ABSTRACT Medical image quality is the attribute of an image that affects the accuracy with which diagnostically useful detail can be seen on it. Poor quality radiographs can impede diagnosis and lead to increased radiation dose to patients through repeat examinations. Some guidelines have been laid down by the European Union in order to determine the quality of lumbar spine radiographs. The aim of this research was to evaluate the image quality of lumbar spine radiographs produced in a diagnostic centre using European Union guidelines (CEC criteria) while also checking the rate of fulfilment of some radiographic technical parameters. A retrospective study was done of 105 AP lumbar spine radiographs and their corresponding lateral radiographs all obtained from the electronic archive of the centre. The image quality of the radiographs was independently evaluated by two experienced radiographers by checking the rate of fulfilment of CEC criteria, also the fulfilment of radiographic technical parameters was also noted. Inter-reader reliability between the two readers was determined by Cohen Kappa statistics. Descriptive statistics such as frequency and percentages were generated from the result and were analyzed using statistical package for social sciences (version 21). The mean Kappa value showing inter-reader agreement for AP and lateral lumbar spine radiographs was observed to be 0.61 and 0.62 respectively, this indicated a substantial agreement between the two readers. The score/rating for a radiograph was determined by the mean value of the two readers’ score/rating for that radiograph. The AP radiographs had a 58.9% quality in terms of compliance to the CEC criteria while lateral radiographs had a 53.5% quality. In terms of gender, male radiographs had a better image quality than female radiographs. For the technical parameters, patient rotation was an area of concern in lateral radiographs as 51.4% of them were rotated, both AP and lateral radiographs were not adequately penetrated. This result showed the need for the implementation of a quality control system in the institution and also the need for proper optimisation of radiographic procedures like patient positioning and technique in order to produce better images.
CHAPTER ONE
INTRODUCTION
- Background of study
The vertebral column is a series of bones in the posterior part of the human body that contains the spinal cord. It consists of thirty three (33) bones (vertebrae) which extend downwards from the occiput. The vertebral column is divided into 24 presacral vertebrae: seven (7) cervical, twelve (12) thoracic and five (5) lumbar, followed by the sacrum (five fused sacral vertebrae) and the coccyx (four fused coccyges vertebrae) (Anne & Allison, 2014).
The lumbar spine is the third region of the vertebral column; it is located below the cervical and thoracic vertebrae and above the sacrum. It contains five (5) vertebrae denoted as L1, L2, L3, L4 and L5.
The lumbar spine is vulnerable to many disorders like fractures, spondylolysis, spondylolisthesis, herniated disc etc. (Andrea, 2005). All these necessitate the need for a lumbar spine radio-graph for proper diagnosis.
A radio graph is an image that is produced by means of an x-ray on a sensitive plate or film (Chesney & Chesney, 1984). A lumbar spine radio graph is a radio graphic image of the lumbar spine. It can be produced with the patient lying supine (Antero-posterior projection) or lying by the side (Lateral projection) (Whitley et al., 2005). Every radio graphic.
