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The purpose of this research is to evaluate the level of compliance to standard criteria for postero-anterior chest radiographs in Enugu State University of Science and Technology Teaching Hospital, Parklane Hospital, Enugu. The research took a prospective approach. Data was collected using assessment sheets. 300 chest radiographs were assessed and the age range of patients whose chest radiographs participated in this study was from (1-75) years. Findings of this study showed that, there were greater numbers of male patients 161(53.7%) than female patients 139(46.3%). Good scapular throw off were achieved in majority of the radiographs.  Density differences were witnessed in both lung fields of some radiographs 278(92%). Some of the chest radiographs 6(2%) appeared to be without identification and/or anatomical marker. The medial ends of the clavicles were not equidistant from spinous process in 82(27.3%) of the studied chest radiographs. Improper breathing technique was shown in some radiographs with poor inspirational effort 76(25.3%) which also affected the delineation of the trachea as air was not trapped in the trachea for it to be visible in 16(5.3%) of the chest radiographs. Some of the chest radiographs has the disc spaces of the thoracic vertebrae well delineated 75(25%). 54(18%) chest radiographs showed poor collimation where parts of the chest were cut off and upper part of the abdomen was seen. The apices of the lungs were cut off in 31(10.3%) chest radiographs while the costophrenic angles were not well seen in 46(15.3%) of the chest radiographs. This study also shows that 80(26.7%) chest radiographs were over exposed leading to burn off of vascular patterns especially close to the periphery of the lungs.





Background of study

Radiographic imaging of the chest is the commonest radiographic procedure performed in medical imaging. The routine chest x-ray provides information about the bony frame work of the thorax, its soft tissue, the mediastinum and the lung field. Its importance in the diagnosis of most pulmonary and respiratory diseases and allergies cannot be overemphasized and as such obtaining an image with good diagnostic quality is of great importance.

A chest radiograph is a projection radiograph of the chest, its contents and nearby structures. Chest radiographs are the most common films taken in medicine. Like all methods of radiography, chest radiography employs ionizing radiation in the form of x-rays to generate images of the chest. The mean radiation dose to an adult from a chest radiograph is about 0.02mSv for a PA view. (Fred Et al, 2008). The role of chest radiography has gained increasing importance in trauma cases, routine checkups, disease conditions and metastatic problems. The rationale behind this study is that many faulty diagnoses on chest radiographs may be associated with  inappropriate radiological techniques and  application  and that improvement of imaging quality of chest  radiography benefits not only the patients infected by disease but also those suffering from various  pulmonary disease. Chest radiographs with poor image quality can cause misdiagnoses or require repeated examinations, which in turn causes waste of economic resources and exposing patients to unnecessary radiation.

Owing to the importance of chest radiographs in diagnosis and treatment of diseases great care should be taken to ensure that the images produced are of good diagnostic quality and so quality assurance tests should be carried out in other to ensure that the images produced are of good diagnostic quality.

Quality assurance (QA) is the planned and systematic activities implemented in a quality system so that quality requirements for a product or service will be fulfilled. (Bassy et al, 1991).  It is the systematic measurement comparison with a standard, monitoring of processes and an associated feedback loop that confers error prevention. Quality assurance in chest radiography is a system designed to continuously improve the quality of chest radiographs at a health facility, and it can be achieved through organized efforts by all staff members involved in taking or reading the chest radiograph. It comprises quality control, quality assessment, and quality improvement. Quality control includes all quality control efforts routinely performed by staff at each health facility such as regular maintenance or checking of x-ray equipment, accessory devices and chemicals and consumables. Quality improvement is the process of using the information gained through assessment to improve quality, with the key component of data collection, data analysis, and creative problem-solving. It includes continuous monitoring and evaluation, identifying defects and retaining of staff for the prevention of recurrent problems.  In other words, we can only achieve quality assurance through quality control, quality assessment, and quality improvement.

What is important in the assessment procedure is to seek the source of the problem and to take the steps to improve, so that in the end the quality of the chest radiograph will be improved.

This research is geared towards ascertaining the extent to which chest radiographs produced in Enugu State University of Science and Technology Teaching Hospital, Parklane hospital Enugu conform to standard procedures and technique required for the production of good diagnostic images of the chest.

According to the European Guidelines on quality criteria for diagnostic radiographic images the following criteria must be met for a radiographic image to be said to be of a good diagnostic quality;

  • Performed at full inspiration (as assessed by the position of the ribs above the diaphragm — either 6 anteriorly or 10 posteriorly) and with suspended respiration.
  • Symmetrical reproduction of the thorax as shown by central position of the spinous process between the medial ends of the clavicles.
  • Medial border of the scapulae to be outside the lung fields.
  • Reproduction of the whole rib cage above the diaphragm.
  • Visually sharp reproduction of the vascular pattern in the whole lung, particularly the peripheral vessels.
  • Visually sharp reproduction of the trachea and proximal bronchi.
  • Visually sharp reproduction of the borders of the heart and aorta.
  • Visually sharp reproduction of the diaphragm and lateral costo-phrenic angles.
  • Visualization of the retrocardiac lung and the mediastinum.
  • Visualization of the spine through the heart shadow.


Statement of problem

  • The level of compliance to the standard criteria for chest radiograph of radiographers in Parklane Hospital is not known.
  • A repeat of the chest x-ray is on the high side.
  • Chest x-ray being the most common radiographic projection in the radiology department of Parklane hospital, its qualities have not been ascertained.

Aim of study

  • To know the number of chest radiographs that meets the standard criteria for chest radiographs
  • To know the number of chest radiographs that does not meet the standard criteria for chest radiographs.
  • To know the most occurring fault or problem in the chest radiographs.

Significance of study

  • The result of this work will help radiographers to strictly adhere to the standard technique in order to produce chest radiographs that meet the standard criteria.
  • This study will help outline the main cause of the repeats encountered in chest x-rays.
  • It will also assure an optimum radiographic output with less repeat of chest radiographs and reduced radiation dose to patients.

Scope of study

This study was carried in ESUT teaching hospital, Parklane Hospital Enugu in Enugu state from May 2017 to July 2017

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