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 fulfillment 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 fulfillment of CEC criteria, also the fulfillment 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.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
ABSTRACT vi
TABLE OF CONTENTS vii
LIST OF ABBREVIATIONS x
LIST OF TABLES xi
LIST OF FIGURES xii
CHAPTER ONE:INTRODUCTION
1.1 Background of study 1
1.2 Statement of problem 5
1.3 Aim of study 5
1.4 Objectives of study 5
1.5 Scope of study 6
1.6 Significance of study 6
CHAPTER TWO: LITERATURE REVIEW
2.1 Empirical review 7
2.2 Theoretical background (anatomy) 9
2.2.1 Anatomy of the vertebral column 9
2.2.2 Sections of the vertebral column
2.2.3 Anatomy of a typical vertebra 14
2.2.4 Joints of the vertebral column 14
2.2.5 Intervertebral foramina 14
2.2.6 Lumbar vertebrae/ lumbar spine 15
2.2.7 Lumbar spine pathology 17
2.3 Radiographic projection/procedure 17
2.3.1 AP projection 18
2.3.2 Lateral projection 20
CHAPTER THREE: MATERIALS AND METHOD
3.1 Research design 22
- Study population 22
- Sample size 22
- Study materials 23
- Data collection 24
3.6 Data analysis 25
CHAPTER FOUR: RESULTS
4.1 The degree of fulfilment of the radiographic technical parameters 26
4.2 Degree of fulfilment of the CEC criteria 27
4.3 Image quality of the AP and Lateral lumbar spine radiographs using
CEC criteria 29
4.4 Image quality of the AP and Lateral lumbar spine radiographs within
age groups using CEC criteria 30
4.4.1 Age distribution of Patients 30
4.4.2 Image quality of the AP radiographs within age group 31
4.4.3 Image quality of the Lateral radiographs within age group 32
4.5 Image quality of the AP and Lateral lumbar spine radiographs within
gender using CEC criteria 33
4.5.1 Gender distribution of the study population 33
4.5.2 Image quality of the AP radiographs within gender 34
4.5.3 Image quality of the lateral radiographs within gender 35
CHAPTER FIVE: DISCUSSION
5.1 Discussion 36
5.2 Conclusion 38
5.3 Recommendations 39
5.4 Area of further studies 39
REFERENCES 40
APPENDIX 43
LIST OF ABBREVIATIONS
ACO- Adequate Collimation
AP – Antero-posterior
APE- Adequate Penetration
CEC-Commission of European Communities
CPA- Correct Placement of Anatomical marker
NAT- No Artefact
NMB- No Motion Blur
NOR- No Rotation
