1. Lecture (4)

2. 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 abnormality 2) Trauma, fracture etc. 3) Degree of arthritic or other degeneration relative to age 4) Distinct pathology, e.g. pagets disease, osteomyelitis etc. 5) Carcinoma primary / secondary Diagnostic Acceptability Does 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?