A clinical audit of anatomical side marker use in a paediatric medical imaging department

Abstract

IntroductionThe gold standard in general radiography is to place a radiopaque anatomical side marker in the field of view for each radiographic image prior to exposure. The advent of digital radiography has allowed for anatomical side markers to be digitally added to films as part of post‐processing. The aim of this audit was to identify whether general X‐ray images performed in a tertiary Women's and Children's Hospital were being appropriately annotated with a definitive side marker, and to identify factors that may contribute to inappropriately labelled images.MethodsFour hundred images from 201 patients’ examinations occurring within a randomly selected time period were assessed to ascertain whether radiographic anatomical side markers were visible when images were viewed via the hospitals main viewing platform. The audit occurred in January 2014. The scope included both mobile and in‐department general X‐ray examinations, with the patient age range extending from 1 day to 18 years.ResultsOf the 400 images evaluated, 88 (22%) were found to have a lead marker that matched the anatomy being imaged within the primary beam; 289 (72.3%) images contained a correct digital marker inserted as part of the post‐processing of the image. In total, 377 (94.2%) images were appropriately marked. Of the 23 (5.8%) images not marked correctly, 22 images had no marker and 1 was incorrectly marked with a digital marker. There was a noticeable relationship between absent anatomical markers and chest X‐rays performed outside of the medical imaging department.ConclusionsWhile it is encouraging that the majority of the images assessed were correctly annotated, with only a small number of missing markers, there are opportunities for further improvement. The audit findings suggest that reduced access to lead markers influences marker use. Strategies that may improve compliance at an individual level include distribution of personalised anatomical side markers, and targeted staff education sessions. At a department level, regular audits and monitoring should be encouraged.

Audit of the quality of medical care as a way to improve the efficiency of medical organizations

“…Клинический аудит широко используется не только в сферах лечения, но и при оценке правильности прове-дения различных диагностических процедур: например, при выполнении рентгенологических исследований [44,45], экспресс-тестов [46], аспирационных биопсий [47].…”

Side marker creep: have radiographers changed their side marker habits?

“…This difficulty is exacerbated in cases of neonatal chest radiography in which there is patient rotation and/or pathology. It is noteworthy that the report by Barry et al . found that radiopaque side marker use in mobile chest radiography was particularly low.…”

“…Most radiographers will be familiar with the term exposure creep which refers to the tendency by radiographers to set exposure factors which overexpose the patient with radiation when performing digital radiography . This edition of JMRS includes a clinical audit by Barry et al . which raises the question of whether another less obvious creep has been lurking in the shadows of digital radiography: side marker creep .…”

“…Barry et al . conducted a clinical audit of side marker usage by radiographers in a paediatric hospital.…”

“…conducted a clinical audit of side marker usage by radiographers in a paediatric hospital. The authors reported a correct lead side marker visible within the primary beam in only 22% of the 400 images included in the audit sample and went on to conclude that “The findings from this clinical audit identified numerous opportunities to improve practice” …”