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Markers and annotation (Rad specific)


Radiographic images are permanently labelled at the time of exposure to indicate patient orientation and uniquely identify the MRT performing the procedure


+ Marking images at the time of exposure

  • Markers in radiography provide important information to those viewing the image:
    • Patient identifiers
    • Marker of right/left side
    • Other aspects of orientation (supine, prone, etc.)
    • Unique MRT identifier


  • Markers placed at the time of exposure become a permanent part of the image, which is important for:1
    • Reducing the chance of error (e.g., wrong side identified)2
    • Reliable transmission to PACS
    • Confidence in future consultation/ investigation


  • Digital markers (annotation) is not a suitable substitute for image marking at time of exposure.

+ Important considerations

  • Markers may be important if the examination is to be used in a court case.
    • Images that include personal identification markers allow the possibility of MRT testimony and may lend credibility to his or her expertise1


  • Digital right and left markers may not be admissible in legal proceedings, since they are not permanent markers:1
    • Images may be marked anywhere
    • Images may be flipped
    • Image layout can be altered

+ Additional annotation

  • Additional annotation can be used to provide further appropriate/relevant information.
    • Annotation is not a replacement for markers
    • This information can complement the markers present, identifies issues, and aid in the interpretation of the image
    • These additional notes may be added at the time of exposure or in post processing

+ References

  1. Carter CE, Veale BL. Digital Radiography and PACS. Revised Reprint, 1st Ed. St. Louis, MO: Mosby Elsevier; 2010.
  2. Herrmann TL, Fauber TL, Gill J, et al. Best practices in digital radiography. ASRT White Paper. Available at: Accessed February 22, 2013.

Related guidelines



April 18, 2013


Canadian Association of Medical Radiation Technologists
85 Albert St, Suite 1000, Ottawa, ON, K1P 6A4
phone: 613 234-0012 / 800 463-9729
fax: 613 234-1097