1. Image review and reporting
Following acquisition, it is the responsibility of the radiographer / RT to ensure that the resultant image is of diagnostic quality and can answer the relevant clinical question. If a repeat image is not required, then the radiographer / RT should ensure that the image is made immediately available to the referrer. This will be commonly undertaken by uploading the image to the hospital Picture Archiving and Communications System (PACS). In some instances, with DR, the referrer may wish to review the image at the point of acquisition. There are likely to be differences in image quality between the display screen on a mobile X-ray unit and those assigned for primary review. Referrers should be advised to check the full image using the designated computer screens and PACS. Following image review it is the responsibility of the radiographer / RT to appropriately annotate the image (Figure 8). Protocols for annotations will be at the discretion of local departments but are likely to include an aspect marker (L or R), projection details (mobile AP erect or supine), exposure factors, time of examination and location. Once the radiographer / RT is satisfied that the image is of sufficient quality and has the necessary annotations then it can be sent to PACS. Where possible mobile images should be sent for urgent reporting by a radiologist or reporting radiographer / RT. Mechanisms should be in place for notifying referrers or urgent or unexpected findings.
Figure 8. Two mobile CXR images from patients with the COVID-19 virus. Annotations (primary and secondary) are present on the images to provide information about the acquisition conditions. A primary (at the time of exposure) aspect marker is indicated by the solid blue arrow (left image). A post-exposure (secondary) aspect marker is indicated by the dotted blue arrow (right image). Other annotations included on the image include the radiographic projection (dotted rectangular box) and the location of the examination (solid rectangular box). The post-exposure annotation protocol will be governed by local protocols and may also include exposure factors, examination time and radiographer details. Images courtesy of Dr Nick Woznitza, London (adapted).