The document evaluates an AP ankle x-ray image. It finds that the image is missing an anatomical marker and beam collimation. However, all pertinent anatomy is visualized and the positioning is correct. The image quality is also acceptable. While some corrections are needed, the evaluator believes the image meets minimum requirements and should be accepted.

1. Image Evaluation: AP Ankle
Jamie Ziska
RADS – 216
Image Evaluation
April 29, 2016

2. HIPAA Compliance
 This image is HIPAA compliant.
 It does not include any information
that would violate patient
confidentiality.

3. Marker & Patient ID
 The image does not have an
anatomical side marker included.
 An anatomical side marker should be
included in the image with
technologist ID. An AP marker to
indicate the position/projection could
also be added.
 This marker does not superimpose
any pertinent anatomy.
 Based on this marker placement, the
image is displayed correctly.
R
123

4. Radiation Hygiene
 Three sides of beam restriction should be
seen in an image, including the side closest
to the patient’s gonads.
 If the gonads are within 5 centimeters of the
primary beam, secondary shielding should
be used.
 This image does not show any evidence of
any collimation or gonadal shielding.
 This image does not adhere to proper beam
restriction/shielding rules.
 Red lines show proper collimation.

5. Completeness of Positions/Projections
 The AP position/projection is routine.
 Other positions/projections include:
 Mediolateral Lateral
 AP Internal Oblique
 AP External Oblique
 All pertinent anatomy is visualized in this
image.

6. Artifact Identification
 This image does not include any of the following
artifacts that would interfere with this study:
1. No physical artifacts
2. No patient clothing/belongings
3. No hospital paraphernalia
4. No superimposing body parts over the area of
interest
5. No indwelling objects or foreign bodies
6. No excess fog or any CR/DR artifacts

7. Image Sharpness
 There is no gross voluntary motion visible in the
image.
 The image shows no evidence of excessive
quantum mottle.
 There is no evidence of a double or previous
exposure.
 Grid lines, artifacts, or cut-off cannot be seen.
Ankles are imaged table top and do not require a
grid.

8. Image Sharpness
 Size distortion in this image does not
appear to be greater than expected.
 There does not appear to be any shape
distortion caused by CR/part/IR alignment.

9. Accurate Part Positioning
 The part is aligned correctly to the image
media with the joint in the center of
exposure area.
 The midpoint of the IR should be centered
to the part midway between the medial
and lateral malleoli.

10. Accurate Part Positioning
 The CR is centered to within 1 cm of the
part, entering midway between the medial
and lateral malleoli.
 The CR is adequately aligned, entering
perpendicular to the joint space and to the
IR.
 The CR’s alignment does conform to an
acceptable exposure recognition
field/template because it has no margins of
collimation.

11. Accurate Part Positioning
 Place the patient in the supine or seated position with the
affected limb fully extended.
 Adjust the ankle joint in the anatomic position (foot pointing
straight up) to obtain a true AP projection. Flex the ankle and
foot enough to place the long axis of the foot in the vertical
position.
 Ball and Egbert stated that the appearance of the ankle
mortise is not appreciably altered by moderate plantar flexion
or dorsiflexion as long as the leg is rotated neither laterally
nor medially.
 Shield gonads.
 Direct CR perpendicular through the ankle joint at a point
midway between the malleoli.

12. Accurate Part Positioning
 The following should be clearly shown:
 Evidence of proper collimation
 Tibiotalar joint space
 Ankle joint centered to exposure area
 Normal overlapping of the tibiotalar articulation with the
anterior tubercle slightly superimposed over the fibula
 Talus slightly overlapping the distal fibula
 No overlapping of the medial talomalleolar articulation
 Medial and lateral malleoli
 Talus with proper density
 Soft tissue

13. Accurate Part Positioning
 Based on the
positioning and
evaluation criteria,
the part is correctly
positioned.

14. Judicious Exposure Techmique
 The most radiolucent structures are the
surrounding oft tissue and joint spaces.
 The most radiopaque structure is the bony
cortex.
 Both are visible in this image.
 I believe the contrast (window width) and
brightness (window level) are adequate for this
image.
 I believe the EI value would be within normal
range.

15. Accept or Reject?
 I believe this image meets minimal
requirements and should be accepted.
 Corrections:
 Include marker with technologist ID
 Collimate so that 3 or more sides show
adequate beam restriction

16. References
 Frank, Eugene D, Bruce W. Long, Barbara J. Smith, Vinita Merrill, and Philip W. Ballinger. Merrill's
Atlas of Radiographic Positioning & Procedures. St. Louis, Mo: Mosby/Elsevier, 2007. Print.
 https://holyfamily9.blackboard.com/bbcswebdav/pid-577620-dt-content-rid-
1551345_1/courses/RADS-216-A-2016SP/Positioning_Criteria_16.pdf
 https://holyfamily9.blackboard.com/bbcswebdav/pid-577621-dt-content-rid-
1551339_1/courses/RADS-216-A-2016SP/Markers_Image_Display_16%281%29.pdf
 https://holyfamily9.blackboard.com/bbcswebdav/pid-576542-dt-content-rid-
1541230_1/courses/RADS-216-A-2016SP/Distortion_16.pdf
 https://holyfamily9.blackboard.com/bbcswebdav/pid-567096-dt-content-rid-
1493317_1/courses/RADS-216-A-2016SP/RADS-216-A-
2016SP_ImportedContent_20160111094521/Gen_Imag_Eval_Info_16.pdf
 http://www.dcorthoacademy.com/journal/journal_09/dec_09/diagnostic_imaging_dec09.php