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

Abstract

Introduction: The 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.

Methods: Four 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.

Results: Of 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.

Conclusions: While 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.

Keywords: Lead marker; medical imaging; patient safety; practice guidelines; radiography; side marker.

Figure 1

Chest X‐rays taken in the neonatal intensive care unit, the first is lacking lead or digital markers and has the potential to confuse treating clinicians. The repeated image shows a lead marker on the correct side. The patient has situs inversus.