Assessment Of Paediatric X-Ray Examination Practices In Two Tertiary Health Institutions In Enugu Metropolis

Justification and optimization are the key principles in the protection of patients exposed to ionization radiation from diagnostic purposes. This is more important in the imaging of children because they are more susceptible to the effect of ionizing radiation and they have longer life expectancy compared to adults. As a result of this, there is also recent requirement for diagnostic radiology department to demonstrate compliance with these principles. A study was carried out to assess and compare the paediatric x-ray examination practices in two tertiary institutions in Enugu metropolis, UNTH and NOHE, with the aim of determining the frequency of paediatric x-ray examinations, quality of radiographic techniques and image quality, practice of image quality criteria and feedback to staff, and causes of film reject, The departmental registers were used to determine the frequency of common paediatric x-ray examinations. Retrospectively, 40 radiographs were collected from the medical records of the two radiological departments studied, to determine the quality of radiographic techniques and image quality, while 34 rejected radiographs were collected over a period of 3 weeks at UNTH to determine the causes of film rejects in this department. Some radiographers were interviewed to ascertain the practice of image quality audit. All the radiographs collected were assessed by a radiographer from each department. The data was analyzed and the result showed that the paediatric x-ray examination request patterns are not the same in the two departments studied. While UNTH has high number of chest request which accounts 62.1%, with higher percentage of males (57.7%) under the age groups of 0-5 years, NOHE has extremities as the most common requested x-ray examination which accounts 71.2%, with higher percentage of females (50.5%) but higher percentage of males are under the age group of 0-5 years (41.4%). In both departments, more than half of films of the film assessed satisfied most of the European image criteria; 69.3% at UNTH displayed excellent radiographic techniques, and 65.7% at NOHE. The image quality audit and feedback to staff is not fully practiced. Also, the common cause of film reject at UNTH is “underexposure” which accounts 52.94% of the rejected radiographs. The result of the hypotheses stated showed that examination type/projection requested affects poor radiographic techniques and image quality in each department and there is a significant difference in some radiographic techniques between UNTH and NOHE. With all these findings, there is need for self-audit and re-evaluation of procedures where necessary in both departments studied.

TABLE OF CONTENTS Title Page Dedication Approval Page Certification Acknowledgement Table of Contents    List of tables List of figures Abstract
CHAPTER ONE: INTRODUCTION 1.1 Background of study 1.2 Statement of the problems 1.3 Purpose of the study 1.4 Significance of the study. 1.5 Statement of hypotheses 1.6 Scope of the study 1.7 Literature review
CHAPTER TWO: THEORITICAL BACKGROUND 2.0 Paediatric radiography. 2.1 Child development and psychological considerations 2.2 Environment 2.3 Challenges 2.4 Paediatric radiation protection issues 2.5 Equipments 2.6 Justification of radiological exposures 2.7 Optimization for paediatric radiation protection 2.8 X-Radiation 2.9 General recommendations for paediatric radiology                                                                                                                                               CHAPTER THREE: RESEARCH METHODOLOGY 3.1 Research design 3.2 Target population 3.3 Sources of data collection 3.4 Method of data collection. 3.5 Method of data analysis
CHAPTER FOUR: DATA ANALYSIS AND PRESENTATION 4.1 Frequency distributions of common paediatric x-ray examinations. 4.2 Radiographic techniques and image quality 4.3 Image quality audit 4.4 Causes of film reject
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS 5.1 Discussion. 5.2 Summary of findings 5.3 Recommendations 5.4 Limitations of the Study 5.5 Areas of Further Research References  Appendix 

LIST OF TABLES Table 1: Radiological examination/projections included in the study Table 2: Image criteria for anteroposterior/posteroanterior chest examinations from the, “European guidelines on quality criteria for diagnostic radiographic images”. Table3: A graded scoring system developed to highlight the differences between the two departments. Table 4a: Monthly distributions of common paediatric x-ray examinations at UNTH Table 4b:  Monthly distribution of common paediatric x-ray examinations at NOHE Table 5a: Age/gender distribution for common paediatric x-ray examinations at UNTH. Table 5b: Age/gender distribution for common paediatric x-ray examinations at NOHE. Table 6: Percentage of films displaying poor radiographic techniques with regard to radiation protection and image quality Table 7: Percentage of films displaying excellent radiographic techniques with regard to radiation protection and clinical information displayed. Table 8: Comparison between examination type and poor radiographic techniques Table 9: Comparison between examination type/projection and image quality      Table 10: Comparison of radiographic techniques and image quality between UNTH and NOHE                                       Table 11: Image quality audit practice at UNTH and NOHE Table 12: Frequencies of common causes of film reject in paediatric examination practices in UNTH.        
LIST OF FIGURES Figure I: Frequency chart for Paediatric x-ray examination UNTH Figure II: Frequency chart for routine paediatric x-ray examinations in NOHE. Figure III: Percentage of films which satisfies the European Image Criteria.