1. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE A TRIAL TOWARDS BEST PRACTICE YU CHI WAI RONALD, RAD I, DR POK OI HOSPITAL

2. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE What is it....... Quality assurance and training program for Digital Radiography in DR, POH Part of the General Radiography Re-engineering initiative promoted by Department Manager of DR in NTWC Focus on radiographic techniques

3. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Targets....... Establish and understand the standard criteria of “Good” images by all radiographers Statistic return of “Good” images compliance in POH. Root cause analysis of suboptimal images with a holistic team/workflow approach.

4. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Our footprints....... Each RAD II was assigned to focus on one examination Establish standard images criteria which were set with reference to the highest theoretically achievable standards (with reference to Radiographic manuals of Merill’s Atlas, Clark’s positioning and the European Guidelines)

5. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Our footprints....... Complied with all the must fulfill criteria will be graded as “GOOD” Failed to comply with ANY must fullfill criteria will be graded as “suboptimal” Screen ALL images of the focused examination and monthy “GOOD” images quality compliance report was generated every six months

6. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Our footprints....... Root causes analysis of “Suboptimal” images with a holistic team / workflow approach Possibility of quality improvement Sharing of practical tips and quality enhancement suggestion in report presentations / discussion sessions

7. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Assumptions....... All images that passed / endorsed by our fellow colleagues are with adequate diagnostic value The “Good” images are excellent / sample images indeed as they are of the highest achievable standards in text book reference X-ray equipments are in proper functional state

8. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Criteria for CXR....... 1Collimation ­­­ Include the whole lung field, i.e, from apices to the costophrenic angle 2No rotation ­­­ distances between sternal ends of the clavicles are the same 3Trachea visibility ­­­ trachea visible in the midline up to the level of T4 4Lung marking visibility ­­­ from the hilum to the periphery of the lung 5Sharpness of the heart, aorta, diaphragm, and lateral costophrenic angles ­­­ all should have sharp outline 6Position of the Scapulae ­­­ Scapulae projected outside the lung field 7Full inspiration unless specify ­­­ either 6 anterior ribs or 10 posterior ribs above the diaphragm

9. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Criteria for CXR.......

10. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Results....... Exam. Region “Good” image % “Suboptimal” image % Major causes of suboptimal images Adult CXR11.788.3 Improper scapulae positioning Insufficient inspiration AXR28.571.75Rotation of spine Paed CXR (age:0-1)4753 Rotation Inadequate inspiration Paed CXR (age:2-12)7723 Rotation Inadequate inspiration Paed CXR (age:13-18)1000 L-spine1585Superimposed of posterior margins of vertebral body Cx spine1288 Mandibular rami overlap the atlas or axis Seventh cervical vertebrae obscured Soft tissue neck6238Collimation too generous to include spinous process

11. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Results.......

12. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Results....... Exam. Region “Good” image % “Suboptimal” image % Major causes of suboptimal images Adult CXR11.788.3 Improper scapulae positioning Insufficient inspiration AXR28.571.75Rotation of spine Paed CXR (age:0-1)4753 Rotation Inadequate inspiration Paed CXR (age:2-12)7723 Rotation Inadequate inspiration Paed CXR (age:13-18)1000 L-spine1585Superimposed of posterior margins of vertebral body Cx spine1288 Mandibular rami overlap the atlas or axis Seventh cervical vertebrae obscured Soft tissue neck6238Collimation too generous to include spinous process

13. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Results....... Exam. Region “Good” image % “Suboptimal” image % Major causes of suboptimal images Adult CXR11.788.3 Improper scapulae positioning Insufficient inspiration AXR28.571.75Rotation of spine Paed CXR (age:0-1)4753 Rotation Inadequate inspiration Paed CXR (age:2-12)7723 Rotation Inadequate inspiration Paed CXR (age:13-18)1000 L-spine1585Superimposed of posterior margins of vertebral body Cx spine1288 Mandibular rami overlap the atlas or axis Seventh cervical vertebrae obscured Soft tissue neck6238Collimation too generous to include spinous process

14. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Results.......

15. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Results....... Exam. Region “Good” image % “Suboptimal” image % Major causes of suboptimal images Adult CXR11.788.3 Improper scapulae positioning Insufficient inspiration AXR28.571.75Rotation of spine Paed CXR (age:0-1)4753 Rotation Inadequate inspiration Paed CXR (age:2-12)7723 Rotation Inadequate inspiration Paed CXR (age:13-18)1000 L-spine1585Superimposed of posterior margins of vertebral body Cx spine1288 Mandibular rami overlap the atlas or axis Seventh cervical vertebrae obscured Soft tissue neck6238Collimation too generous to include spinous process

16. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Discussion....... Radiographers (especially the RAD II) are familiar with the criteria for “Good” images The standard criteria of “Good” images were established and understood by radiographers At least one-tenth of radiographs are of excellent quality Patient’s cooperation and intrinsic condition play a key role in failing the must fulfill criteria

17. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Limitation....... No detail breakdown of percentage failing of must fulfill criteria No account of NG radiographs

18. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Conculsion....... A successful attempt to benchmark general radiography in DR POH Prepared to the journey to Best Practice

19. GENERAL RADIOGRAPHY IMAGE REVIEW EXERCISE Acknowledgement....... All the enthusiastic and devoted radiographers in Department of Radiology, Pok Oi Hospital, especially the RAD IIs.

20. THANK YOU YU CHI WAI RONALD, RAD I, DR POK OI HOSPITAL