1. Image Evaluation Guidelines for Image Analysis Chapter 1

2. Facility’s Id Correct marker Required anatomy Accurate projection/position No unwanted distortion Cortical Outlines sharp Collimation Radiation Protection IR size & alignment Correct IR system Density & penetration Image contrast No preventable artifacts Properly ordered Requisition & Post-procedure

3. Facility’s ID Facility’s name Patient’s name, age or birth date Exam time and date ID plate * outside collimated field * away from direction CR is angled * next to narrowest anatomical

4. Marking Images Within collimated field? Best position? Accurate *Screen film *Digital * Is Required anatomy present on image?

5. Patient Obliquity & Extremity Flexion Accurate position demonstrated Imaginary line Degree of extension

6. Shape Distortion CR Elongation Foreshortening Joint spaces Poor positioning * magnified structure

7. Helpful Hints Use a grid if part thickness is over 5 inches and over 70 kVp is used Small to medium plaster cast +5-7 kVp +50-60% mAs Large plaster cast +8-10 kVp + 100% mAs Fiberglass cast +3-4 kVp + 25-30% mAs

8. Detail Sharpness Small focal spot Unwanted motion No magnification Detail screen Poor screen film contact If CR is used; small possible IR

9. Collimation All four sides Within ½ inch of skinline To specific anatomy on torso All required anatomy visible

10. Radiation Protection Present Accurate for male and female Tight collimation Anatomical artifacts Personnel protected * IR positioned CW or LW properly

11. Body Habitus CW or LW Smallest IR, multiple positions Aligned in same direction Correct IR system

12. Density & Penetration Optimal density Overexposure & Underexposure Changing penetration Hypothetical conversation Compensating filter or anode heel effect

13. Guidelines for Digital Correct diagnostic specifier for anatomy For non-routine correct specifier Center structure Do not overlap collimation edges Collimate tightly

14. Image Contrast Bony & soft tissue Amount of scatter controlled

15. Ordered Procedure Postprocedure Repeat or reject analysis