10 point checklist

Question 1

What is the 10 point checklist?

Answer 1

1- Patient Identification
2- Area of Interest
3- Markers and Legends
4- Correct Projection
5- Image Exposure
6- Definition
7- Collimation
8-Artifacts
9-Further Projections
10- Anatomical Variations

Question 2

Why is patient identification important?

Answer 2

• Legal requirement under IR(ME)R
• Ensure all forms of ID match including hospital number
• Correct name, D.O.B, and date/time of examination

Question 3

Area of interest

Answer 3

• Can you identify 4 borders of collimation?
• Has important anatomy been ‘cropped out’ at the post processing stage?
• Can you see the glenohumeral joints?
• Is the image centered correctly?
• Is all necessary anatomy included?
• 8-10 POSTERIOR RIBS ON A CHEST X-RAY?

Question 4

Markers and legends

Answer 4

• Is there a marker present in the primary beam?
• If not has it been added during post processing?
• Is the marker correct?
• Is it obscuring anatomy?
• What was the patient position?

Question 5

Correct projection

Answer 5

• Has the correct projection been performed to best answer the clinical question?
• Is the patient positioned appropriately?
• Is there evidence of rotation?
• Are the clavicles equidistant from the spinous process?
• If appropriate is symmetry present?

Question 6

Image exposure

Answer 6

• Has the correct exposure factors being used for the patient habitus
• kV and mAs
• Is the image under or over penetrated?
• Can you see T4?

Question 7

Definition

Answer 7

• Is there suitable contrast between bone, air and soft tissues?
• Can you differentiate between structures?
• Refers to the overall brightness, displayed in shades of grey
• Lung markings

Question 8

Collimation

Answer 8

• There are 4 collimating borders

Question 9

Artifacts

Answer 9

• Medical artefacts
• Unknown artefacts
• Piercings
• Metal
• Clothing
• Underwear
• Equipment

Question 10

Further projections

Answer 10

• Has sufficient kV been applied to allow tissue differentiation?
• Can be caused by scatter radiation, and is often an issue imaging patients with a large patient habitus
• Density between neighboring regions on a chest radiograph

Question 11

Anatomical variations

Answer 11

• After assessing the previous factors is the image diagnostic and does it answer the clinical question?
• If not, what are you going to change to ensure the repeat improves the image
• Is there any concerning pathology which requires follow up?
• Discuss concerns with referrer
• ALWAYS DOCUMENT

Question 12

Common chest pathology

Answer 12

• Pneumothorax
• Pleural Effusion
• Consolidation
• Perforation
• Cardiomegaly