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Radiographic Critique
By:Masood Ahmed
Radiographer (AKUH)
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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.
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Display and Critiquing the image
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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
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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)
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Radiographic Analysis or Critique PACEMAN
Method of critiquing images- adevised by Roger Windle
Approach every image you create with this technique.
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P Patient (part) position – is it a true AP,PA
OR Lateral etc, no rotation
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A Area covered – does it cover adjacent
joints etc. all anatomy required on the film
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C Collimation – is it adequate and can it be
seen on all 4 sides
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E Exposure Contrast (usually OK when the optimum
kVp is set – black & white Density – correct mAs? –see trabecula
patterns, soft tissue
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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
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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
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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
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Lumbar Spine - AP
LABELLABEL REMOVE OVERLAYREMOVE OVERLAY
anterior viewanterior view posterior viewposterior view
Atlas Images – Lumbar Vertebrae
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Lumbar Spine - Lateral
LABELLABEL REMOVE OVERLAYREMOVE OVERLAY
Atlas Images – Lumbar Vertebrae
Vertebral body
Intervertebral disc
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Lumbar Spine - Oblique
LABELLABEL REMOVE OVERLAYREMOVE OVERLAY
Atlas Images – Lumbar Vertebrae
right transverse
process – L5
pedicleL4
vertebralbody – L2
inferior articulating process – L2
left transverseprocess – L5
superior articulating process – L3
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Lumbar Spine - MRI
LABELLABEL REMOVE OVERLAYREMOVE OVERLAY
Atlas Images – Lumbar Vertebrae
Vertebral body
Intervertebral disc
L5
L4
L3
L2
L1
T12
Spinal cord
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Find the critique
The both SI joints and the sacrum.
Irregularities may be due to fracture or a variant anatomy.
Low kVp less pentration.
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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.
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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.
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Would you repeat this radiograph, why or why not?
Marker is in the field of interest.
closely collimated
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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
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THANKS