Revalidating the Clinical Importance of Anatomical Side Markers in Radiography Pre- and Post-Computed Radiography Installation: An Audit Assessing Local Practice at a Referral Hospital

The gold standard in clinical diagnostic imaging is to place a radiopaque anatomical side marker (ASM) prior to exposure; nonetheless, mistakes and errors can be made, resulting in wrong-side surgery, misdiagnoses and medico-legal problems. The goal of computed radiography (CR) with electronic and post- processing image annotation capabilities is to enhance diagnostic imaging practice and reduce these errors. We aim to assess the local practice of image annotation in clinical diagnostic imaging at our center, pre- and post- CR installation and revalidate the clinical importance of ASMs.This cross-sectional retrospective study was conducted between July 2023 to July 2024 at Benue State University Teaching Hospital (BSUTH), Makurdi's radiology department. Data was collected from two departmental sources: physical archive from 2012-2020 and digital archive from 2021-2024, respectively, containing images created before and after CR installation. The data was analyzed using Microsoft Excel 2007 and SPSS version 23 software, with statistical significance determined using a p<0.05 value. Data distribution was displayed using tables, figures, and percentages. The audit recorded no significant difference in the mean age of the patients, which was 40.2years ±18.9 and 41.2years±18.4 respectively, before and after CR installation. Post-CR installation at BSUTH, clinical practice significantly changed regarding ASM use (p=0.000-0.044), with 225(75.0%) and 162(54.0%) ASMs placed in the primary radiation beam, while only 22(3.7%) ASMs obstructed essential anatomy. The incidence of missing markers was generally low 1(0.2%), which is good practice. Prior to CR installation, 52 (17.3%) post-processed and 247 (82.3%) lead markers were used respectively for radiographic image annotation, whereas 300 (100%) digital ASMs were employed exclusively after CR installation, demonstrating an increasing use of technology in radiology. BSUTH implemented a managerial strategy, increasing personnel recruitment 33(45.2%) and employing seven Xray technicians despite a decrease in experienced radiographers. The study comes to the conclusion that, despite not meeting the audit criteria of 100%, the pre- and post-CR installation audit at BSUTH showed a significant shift in anatomical side marker practice, with few missing markers and over 50% compliance with standard ASM placement in the primary radiation beam. Since ASMs are essential for quality control and accurate radiographic identification, their absence on images can lead to patient safety issues, misdiagnoses, wrong-site surgeries, and medico-legal penalties.