1. The Quality of Abdominal Radiographs At East Surrey Hospital
Dr. Hooria Cheema (Foundation Year 1 Doctor)
Department of Colorectal Surgery, Surrey & Sussex Healthcare NHS Trust
Background
Charts 4-7: Number of radiographs including the various anatomical landmarks
Abdominal radiographs are commonly requested for patients with abdominal symptoms, especially on surgical wards. The diagnostic usefulness of the investigation can be limited by the quality of the radiograph including inadequate exposure or the inability to cover appropriate anatomical landmarks.
Exposure may need to be adjusted according to patient size and more than one radiograph may need to be performed to image the entire abdomen.
The Royal College of Radiologists recommends plain abdominal radiography for only a limited number of indications. Therefore when it is performed, the relevant anatomy should be included to maximise the diagnostic information obtained.
According to ACR 2009 guidelines on abdominal radiography:
All abdominal radiographs which are performed should include the pubic symphysis and both hemi-diaphragms, and extend sufficiently laterally to ensure that all bowel is included as well as both flanks.
The target for this is 95% of patients.
The aim of this audit is to examine the number of examinations which adhere to the ACR guidelines for abdominal radiography technique in adult patients at East Surrey Hospital.
Methods
This was a retrospective analysis of the last 50 plain abdominal radiographs performed. They were examined against the standard for including all the required anatomical landmarks and the quality was rated on a scale of 1 to 3 (good, adequate, poor). For cases where the initial film does not meet standard the clinical indication for the examination was checked.
Conclusion
Outcomes
This audit found that only 82% of abdominal radiographs met the RCR standards for anatomical landmarks. The breakdown of these results are as follows:
52% included the pubic symphysis
22% included both hemidiaphragms
68% included the full bowel
48% included both flanks
Overall the quality of radiographs in terms of exposure was not adequate. Out of the 50, only 33 had an exposure quality rating of good. 10 radiographs were adequately exposed and 7 were poor in quality.
Chart1: Number of radiographs which included all required anatomical landmarks
Standard
Result
95% of patients
82% of patients
Recommendations
Chart 2: The quality of abdominal radiographs in terms of exposures
The goal is to improve the quality of abdominal radiographs at East Surrey Hospital. This involves familiarising the radiographer with the guidelines set by the RCR. This can be achieved by displaying the guidelines in the radiology department. We will review and re-audit in 6 months time.
Chart 3: The indications for abdominal radiographs
References
American College of Radiology: ACR practice guideline for the performance of abdominal radiography: 2006www.acr.org/secondarymainmenucategories/quality_safety/guidelines/pediatric/abdominal_radiography.as
Royal College of Radiologists. Making the Best Use of Clinical Radiology Services. Referral Guidelines. Sixth edition. London: RCR,
Please send all correspondence to Dr Hooria Cheema, East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Canada Avenue, Redhill, Surrey RH1 5RH