GENERAL RADIOGRAPHY
IMAGE REVIEW
EXERCISE
A TRIAL TOWARDS BEST PRACTICE
YU CHI WAI RONALD,
RAD I, DR
POK OI HOSPITAL
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
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.
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)
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
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
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
GENERAL RADIOGRAPHY
IMAGE REVIEW EXERCISE
• Criteria for CXR.......
1
Collimation Include the whole lung field, i.e, from
apices to the costophrenic angle
2
No rotation distances between sternal ends of the
clavicles are the same
3
Trachea visibility trachea visible in the midline up to
the level of T4
4
Lung marking visibility from the hilum to the
periphery of the lung
5
Sharpness of the heart, aorta, diaphragm, and lateral
costophrenic angles all should have sharp outline
6
Position of the Scapulae Scapulae projected outside
the lung field
7
Full inspiration unless specify either 6 anterior ribs or
10 posterior ribs above the diaphragm
•
GENERAL RADIOGRAPHY
IMAGE REVIEW EXERCISE
Results.......
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
GENERAL RADIOGRAPHY
IMAGE REVIEW EXERCISE
• Limitation.......
 No detail breakdown of percentage failing of must
fulfill criteria
 No account of NG radiographs
GENERAL RADIOGRAPHY
IMAGE REVIEW EXERCISE
• Conculsion.......
 A successful attempt to benchmark general
radiography in DR POH
 Prepared to the journey to Best Practice
GENERAL RADIOGRAPHY
IMAGE REVIEW EXERCISE
• Acknowledgement.......
 All the enthusiastic and devoted radiographers in
Department of Radiology, Pok Oi Hospital,
especially the RAD IIs.
THANK YOU
YU CHI WAI RONALD,
RAD I, DR
POK OI HOSPITAL