Whose X-Rays Are These?

Some person's films come into the office for review. At one time, there was a sticky-note on them to identify the owner of the films and the reason for the films to be reviewed. Who knows what happened to the note? No one except the person who wrote the patient's name on the ID card can decipher what was written in the ID box. The films are read with a blank space for identifying the patient and referring doctor. Someone calls from the office that sent the films and states: "I think those were so and so's films. We need them right away. This is a litigated case and we go to court tomorrow."

The x-ray report notes significant ligamentous instability at several motor units. There is just one problem. This patient had previous films which were not reviewed but were, however, appropriately labeled. The post-accident films were not labeled well, and it was impossible to discern the handwriting in the ID box. The defendant's lawyer would not allow the admission of the report or the films as supportive evidence of this patient's injuries. He suggested that these films may not belong to this patient. In brief, to shorten this story, the films were repeated. Luckily or unluckily, the patient's film demonstrated similar instability on the same areas described on the previous report.

This is a true story. The names have been omitted to protect the guilty, and the story has been abbreviated to protect the innocent. It is extremely important to label films. The label should be permanent and not easily tampered with. If you are presently not labeling your films, start now. There are numerous methods available for marking x-ray films. Translucent identification cards are one of the most common methods. The information is typed onto the card (please don't write the information unless you or one of your staff has perfect penmanship) and then transferred photographically to the x-ray film using a film identification printer before processing the film.

The older method, but still just as efficient, is the aluminum marker plate. It has grooves for the placement of lead numbers and letters for labeling the film when the exposure is performed on the patient.

The most advanced method is a Kodak X-omatic identification camera in conjunction with Kodak X-omatic cassettes. The cassette is inserted into the camera, a slide cover on the cassette is opened and the identification exposure is made. The exposure is automatically timed so that you can never over or underexpose the marker.

What should be included on the ID marker? Proper identification includes:

• patient's name, last and first;
• patient's age (birth date is even better);
• patient's gender;
• date of examination;
• location where the examination was performed;
• name of the referring doctor.

Many institutions use an identification number, case number or social security number to identify the patient. This is useful for filing and in case names are the same.

The use of right and left markers is extremely important. There should be no question about which side of the body has the pathology. The use of markers to designate the patient's position and special projections, i.e., upright, recumbent, right and left obliques, is also strongly recommended.

The time spent performing the task of identifying your films will save you the embarrassment of criticism in court.