Page 23 - IMPRESSION Newsletter March19

Digital imaging has created a few challenges. Verifying that the images were hung

correctly and the correct marker was used is harder now. With film/screen cassettes it was
fairly easy to tell if you accidentally marked the wrong side because you knew if you took the
image AP or PA, and you could use the bopper placement to help determine original cassette
orientation. It’s also harder to use markers on cassette-less systems because you have to

place the marker on the patient. Yes, even if we use lead markers, we can make mistakes.
With digital imaging, it is easy to assume that the computer will do the right thing. You
assume that the manufacturer set up the presets correctly and that when you click on “PA
chest” the computer will automatically flip the image every time. Most of the time this is
true, but it is still up to us to double check. Do not trust the algorithms, even when the title
matches the exam you are doing. Trust yourself and trust your training. It is our job to

double check and make sure we are delivering the best care to our patients.

The biggest issue is patient safety and an eventual possible legal issue. We are human and
mistakes are inevitable, but we can work toward minimizing the chance that they will

happen. Unfortunately, when left vs. right mistakes are made the radiologists may report
incorrect findings. This may lead to incorrect or inappropriate treatment or treatment delay.
Worst case scenarios include the wrong limb being operated on or a chest tube placed in the
wrong lung. Pathologies, like situs inversus or dextrocardia, which depend on laterality, may
not be diagnosed at all. Events like this have been documented and attributed to the

radiology department. As radiographers, we may be held legally responsible for mistakes that
happened due to mismarked or unmarked images. A radiologist may refuse to read images
without lead markers or request a repeat with a lead marker present. In legal cases, digital
markers are not sufficient evidence of laterality.

Let’s take the time to do what is right for our patients, to be professionals, and to use our
lead markers. Slow down! Don’t make assumptions and double check your work. If
something seems off, trust your intuition! Even when you feel the pressure to be faster and
to get the patients done, everyone will be grateful when you take a minute to figure it out.