How compliant are  your radiographs? Would you be happy to send them for a second opinion?

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 RCVS 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 even not getting done 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.

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