Section II: FILM IDENTIFICATION
4-10. PROJECTION
a. As stated earlier, what you do in the exposure and processing room is the
heart of your job as a radiographer since your job is to demonstrate pathology
radiographically. However, the importance of proper film identification cannot be overly
stressed. There is no situation in which proper film identification is unimportant. What
is the good of a clearly demonstrated anatomical structure if it has been mislabeled?
Mislabeling anatomical structures, such as the right lung for the left lung, can lead to a
failure to treat a diseased lung and unnecessary intervention on a healthy lung. If an
incorrect family member prefix is entered on an X-ray, for example, 01 for 02, the
radiologist's report will incorrectly attribute a condition to the wrong sibling. Film
identification is always important, but it becomes particularly important in comparison
studies on follow-up examinations and in malpractice suits where compensation for
injury and damages is at stake.
b. If, for example, the growth of a cancerous lesion is being compared from one
week to the next, an accurate date becomes a crucial identifying factor and assessment
tool. For such an examination, the cumulative time following injection of the contrast
medium (for example, 5 minutes post injection) would be required. The age of the
patient is also crucial in comparison studies that attempt to measure the progress of a
disease since certain diseases travel faster depending upon the age of the patient. In
tomography, the level of the fulcrum (for example, 8 cm--see figure 4-20) would be
required. Other X-rays may be marked to indicate the patient's bodily position (for
example, prone or decubitus). Local standard operating procedure (SOP) may also
require other identifiers. As with all components of the medical record, film identification
represents medical and legal documentation of the actions taken. Thus, this aspect of the
job (patient and film identification) should never be taken lightly or done absent-mindedly.
THE CASE OF THE INCORRECTLY LABELLED X-RAYS
A 6-month old infant is admitted to the hospital for a bad cold. The attending physician, listening
with her stethoscope, detects heavy congestion in the left lung. Based on the preliminary exam, she
fills out an X-ray request slip requesting chest X-rays. The radiographer picks up the request,
verifies the entries, and proceeds to label the film. Now, the technologist is used to seeing adult
patents at a vertical chest X-ray unit leaning with the chest against the X-ray film cassette. In this
position, the adult patients left lung is demonstrated on the left side of the film. Infants, less frequent
candidates for chest exams, must be handled differently due to their size. These pint-sized patients
must be placed in the supine position, lying face up on the X-ray film cassette. In this position, the
left lung is, of course, demonstrated on the right side of the film. The X-ray technologist, forgetting
that the baby's body is reversed from the customary orientation, inadvertently marks an "R" on the
upper right-hand side of the film, which, in fact, corresponds to the infant's left lung. Based on the
inaccurately labeled X-rays, the healthy lung is treated and the ailing lung is left unattended. The
baby dies. The parents sue the hospital, the attending physician, and the radiologist. The X-ray
technologist is no longer trusted to the same extent as before, by his supervisor. The unnecessary
death; the adverse publicity for the hospital and the health care team; the cost in terms of time,
money and stress; and erosion of morale are all directly attributable to one incorrectly placed L or R
(see figures 4-21 and 4-22).
MD0961
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