In any appraisal of a radiograph the following areas should be assessed:

Projection is that requested

Identification
Correct name, see request card
Correct dept ID (Hospital information & Patient Number)
Date
Is it legible?
Does it obscure any detail on the radiograph?

Markers
Has the correct marker been applied and at the time of exposure?
Is it in the correct position?
Is it away from area of examination?
Is it legible?

Area Under Examination
Limits of the examination superiorly, inferiorly and lateraly / medialy
Has all relevant anatomy been included?
Name relevant anatomy.

Projection
Is it the correct projection?
Assess projection for:
Patient position
Correct centring point
Is there need for further projections?
If YES, why and what projections are necessary?

Collimation
Does it include all the relevant information?
Is the field too large/too small?
What corrections should be made if necessary?

Image Quality
Is there sufficient density and penetration to visualise the required bony and/or soft tissue structures?
Is there sufficient radiographic contrast to visualise the required bony and/or soft tissue structures of interest?
Is there any unsharpness? of which type?
Clarify reasons for negative or positive answer.
Could the image quality be improved?
How?
Are there any avoidable artefacts?  If YES, describe.

Anatomical Variation of Gross Pathology
Describe any anatomical variation or gross pathology demonstrated on the radiograph.
1) Congenital abnormality
2) Trauma, fracture etc.
3) Degree of arthritic or other degeneration relative to age
4) Distinct pathology, eg pagets diseaese, osteomyelitis etc.
5) Carcinoma primary / secondary

Diagnostic Acceptability
Does this radiograph require a repeat?
If YES, why?
If NO would you describe the radiograph as a ‘gold standard’ for this examination?
State any improvements that could be made, if it is not at gold standard.
Is there a need for further projections?
If YES, why and what projections are necessary?