Chapter 3
APPENDIX II



EXAMPLES OF IMAGE QUALITY ASSESSMENT FORMS

Face and sinuses

Spine

Chest, HRCT

Liver and spleen

Osseous pelvis


FACE AND SINUSES

 Name of radiologist/radiographer: ________________________________________

Patient number: ____________________       Hospital code: ____________________


Image quality criteria		 Sequence 1 Sequence 2 Total examination
Yes No Yes No Yes No
Visualization of
  1. Entire face from palate to the top of the frontal sinus
            
  1. Vessels after intravenous contrast media
            
Critical reproduction
  1. Visually sharp reproduction of the cortical and trabecular bone structures
            
  1. Visually sharp reproduction of the frontal sinuses
            
  1. Visually sharp reproduction of the sphenoid sinuses
            
  1. Visually sharp reproduction of the orbitae
            
  1. Reproduction of the globe, optic nerve and orbital muscles
            
  1. Visually sharp reproduction of the ethmoid
            
  1. Visually sharp reproduction of the maxilla and its sinuses
            
  1. Visually sharp reproduction of the nasal cavity
            
  1. Visually sharp reproduction of the rhinopharynx
            
It is important for every criterion to evaluate if it is fulfilled or not. If a criterion cannot be evaluated it should be clearly marked by NA in the yes box.

General assessment:
  • Acceptable noise
 *
  • Acceptable spatial resolution
 *
  • Diagnostic acceptability
 #


* + optimum; ^ too much; v too little
# 1: fully acceptable; 2: probably acceptable; 3: only acceptable under limited conditions; 4: unacceptable (give reasons)


Comments___________________________________________________________________


VERTEBRA AND PARAVERTEBRAL STRUCTURES

 Name of radiologist/radiographer: ________________________________________

Patient number: ____________________       Hospital code: ____________________


Image quality criteria		 Sequence 1 Sequence 2 Total examination
Yes No Yes No Yes No
Visualization of
  1. The entire region of suspected pathology
            
  1. Vessels after intravenous contrast media
            
  1. Spinal cord and nerve roots after intrathecal injection of contrast media (CT-myelography)
            
Critical reproduction
  1. Visually sharp reproduction of the cortical and trabecular vertebral bone
            
  1. Visually sharp reproduction of the intervertebral joints
            
  1. Visually sharp reproduction of the intervertebral disk profiles
            
  1. Visually sharp reproduction of the intervertebral radicular canals
            
  1. Reproduction of thecal sac
            
  1. Visually sharp reproduction of the spinal cord or canda equina (CT- myelography)
            
  1. Reproduction of the paravertebral ligaments
            
  1. Visually sharp reproduction of the paravertebral muscles
            
  1. Reproduction of the main vessels and perithecal venous plexuses after intravenous contrast media
            
It is important for every criterion to evaluate if it is fulfilled or not. If a criterion cannot be evaluated it should be clearly marked by NA in the yes box.

General assessment:
  • Acceptable noise
 *
  • Acceptable spatial resolution
 *
  • Diagnostic acceptability
 #


* + optimum; ^ too much; v too little
# 1: fully acceptable; 2: probably acceptable; 3: only acceptable under limited conditions; 4: unacceptable (give reasons)


Comments___________________________________________________________________


CHEST, HRCT

 Name of radiologist/radiographer: ________________________________________

Patient number: ____________________       Hospital code: ____________________


Image quality criteria		 Sequence 1 Sequence 2 Total examination
Yes No Yes No Yes No
Visualization of
  1. Entire field of lung parenchyma
            
Critical reproduction
  1. Visually sharp reproduction of the lung parenchyma
            
  1. Visually sharp reproduction of pulmonary fissures
            
  1. Visually sharp reproduction of secondary pulmonary lobular structures such as interlobular arteries
            
  1. Visually sharp reproduction of large and medium sized pulmonary vessels
            
  1. Visually sharp reproduction of small pulmonary vessels
            
  1. Visually sharp reproduction of large and medium sized bronchi
            
  1. Visually sharp reproduction of small bronchi
            
  1. Visually sharp reproduction of the pleuromediastinal border
            
  1. Visually sharp reproduction of the border between the pleura and the thoracic wall
            
It is important for every criterion to evaluate if it is fulfilled or not. If a criterion cannot be evaluated it should be clearly marked by NA in the yes box.

General assessment:
  • Acceptable noise
 *
  • Acceptable spatial resolution
 *
  • Diagnostic acceptability
 #


* + optimum; ^ too much; v too little
# 1: fully acceptable; 2: probably acceptable; 3: only acceptable under limited conditions; 4: unacceptable (give reasons)


Comments___________________________________________________________________


LIVER AND SPLEEN

 Name of radiologist/radiographer: ________________________________________

Patient number: ____________________       Hospital code: ____________________


Image quality criteria		 Sequence 1 Sequence 2 Sequence 3 Total examination
Yes No Yes No Yes No Yes No
Visualization of
  1. Entire liver
                
  1. Entire spleen
                
  1. Vessels after intravenous contrast media
                
Critical reproduction
  1. Visually sharp reproduction of the liver parenchyma and intrahepatic portal veins
                
  1. Visually sharp reproduction of the liver veins
                
  1. Visually sharp reproduction of the structures of the liver hilus
                
  1. Visually sharp reproduction of the common hepatic duct
                
  1. Reproduction of the ductus choledochus (common bile duct) in the pancreatic parenchyma
                
  1. Reproduction of the gallbladder wall
                
  1. Visually sharp reproduction of the splenic parenchyma
                
  1. Visually sharp reproduction of the splenic artery
                
  1. Visually sharp reproduction of the extrahepatic portal vein system including v. lienalis and v. mesenterica sup.
                
  1. Visually sharp reproduction of the aorta and inferior vena cava
                
  1. Visually sharp reproduction of the origin of the coeliac trunk
                
  1. Visually sharp reproduction of the mesenteric artery
                
It is important for every criterion to evaluate if it is fulfilled or not. If a criterion cannot be evaluated it should be clearly marked by NA in the yes box.

General assessment:
  • Acceptable noise
 *
  • Acceptable spatial resolution
 *
  • Diagnostic acceptability
 #


* + optimum; ^ too much; v too little
# 1: fully acceptable; 2: probably acceptable; 3: only acceptable under limited conditions; 4: unacceptable (give reasons)


Comments___________________________________________________________________


OSSEOUS PELVIS

 Name of radiologist/radiographer: ________________________________________

Patient number: ____________________       Hospital code: ____________________


Image quality criteria		 Sequence 1 Sequence 2 Total examination
Yes No Yes No Yes No
Visualization of
  1. Whole pelvic ring
            
  1. Hip(s) including the trochanter region
            
  1. Sacroiliac joints
            
  1. Pubic symphysis
            
Critical reproduction
  1. Visually sharp reproduction of the pelvic bones
            
  1. Visually sharp reproduction of the hip joint(s)
            
  1. Visually sharp reproduction of the sacroiliac joints
            
  1. Visually sharp reproduction of the pubic symphysis
            
  1. Visually sharp reproduction of the pelvic musculature
            
It is important for every criterion to evaluate if it is fulfilled or not. If a criterion cannot be evaluated it should be clearly marked by NA in the yes box.

General assessment:
  • Acceptable noise
 *
  • Acceptable spatial resolution
 *
  • Diagnostic acceptability
 #


* + optimum; ^ too much; v too little
# 1: fully acceptable; 2: probably acceptable; 3: only acceptable under limited conditions; 4: unacceptable (give reasons)


Comments___________________________________________________________________