Image markers and patient identification

A minimum of two types of markers should be imprinted on every radiographic image. These are (1) patient identification and date and (2) anatomic side markers.

PATienT iDenTiFiCATion AnD DATe (FilM-sCReen CAsseTTe [AnAlog] sysTeMs) Generally, this patient information, which includes data such as name, date, case number, and institution, is provided on an index card and is photoflashed on the film in the space provided by a lead block in the film cassette. Each cassette or film holder should have a marker on the exterior indicating this area where the patient ID, including the date, will be flashed (Fig. 1-101).

Throughout this text, the preferred location of this patient ID marker is shown in relation to the body part. A general rule for chests and abdomens is to place the patient ID information at the top margin of the IR on chests and on the lower margin on abdomens (see arrows on Fig. 1-102). The patient ID marker must always be placed where it is least likely to cover essential anatomy. The anatomic side markers should always be placed in a manner on the IR so that they are legible and esthetically correct. It must be within the collimation field so that it provides a permanent indicator of correct side of the body or anatomic part.

Digital systems With storage phosphor cassette–based systems, often a bar-code system imprints the patient information before or after exposure. Care must be taken so that this area does not obscure the essential anatomy that is being demonstrated. With flat panel detector with thin film transistor (FPD-TFT) systems and charged couple device (CCD) systems, patient identification is typically entered before exposure.

AnAToMiC siDe MARKeR A right or left marker must also appear on every radiographic image correctly indicating the patient’s right or left side or which limb is being radiographed, the right or the left. This may be provided as the word “Right” or “Left” or just the initials “R” or “L.” This side marker preferably should be placed directly on the IR inside the lateral portion of the collimated border of the side being identified, with the placement such that the marker will not be superimposed over essential anatomy.

These radiopaque markers must be placed just within the collimation field so that they will be exposed by the x-ray beam and included on the image.

The two markers, the patient ID and the anatomic side marker, must be placed correctly on all radiographic images. Generally, it is an unacceptable practice to write or annotate digitally this information on the image after it is processed because of legal and liability problems caused by potential mismarkings. A radiograph taken without these two markers may have to be repeated, which results in unnecessary radiation to the patient, making this a serious error. In the case of digital images, annotating the image to indicate side markers is an unacceptable practice. The exposure should be repeated to ensure correct anatomy was imaged.

Fig. 1-101 Patient identification information.

Fig. 1-102 Correctly placed side markers and patient identification marker (patient’s right to viewer’s left).