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Interpretation of diagnostic images is clearly the purview of the radiologist or physician managing the patient’s care. Understanding normal anatomy, common anatomical variants, lifespan changes, and recognizing obvious pathoanatomical features on diagnostic imaging, however, can enhance the nonphysician practitioner’s understanding of the patient’s overall status and, thus, improve clinical reasoning and the overall course of care. Further, understanding correlates of the history, clinical examination, and imaging results are essential elements for the various clinicians interacting with patients over their courses of care.

Additionally, nonphysician providers may also have an important role in patient education, addressing patient comprehension of pathologies, findings on the images, and understanding of the language and taxonomy of radiologists’ reports. This is particularly relevant in the current practice environment wherein patients will often possess or transport their own digital records and have ready access to the images and radiologists’ reports. Lifespan changes, anatomical variants, and nonpathological findings often serve to confuse patients and potentially affect their own internal concepts of their conditions. The impact of this can be negative on patients and can potentially harm outcomes of care or complicate optimal patient management. By assisting patients in understanding image findings and their relevance, the health care practitioner can serve a vital role in the patient care.


The first step in viewing images is establishing the correct orientation of the image. With the majority of images now encountered clinically being digital, the orientation of the image is automated and the viewer must recognize that orientation. “Plain film” hard copy radiographs may still be used in some circumstances. Thus, the process of viewing the image on a view box may still arise. By convention, the film is placed on a view box as if the patient were in the anatomic position (facing toward the reader). This allows the reader to have a relatively constant orientation providing an expected presentation and enhancing the ability to perceive any alteration from the norm to be more obvious. Shadows, image magnifications, image distortions, and overlapping structures are seen in their expected positions and the observer is able to concentrate on seeing the abnormal.

Radiographers have agreed to place L (left) or R (right) anatomic markers onto the film or digital image to indicate whether the image is of a right or left extremity or side of body. A common novice error is to orient the hard copy image to be able to read the R/L designation rather than placement of the image in the anatomic position as the markers will often be placed onto open space and not related to image orientation (e.g., anteroposterior [AP], posteroanterior [PA]) (Figures 3-1 and 3-2). When looking at an extremity, therefore, the image should be placed upright as seen in the anatomic position, except for the hand and foot, which are normally placed with the digits directed upward. Additional markers on ...

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