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Guidelines in the Proper Use of Lead Markers in Radiographic Examinations

Every radiographic examinations has its own specific rules or specifications to follow, as well as the use of various cassettes, which contains barcode labels. These rules or specifications may vary form one patient to another or from one requesting physician to another. Whatever the instructions or guidelines they are, there are still general rules or guidelines that must be followed.

I have listed below the:

Guidelines in the Proper Use of Lead Markers in Radiographic Examinations 

1. Left or right markers must always be used in all films.
2. Markers should be placed on the cassette where they will be clearly seen on the radiograph but not obscuring the required anatomy.

a. Markers should not be placed over the patient’s identification number
b. Markers should be placed within the collimated film.
c. Markers should be placed away from the area where lead shielding on the px or the table may obscure the markers.

3. Markers should be placed appropriately to identify the px’s right or left side.
4. When the extremities and heart or shoulder girdles are being radiographed, markers should be placed on the lateral side of the body part.
5. When one film is being used for two projections of the same body parts, only one of the projections must be marked.
6. If bilateral projections are positioned in one film both left and right markers should be used to identify the corresponding sides.
7. Auxiliary markers should be used whenever possible and positioned away from the critical anatomy.
8. When lateral decubitus projections are performed, a marker indicating the side-up should be place on the upside of the cassette away from any anatomy of interest.
9. For lateral projection, a marker indicating the side closest to the film should be used.
10. When the spine is being radiograph in the lateral position, markers should be placed on the cassette anterior to the spine to be clearly visualized.
11. When the chest, abdomen or spine is being radiograph in an oblique position, the side nearest the film is generally marked. So when both sides are on the film, either marker can be used.

NOTE: The lead marker may also be used to identify the anatomical structures seen on the projection.


The author is a Radiologic Technologist, currently in the academic field, hoping to mold and produce future Radiologic Technologists who will be theoretically and technologically competent.

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