Radiographic Critique

By:Masood Ahmed

Radiographer (AKUH)

Critique?

The term critique derives from the Greek term kritikē (κριτική), meaning "(the art of) discerning", that is, discerning the value of persons or things.

Display and Critiquing the image

Display Torso, Vertebrae and Head Images viewed as if you are facing the

patient Right side of patient on viewer’s left Left side of patient on viewer’s right AP-marker facing up on the IR PA – marker facing down on IR

Display Extremities As if viewer’s eyes were the x-ray beam Right hand viewed so right thumb toward

viewer’s left side Marker placed on IR facing up (as in AP for

trunk)

Radiographic Analysis or Critique PACEMAN

Method of critiquing images- adevised by Roger Windle

Approach every image you create with this technique.

P Patient (part) position – is it a true AP,PA

OR Lateral etc, no rotation

A Area covered – does it cover adjacent

joints etc. all anatomy required on the film

C Collimation – is it adequate and can it be

seen on all 4 sides

E Exposure Contrast (usually OK when the optimum

kVp is set – black & white Density – correct mAs? –see trabecula

patterns, soft tissue

M Markers – correct orientation within

collimated area, accurate position, straight, level

Place on IR instead of patient or table – less distortion- avoid Star Wars placement

A Aesthetically pleasing – collimation parallel

with edge of film, centre of exposed area to centre of film, all body parts facing the same direction, smallest possible IR, no unwanted artefacts

N Name included – correct details- Patient

name, age, date of birth, date of examination, facilities name.

Is the ID plate positioned so it does not obscure any anatomy- have ID plate out of collimation away from anatomical structures

Lumbar Spine - AP

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anterior viewanterior view posterior viewposterior view

Atlas Images – Lumbar Vertebrae

Lumbar Spine - Lateral

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Atlas Images – Lumbar Vertebrae

Vertebral body

Intervertebral disc

Lumbar Spine - Oblique

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Atlas Images – Lumbar Vertebrae

right transverse

process – L5

pedicleL4

vertebralbody – L2

inferior articulating process – L2

left transverseprocess – L5

superior articulating process – L3

Lumbar Spine - MRI

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Atlas Images – Lumbar Vertebrae

Vertebral body

Intervertebral disc

L5

L4

L3

L2

L1

T12

Spinal cord

Find the critique

The both SI joints and the sacrum.

Irregularities may be due to fracture or a variant anatomy.

Low kVp less pentration.

Find the Critique

Poor penetration The arrow shows the

iliac wing, which is severly rotated.

There is too much rotation of the greater sciatic notch as well.

Find the Critique The mark was missed in this

positioning attempt and as a result there is too much of the lumbar spine demonstrated and too little of the sacrum.

The collimation is poor reflecting the uncertainty of the radiographer in accomplishing this radiograph.

This is a high contrast film having poor penetration of the lumbosacral junction.

Would you repeat this radiograph, why or why not?

Marker is in the field of interest.

closely collimated

References Lecture notes Roger Windle,2006 McQuillen Martenson, K,Radiographic

image analysis,2nd edn Ballinger,P,Frank,E, Merrill’s atlas of

radiographic positions & radiologic procedures, 10th edn

THANKS