Ten Commandments of Emergency Radiology

The ‘Ten Commandments of Emergency Radiology’ according to Touquet et al (1995):

  • Treat the patient, not the radiograph
  • Take a history and examination before ordering a radiograph
  • Request a radiograph only when necessary
  • Never look at a radiograph without seeing the patient, and never see a patient without looking at the radiograph
  • Look at every radiograph, the whole radiograph, and the radiograph as a whole
    – remember the ABCS: alignment/ adequacy, bones, cartilage (joints) and soft tissues.
  • Re-examine the patient when there is an incongruity between the radiograph and the expected findings
  • Remember the rule of twos
    — two views, two joints (above and below the injury), two sides (for comparison), two occasions (may need a follow up x-ray) and two radiographs (compare to a normal radiograph)
  • Take radiographs before and after procedures
  • If a radiograph does not look quite right ask and listen: there is probably something wrong.
  • Ensure you are protected by fail safe mechanisms
    — establish a quality control system


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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