AJR 2000; 174:578
© American Roentgen Ray Society
Hooks Right, Eyes Left
Brassiere Fasteners as a Clue to Situs
Tamara Miner Haygood
Radiology Associates Corpus Christi, TX 78465-5608
In an ideal world, all radiographs would be properly labeled as to which
side is left and which is right, and patients would never undergo radiographic
examination while wearing extraneous bits of radiopaque clothing. However, in
all the radiology departments where I have ever worked, radiographs are
occasionally either mislabeled or not labeled at all, and various wearable
paraphernalia sporadically appear on the radiographs. Recently, I noticed that
brassiere hook-and-eye fasteners always seem to be oriented with the hooks on
the patient's right and the eyes on the patient's left.
Beginning July 24, 1997, I began recording the arrangement of brassiere
closures on the images I interpreted. For each radiograph obtained of a
patient who wore this piece of apparel, I noted the type of study on which it
was seen, the relative position of the hooks and eyes, and the means by which
the position could be verified. In particular, I looked for the side label and
the position of the liver, stomach bubble, and major cardiovascular
structures. I collected images until January 1, 1998, when I had accumulated
40 cases.
Eight of the 40 studies were abdominal examinations, 16 were chest
radiographs, 15 were anteroposterior views from lumbar spine radiographs, and
one was a shoulder study. In all 40 patients, the brassiere hooks were on the
patient's right; the eyes, on the patient's left. In 38 of the patients, this
positioning could be confirmed by noting the location of the side label. For
the two imaging studies on which labels were not visible, I accessed older
radiographs that did show side labels, thus confirming situs solidis.
In each case, at least one and sometimes all three anatomic markers also
confirmed the positioning of the brassiere fasteners. Positioning was
confirmed by the placement of the liver in 29 patients, by the position of the
stomach bubble in 24, and by the orientation of the cardiovascular structures
in 25. In the year and a half that has elapsed since I ceased formally to
collect cases, I have continued to note the position of brassiere hook-and-eye
assemblies. With a single exception, all hook-and-eyes devices have been
oriented with the hooks on the right, the eyes on the left (Figs.
6,
7,
8).
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Fig. 6. —50-year-old woman with simple arrangement of hook-and-eye brassiere
closures. Single hook (arrow) is engaged with eye that is farthest
right of three eyes. Underwires confirm that hooks and eyes almost certainly
are part of brassiere.
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Fig. 7. —15-year-old girl with complex arrangement of hook-and-eye brassiere
closures. Three hooks are entwined with farthest left eye of three rows of
three eyes. One unused eye has folded over and points caudally
(arrow).
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Fig. 8. —67-year-old woman with jumbled brassiere closures. To determine
orientation of hooks and eyes, ignore extra eyes that are arranged somewhat
randomly. Concentrate on engaged hook-and-eye pairs. Arrow points to one
engaged pair.
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I propose that hook-and-eye brassiere fasteners be used as a largely (but
not perfectly) reliable marker for the patient's right and left. However,
using this marker could cause confusion when a patient's clothing is
disheveled, with the back of the brassiere pulled around to the patient's
front or the brassiere worn inside out. Moreover, hooks and eyes assumed to be
part of a brassiere may actually be part of another type of clothing. Finally,
a brassiere may be made with its fastener reversed.
Acknowledgments
I thank Cheryl Bost (photographer, Christus Spohn
Shoreline Hospital) for producing the photographs.
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