quality could be improved with better positioning, centering, and use of a compensating filter. 7. The image meets minimum acceptance standards

1. AP THORACIC SPINE
JAADA GARMS
RADS 216

2. HIPAA COMPLIANCE
 This image is HIPAA Compliant
it does not obtain any
information about the patient
or the facility it was performed
at.

3. MARKER & PATIENT ID
 The correct anatomical side marker is visible.
 The side marker is placed correctly on the image.
 There are no side markers superimposing pertinent
anatomy.
 There are no additional markers needed.
 The image is displayed correctly based on marker
placement.
 The marker does not obtain the techs initials
because it is a postprocessing annotation.

4. RADIATION HYGIENE
 There must be at least three sides of beam restriction
visible on each image including the side closest to the
gonads. Although, for this projection the collimation is
generally left open to the length of the IR. Post processing
masking probably took place since the image width is so
narrow.
 There must also be evidence of appropriate secondary
shielding if the beam is within 5cm of the gonads.
 This image does not show accurate primary or secondary
shielding.

5. Completeness of
Position/Projection
Routine images of the T-spine include:
 AP
 LATERAL
 SWIMMERS Lateral Cervicothoracic
 This image does comply with routine
positions/projections.
 All anatomical parts are not correctly
visualized.

6. ARTIFACT
IDENTIFICATION
 There are no preventable
artifacts .
 There are no body parts
superimposed that should not
be.
 There is no hospital paraphernal
visible.
 The patent's clothing is not
visible.
 No indwelling artifacts or
foreign bodies visible in the
image.
 There are no CR/DR artifacts on
the image.
 No excess fog degrading image
quality.

7. IMAGE SHARPNESS
 There is no gross voluntary motion visible and bony
trabeculae are well visualized.
 There was no quantum mottle visible because the
appropriate MAS was used.
 No evidence of previous/ghosted exposure.
 There are no grid lines/artifacts because a reciprocating
grid was used
 Size distortion does not appear greater than expected.
 There is no shape distortion due to poor CR/IR/Part
Alignment.

8. Accurate Part Positioning
 The part does not appear to be
adequately aligned to the image
media it appears to be some slight
rotation based on the position of the
clavicles or this can be due to the
patients scoliosis.
 The part is accurately centered to the
image media.
 The CR is centered within 1 cm of the
anatomical part which is T7.
 The CR is adequately centered with
the image media.
T7
T12

9. Accurate Part
Positioning
 Since there is no
collimation the CRs
alignment does not
conform to an
acceptable IR
exposure field
recognition template.

10. Accurate Part
Positioning
 Center IR/CR to the level of T7
 Position the upper thoracic
toward the anode end of the tube
 Shoulders and hips in the same
horizontal plane
 Align MCP parallel with the IR

11. Image Evaluation
Criteria
 Uniform brightness across the
entire T-spine.
 Spinous processes should be
aligned with the midline of the
vertebral bodies.
 Intervertebral disk spaces open.
 The 7th thoracic vertebrae seen
at the center of the exposure
field.
 The Part is correctly positioned
based on this criteria.

12. Judicious Exposure Technique
• The most radiolucent structures are the lungs
an intervertebral disk spaces.
• The most radiopaque structures are the
pedicles on the lumbar & thoracic spine as
well as the bony cortex.
• The EI value is unknown.
• Bony structures should demonstrate short
scale contrast this image appears to have
adequate contrast and we are able to
visualize bony trabeculae.
• The brightness towards the bottom of the
image appears to be slightly higher, therefore
a compensating filter should be used in
addition to the anode heel effect.

13. Accept/Reject Image
 This image does meet
the minimum
standards for
acceptance.
Changes to be made:
 beam restriction should be
made visible.
 A proper marker including
initials.
 Better align the shoulders to
assure they are on a horizontal
plane with the hips.

14. References
Gaillard, Frank. "Carpometacarpal Fracture | Radiology Case." Radiopaedia.org. N.p.,
n.d. Web. 27 Mar. 2017.
McQuillen-Martensen, Kathy. Radiographic Image Analysis. St. Louis, MO: Elsevier
Saunders, 2015. Print
"AP Thoracic Spine Breathing Technique." WikiRadiography. N.p., n.d. Web. 09 Apr.
2017.