Why adding a digital left or right marker can create serious legal and patient-safety issues in radiologic imaging

Label accuracy isn’t a shiny add-on in radiology—it’s the core that keeps diagnoses honest and patient care safe. Imaging isn’t just about pretty pixels; it’s about trust—trust that what you see on the screen truly corresponds to the patient and the body part in question. That trust is built through careful labeling, clear data, and a straightforward workflow. Let me ask you this: what happens when a label gets altered after the shot? A simple marker change can ripple into bigger problems than you’d expect.

Three post-processing moves that can cause trouble

When we talk about post-processing tweaks, there are a few things technologists might be tempted to adjust after the image is captured. Some changes impact the viewer’s understanding in a way that could have serious consequences. Here are the three that come up most often in real-world discussions about safety, accuracy, and accountability:

• A. Adding a digital left (L) or right (R) marker

• B. Electronically changing the field of view

• C. Adding a post-processed time stamp

• D. Not including the patient name and exam date

The correct answer is A: adding a digital L or R marker. Why does this one stand out? Because the left-right marker is the navigational cue for orientation. If you add or alter that marker after the image is taken, you may flip the orientation of the anatomy in the viewer’s mind. A left leg shown as right, or a chest image labeled as the opposite side, isn’t just a small mix-up—it’s a misrepresentation of the patient’s anatomy. In medical imaging, accuracy of labeling isn’t a nicety; it’s a requirement. And misrepresentation can become a legal liability, not to mention a patient safety risk.

That doesn’t mean the other actions are harmless. They can still lead to legal headaches or clinical errors, and they certainly affect clarity and record-keeping.

• B. Changing the field of view (FOV) electronically

• C. Adding a time stamp after the fact

• D. Omitting patient name and exam date

These moves can confuse or mislead, but they don’t alter the anatomical orientation in a way that directly misinform the viewer about which side is which. A different FOV might crop out what you need to compare with prior studies. A post-processed time stamp could cause timeline mix-ups, especially in busy departments. Leaving out patient identifiers is a privacy and documentation problem. Each of these can contribute to miscommunication or improper care, but they don’t carry the same ethical and legal weight as mislabeling the side of the body.

Why mislabeling is such a big deal

Think of the labeling system as a map. If the map shows the wrong destination, the journey goes off course. In radiology, that wrong destination translates to the wrong part of the body being treated or operated on, which can lead to incorrect diagnoses, inappropriate interventions, or even wrong-site surgery. The integrity of the image and its metadata is what makes it a trustworthy record in the patient’s medical history. If the L/R marker is added or altered after the shot, it undermines that trust. The consequences aren’t just theoretical: they can spark legal questions about professional responsibility, patient safety, and the credibility of the imaging team.

On the other hand, we’re also balancing reality: imaging workflows aren’t perfect, and human error happens. A marker might be misplaced during the initial capture, or a later viewer might misinterpret a label if the image wasn’t labeled consistently with prior studies. The point is to minimize opportunities for error and to keep the labeling transparent and accurate.

A quick tour of the other pitfalls—and why they matter

• FOV changes: When you widen or tighten the field of view after the fact, you might exclude relevant anatomy or context. This isn’t just a cosmetic tweak; it can alter what a clinician believes they’re seeing, which can affect diagnosis or decisions. It’s not inherently malicious, but it needs a clear, documented rationale and a record of the original acquisition.

• Time stamps: A post-processed timestamp can help with chronology, but if it diverges from the actual capture time, it creates a mismatch across the patient’s imaging timeline. In fast-paced settings, this can lead to confusion in critical moments, especially when multiple images from different modalities are being contrasted.

• Missing patient name and exam date: Identity and date are the anchors of a patient’s record. Without them, images can drift into misfiled spaces, become hard to find, or even be paired with the wrong person. Privacy policies and audit trails aside, clear identifiers reduce the risk of accidental exposure or wrong patient interactions.

Keeping the focus on patient safety—and your career

So, what does all this mean for day-to-day work? It boils down to a simple habit: preserve authenticity. The marker is not a decorative feature; it’s a functional element that communicates a precise orientation. Any post-processing step that could cast doubt on that orientation deserves a hard look before it’s applied—and ideally, should never be needed in the first place.

Here are practical moves that help keep imaging authentic and compliant:

• Treat L/R markers as immutable after acquisition. Do not add or re-create them later. If you notice a labeling error, report it and retrieve the original unaltered image set rather than patching it in the post-processing stage.

• Establish a clear labeling protocol. Use consistent conventions across all imaging modalities and workstations. A shared standard reduces the chance of mismatches when images flow through PACS and electronic health records.

• Validate orientation with prior studies. When possible, compare to the patient’s earlier images to confirm that the anatomy aligns with the expected side. If there’s any doubt, pause and verify with a supervisor or radiologist.

• Keep patient identifiers intact and documented. Identity, date of exam, and study details should be visible and traceable. This isn’t just about compliance; it’s about ensuring the right patient gets the right care.

• Maintain an audit trail. Every adjustment should be logged, with who made it and why. Transparency matters when questions arise later on.

• Use DICOM standards and best practices for metadata. Rely on built-in checks and system prompts to minimize manual alterations that could compromise data integrity.

A practical mini-checklist you can tuck into your daily routine

• Before you finalize any image set, confirm the L/R marker corresponds to the anatomy you captured.

• If a session demands edits, document the reason, keep the original file, and use non-destructive editing whenever possible.

• Verify that patient name, date, and exam details are present and accurate.

• Cross-check with prior imaging to ensure orientation and landmarks match.

• When in doubt, pause and escalate—it's better to double-check than to risk a mislabeling error being discovered later.

A moment of reflection—and a gentle reminder

Radiology often moves at a brisk pace. There are moments when speed is essential, and moments when accuracy must lead the way. The marker on an image is a small thing, yet it holds a big responsibility. If you’ve ever wondered how a tiny label can ripple through patient care, you’ve reflected the core ethic of radiology: precision paired with integrity.

To wrap up, the three post-processing actions can be framed like this: mislabeling with an extra digital L/W marker is the one that most directly distorts anatomy and can raise serious legal concerns. The other changes—adjusting the field of view, adding a timestamp, or omitting basic patient details—still matter and can complicate care, but they don’t carry the same direct risk of misrepresenting the body’s anatomy. In a field built on trust, authenticity is the baseline, and good habits are the armor.

If you’re ever uncertain, here’s a simple philosophy: preserve the original image, preserve the truth it carries, and preserve the patient’s safety. That approach doesn’t just protect patients; it protects you, your reputation, and the clinical team you’re part of.

Want a quick mental note to carry through your day? Remember this: the left-right marker isn’t optional flair. It’s the compass that keeps the image honest. Keep it intact, keep it accurate, and you’ll be doing more than getting through the workflow—you’ll be upholding the standard that makes radiology trustworthy for everyone who depends on it.