ADVERTORIAL
Written by Kat Evans , BCF in-house Radiographer
How compliant are
your radiographs ?
Would you be happy to send them for a second opinion ?
Radiographs are an integral part of veterinary practice . When radiographs are not of diagnostic quality , it can result in a number of serious consequences . Radiographs that fail to disclose existing diseases or pathology are a disservice to the patient and client . In addition , should a client bring legal action against a veterinary practitioner who is not in possession of diagnostic quality radiographs , the veterinarian may face negative legal consequences . To comply with general practice requirements of the SAVC practice standards scheme , images must be retained for an appropriate period ( widely accepted to be a minimum of 5-7 years ) and have a means of patient identification .
Diagnostic quality not only refers to definition or resolution of the radiograph , dependent on the correct exposure , but also whether or not the radiograph is labelled correctly with patient details , collimation , anatomical identification , and appropriate positioning .
Why does it matter if at the time you know what you ’ re looking at ? Well , what if you need to refer to a specialist or are sending radiographs for a telemedicine consult ? Although there are many anatomical landmarks we can use to orientate ourselves , these may not be visible on the radiograph . Labelling radiographs is extremely important not only at the time of acquisition but also for future reference . Reviewing a comparative set of radiographs when it is unclear which is medial or lateral on the pastern of a horse or which lateral chest view is left or right can be tricky .
Patient information
Information on your radiographs should include ; owner ’ s name , patient ’ s name , clinic name , area of anatomy radiographed and date of acquisition . With digital imaging input of patient details is required before acquisition can take place and if correctly installed the equipment should be registered to your practice , therefore this information is automatically added to the radiographs . You are also prompted to specify which region of anatomy is to be radiographed , again as part of the automatic labelling process done by the equipment .
Orientation markers ( L , R , VD DV )
Easy to forget when you ’ re in a hurry but essential for reviewing images . Ideally a left or right marker should be placed within the primary beam but not so as to obscure the object of interest . Markers should be placed laterally and cranially where possible as an aid to orientation . Digital systems will allow these markers to be added to the image after processing , but if you don ’ t do it at the time the Radiograph is taken it increases the likelihood of incorrect marker placement or markers not being placed at all .
Collimation
Not only does collimating correctly reduce scatter and therefore maximise safety , it also focuses the primary beam on your object of interest and will result in better quality radiographs . Do not collimate to the edges of the plate , collimate to the margins of your area of interest .
Positioning and views
There are standard views for all species covering all anatomy so we can compare like for like and have interpret what variations are normal . Poor positioning and / or minimal oblique views can result in missed or incorrect diagnosis due to difficulty in interpretation or incomplete radiographic examination .
Below is a great example of where diagnostic quality could be improved . The image is lacking any marker in the primary beam ( questionably a marker is just out of view in the top left corner ). Fortunately , this has been labelled post acquisition . There is poor collimation at the top of the image and we have no patient details present . All easy things to get right at the time of acquisition . In short , don ’ t settle for second best .
Whenever possible take time to position your patient correctly and add markers when appropriate . If you ’ re struggling with a radiographic diagnosis and ask for a second opinion , make sure the images you send are some you are proud to have taken .
Issue 02 | APRIL 2017 | 27