AN EVALUATION OF THE IMAGE QUALITY OF ANTERO-POSTERIOR AND LATERAL LUMBAR SPINE RADIOGRAPHS PRODUCED IN A PRIVATE HEALTH CARE FACILITY IN ABA, ABIA STATE. 

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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