REPEAT FILM ANALYSIS FORM

Document Sample
REPEAT FILM ANALYSIS FORM Powered By Docstoc
					                                                           REPEAT FILM ANALYSIS FORM
       Examination ________________________                                                    Name_______________________________________
       Clinical Site: __________________                 Room: ____________                    Film Type: _________           Film Size: ______
       INSTRUCTIONS: Select one of your own repeated radiographs to critique. In column A, provide all exposure factors and critique your film in
       detail using the indicators as a guide. In column B, provide exposure factors used on the repeat and discuss in detail what corrections you made
       and how the image improved.           A                                                                            B

                                                                                          WHAT SPECIFIC CORRECTIONS DID YOU MAKE?
EXPOSURE FACTORS              Acceptable? Yes               No
                                                                            MANUAL:                    AEC:
MANUAL:                       AEC:
                                                                            MA:                        Cells:   R    L Center ALL
MA:                           Cells:   R    L Center     ALL
                                                                            Time:                      Density Setting:
Time:                         Density Setting:
                                                                            kVp:                       Back-up mA:
kVp:                          Back-up mA:
                                                                            Distance:                  Back-up time:
Distance:                     Back-up time:
                                                                            Grid: Y   N                Actual mAs used:
Grid: Y   N                   Actual mAs used:
                                                                                                       kVp used:
                              kVp used:

                                                                            EXPLAIN TECHNICAL CORRECTION IF ANY MADE:
POSITIONING                          Acceptable? Yes              No
Describe the film AS IT IS:
CR location:

Patient Position:

CR/Film alignment:

Marker and ID:

                                                                            EXPLAIN POSITIONING CORRECTION IF ANY MADE:

CONTRAST:       Acceptable? Yes               No
Describe the film AS IT IS:
Scale of contrast:

Penetration:


DENSITY:        Acceptable? Yes                No
Describe the film AS IT IS: