Radiographic Technique and Image Evaluation Form
Document radiographic technique and assess image quality in a streamlined, minimal form.
Date of Examination
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Exam Type / View
*
Please Select
Chest PA
Chest Lateral
Abdomen AP
Extremity
Spine
Other
Exposure Factors (kVp / mAs)
*
Patient Positioning
*
Optimal
Acceptable
Needs Improvement
Image Contrast
*
Optimal
Acceptable
Needs Improvement
Image Sharpness
*
Optimal
Acceptable
Needs Improvement
Presence of Artifacts
*
None
Minor
Significant
Overall Image Quality
*
Excellent
Good
Fair
Poor
Comments / Recommendations
Submit Evaluation
Should be Empty: