An audit of radiographers’ practice of left-right image annotation in film-screen radiography and after installation of computed radiography in a tertiary hospital in Africa

Abstract

Abstract Background Errors in radiographic image annotation by radiographers could potentially lead to misdiagnoses by radiologists and wrong side surgery by surgeons. Such medical negligence has dire medico-legal consequences. It was hypothesized that newer technology of computed radiography (CR) and direct digital radiography (DDR) image annotation would potentially lead to a change in practice with subsequent reduction in annotation errors. Following installation of computed radiography, a modality with electronic, post-processing image annotation, the hypothesis was investigated in our study centre. Results A total of 72,602 and 126,482 images were documented for film-screen radiography (FSR) and computed radiography (CR), respectively in the department. From these, a sample size of 9452 made up of 4726 each for FSR and CR was drawn. Anatomical side marker errors were common in every anatomy imaged, with more errors seen in FSR (4.6%) than CR (0.6%). Collectively, an error rate of 3.0% was observed. Errors noticed were as a result of marker burnout due to over-exposure as well as marker cone off due to tight beam collimation. Conclusion Error rates were considerably reduced following a change from film-screen radiography (FSR) to computed radiography (CR) at the study centre. This change was, however, influenced more by a team of quality control radiographers stationed at CR workstation than by actual practice in x-ray imaging suite. Presence of anthropomorphic phantom in the teaching laboratories in the universities for demonstrations will significantly inculcate the skill needed to completely eliminate anatomical side marker (ASM) error in practice.

Keywords

• Anatomical side markers
• Radiographs
• Radiographers
• Film-screen radiography
• Computed radiography