Step by Step Guide to a Typical Radiographic Examination

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Lecture (4)
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Step by Step Guide to a Typical Radiographic
Examination

• Request Form
• Check form is fully completed and signed. Check
  pregnancy question if required. Check
  examination request correlates to clinical
  history. Register on computer. Take special
  care with details from, elderly, handicapped,
  deaf, blind, very young, individuals with poor
  English etc. Review any previous reports and or
  films

3

• Request form Patient.
• Confirm details of patient and examination.
  Check you understand any terminology and know
  full details of the projections required.
  Previous examinations, Check and have patient
  sign for pregnancy risk if appropriate

Escort patient to changing cubicles Give changing
instruction relevant to examination. Use starch
free examination gown and dressing gown. Ensure
patient's modesty is protected and they are warm
enough. Instruct patients in the removal of
artifacts relevant to the examination, i.e.
jewellery and prostheses,
4

• Whilst Patient is changing
• Pre examination Preparation 1)Ensure examination
  room is clean and tidy, linen pads cassettes etc.
  2)Plan sequence of films for maximum speed and
  patient convenience. 3)Ensure all
  emergency equipment is functional and ready.
  4)Ensure any cassettes, grids, lead rubber
  protection, foam pads etc. you may require are
  clean and to hand. 5)Set appropriate exposure
  for first projection. 6)Place cassette and
  anatomical marker in position for first
  projection.
• Collect Patient and escort to examination room

5

• The Examination 1)Greet patient and make
  positive identity check. State your name and
  grade. 2)Check request details match patients'
  symptoms
• i.e. limbs Right/left.
• Inform patient of basic procedure.
• Position patient.
• Position gonad protect if required.
• Finalize exposure.
• Rehearse any breathing /moving procedures.
• 3)Instruct patient and visually check them in
  respiratory maneuvers or required movements.
  4)Visually check all round to ensure it is safe
  to make exposure. Expose 5)Inform patient to
  relax and breath normally 6)Remove cassette to a
  safe place 7)Proceed with the next position etc.
  8)When finished escort patient to waiting
  cubicle and instruct to 9)wait and or to redress
  if required. 10)Mark name on films and process.
  11)Complete documentation on request form and in
  computer.

6

• Assessing the Radiograph
• Place the radiograph correctly on the viewing
  box. Check.
• Identification, name date, hospital, registration
  number.
• Check anatomical marker/legend correct R/L and
  AP/PA. Area under examination, limits of
  examination.
• Correct protection. Patient position, MSP, RBL,
  etc.
• direction and centering of X-Ray beam.
• Exposure, Contrast (Kv) Density (mAS)
• Unhappiness, movement, photographic, geometric.
• Collimation, suitability of film size.
• Artifacts, patient and radiographic / processing.
  
• Anatomy and pathology.
• Need for repeats
• Need for further projections.     
• Is the radiographic information sufficient to
  make the required diagnosis?

7

• Departure of the Patient
• Inform patient examination is completed.
• Return any jewellery or artifacts removed.
• Inform patient that any dietary preparations are
  finished and any side /
• after effects of any drugs or medication
  e.g. white stools after Barium
• examinations blurred vision after muscle
  relaxants.
• In any appraisal of a radiograph the following
  areas should be assessed

8

• Projection is that requested
• Identification
• Correct name, see request card
• Correct dept ID (Hospital information Patient
  Number)Date
• Is it legible?
• Does it obscure any detail on the radiograph?
• Markers
• Has the correct marker been applied and at the
  time of exposure?
• Is it in the correct position?
• Is it away from area of examination?
• Is it legible?
• Area Under Examination
• Limits of the examination superiorly, inferiorly
  and laterally / medially
• Has all relevant anatomy been included?
• Name relevant anatomy.

9

• Projection
• Is it the correct projection?
• Assess projection for
• Patient position
• Correct centering point
• Is there need for further projections?If YES,
  why and what projections are necessary?
• Collimation
• Does it include all the relevant information?
• Is the field too large/too small?
• What corrections should be made if necessary?
• Image Quality
• Is there sufficient density and penetration to
  visualize the required bony and/or soft tissue
  structures?
• Is there sufficient radiographic contrast to
  visualize the required bony and/or soft tissue
  structures of interest?
• Is there any unsharpness? of which type?
• Clarify reasons for negative or positive answer.
• Could the image quality be improved?How?
• Are there any avoidable artifacts

10

• Anatomical Variation of Gross Pathology
• Describe any anatomical variation or gross
  pathology demonstrated on the radiograph.1)
  Congenital abnormality2) Trauma, fracture
  etc.3) Degree of arthritic or other degeneration
  relative to age4) Distinct pathology, e.g.
  pagets disease, osteomyelitis etc.5) Carcinoma
  primary / secondary
• Diagnostic AcceptabilityDoes this radiograph
  require a repeat?If YES, why?If NO would you
  describe the radiograph as a gold standard for
  this examination?State any improvements that
  could be made, if it is not at gold standard.Is
  there a need for further projections?If YES, why
  and what projections are necessary?