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

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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. 1 This edition of JMRS includes a clinical audit by Barry et al. 2 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. 2 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”. 2 It is noteworthy that the report by Barry et al. 2 found that radiopaque side marker use in mobile chest radiography was particularly low... This patient had been previously stabilised at another hospital where several X‐ray examinations had been performed... The chest radiograph accompanying the patient did not show a side marker (Fig.  1)... This was not an ambiguous finding because the radiographer had placed a radiopaque side marker within the primary beam... This case demonstrated to me the safety benefits of this ‘old‐fashioned’ practice... Another related point of interest was identified in an article by Khosa et al. in 2015. 4 The authors noted the importance of “… placement of markers so that they do not obscure anatomy”. 4 My observation of current clinical practice is that most radiographers do not consider whether postprocessing annotations are placed over bony anatomy, particularly with chest radiography... It is a relatively easy task to position annotations so that they are not overlying patient bony anatomy... A further benefit of using initialled radiopaque markers (i.e. markers which incorporate the radiographers’ initials) is what might be called the signed‐artwork effect... A 2012 study by Gibson and Davidson1 reported that exposure creep identified in ICU portable chest radiography could be halted with a strategic intervention... It would be worth investigating whether an intervention such as a periodic audit of radiopaque side marker use could reduce side marker errors... The use of radiopaque side markers is not anachronistic... Placement of a radiopaque side marker within the primary beam is not an outdated practice – it is a safe practice.

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Initial chest X‐ray without a side marker.
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jmrs181-fig-0001: Initial chest X‐ray without a side marker.

Mentions: Another area of heightened risk is the emergency room where there can be rapid interventions following chest radiography in trauma patients. This potential risk of failing to use radiopaque side markers in the emergency room was brought into sharp focus for me when one of my colleagues was called to the emergency room following the arrival of a priority one patient. This patient had been previously stabilised at another hospital where several X‐ray examinations had been performed. The chest radiograph accompanying the patient did not show a side marker (Fig. 1). A repeat chest X‐ray examination was ordered on the arrival of the patient in our Emergency Department. This chest X‐ray demonstrated that the patient had situs inversus (Fig. 2). This was not an ambiguous finding because the radiographer had placed a radiopaque side marker within the primary beam. This case demonstrated to me the safety benefits of this ‘old‐fashioned’ practice.


Side marker creep: have radiographers changed their side marker habits?
Initial chest X‐ray without a side marker.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016621&req=5

jmrs181-fig-0001: Initial chest X‐ray without a side marker.
Mentions: Another area of heightened risk is the emergency room where there can be rapid interventions following chest radiography in trauma patients. This potential risk of failing to use radiopaque side markers in the emergency room was brought into sharp focus for me when one of my colleagues was called to the emergency room following the arrival of a priority one patient. This patient had been previously stabilised at another hospital where several X‐ray examinations had been performed. The chest radiograph accompanying the patient did not show a side marker (Fig. 1). A repeat chest X‐ray examination was ordered on the arrival of the patient in our Emergency Department. This chest X‐ray demonstrated that the patient had situs inversus (Fig. 2). This was not an ambiguous finding because the radiographer had placed a radiopaque side marker within the primary beam. This case demonstrated to me the safety benefits of this ‘old‐fashioned’ practice.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

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. 1 This edition of JMRS includes a clinical audit by Barry et al. 2 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. 2 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”. 2 It is noteworthy that the report by Barry et al. 2 found that radiopaque side marker use in mobile chest radiography was particularly low... This patient had been previously stabilised at another hospital where several X‐ray examinations had been performed... The chest radiograph accompanying the patient did not show a side marker (Fig.  1)... This was not an ambiguous finding because the radiographer had placed a radiopaque side marker within the primary beam... This case demonstrated to me the safety benefits of this ‘old‐fashioned’ practice... Another related point of interest was identified in an article by Khosa et al. in 2015. 4 The authors noted the importance of “… placement of markers so that they do not obscure anatomy”. 4 My observation of current clinical practice is that most radiographers do not consider whether postprocessing annotations are placed over bony anatomy, particularly with chest radiography... It is a relatively easy task to position annotations so that they are not overlying patient bony anatomy... A further benefit of using initialled radiopaque markers (i.e. markers which incorporate the radiographers’ initials) is what might be called the signed‐artwork effect... A 2012 study by Gibson and Davidson1 reported that exposure creep identified in ICU portable chest radiography could be halted with a strategic intervention... It would be worth investigating whether an intervention such as a periodic audit of radiopaque side marker use could reduce side marker errors... The use of radiopaque side markers is not anachronistic... Placement of a radiopaque side marker within the primary beam is not an outdated practice – it is a safe practice.

No MeSH data available.