Why was this image rejected? Spot the cause, learn the fix.
Anatomy of interest cut off — apices not included.
IR positioned too low or CR centered below T7.
Raise IR until top is 1.5 in above shoulders; re-center to T7.
Cortical margins blurred — non-diagnostic.
Long exposure, patient breathing or moving.
Coach breath-hold, drop mAs and raise kVp, use shortest exposure time possible.
Lateral joint space closed between talus and fibula.
Foot turned in but leg not rotated from the hip.
Rotate the whole leg internally 15–20° from the hip.
SC joints asymmetric to spine; heart shifted.
Shoulders not square to the IR.
Even weight on both feet, square shoulders, recheck SC joints.
Joint space closed, distal femur clipped.
CR placed over patella instead of joint space.
Center ½ in below the patellar apex with 0–5° cephalic CR.
Metallic chain superimposes mediastinum.
Patient did not remove jewelry.
Always check for jewelry, hair clips, snaps, bra wires before exposure.
Image is not legally valid without the correct anatomical side marker.
Marker placed off the IR or wrong side used.
Place lead marker inside collimated field, on correct side, before exposure.
Carpals overlap — scaphoid and lunate undiagnostic.
Fingers fully extended flattened the carpal arch.
Slightly flex fingers until palm just lifts off the IR.
C7/T1 junction obscured by shoulders — cannot clear C-spine.
Shoulders not depressed; cannot clear collar without C7 visualization.
Pull arms down without rotating spine; if still obscured, perform Swimmer's projection.
Sinuses obscured by petrous bones — cannot assess for fluid level.
Insufficient chin extension (OML <37° to IR).
Extend chin further so the mentomeatal line is perpendicular to the IR.
Legs externally rotated — femoral necks foreshortened.
Feet allowed to fall laterally; no immobilization.
Internally rotate legs 15–20° from the hip and immobilize with sandbags.