Radiographic Quality Research Articles

Analysis of endodontic dental records of patients who were treated in a public university in south of Brazil

Dental record has a fundamental role in dentist performance. This study evaluated the standard registration of dental records of patients submitted to endodontic treatment for undergraduate students (CG) and specialists endodontics students (CE) in a public university in the south of Brazil. The sample was obtained by convenience, consecutively and included dental records patients of a public university in the south of Brazil who were treated at CE and clinical records of patients who were treated at CG, during on the year 2014. Was analyzed the description of endodontic treatment, data retrieved was scored and rated using a modification of the scoring system proposed by Streiner & Norman (1996) and quality of radiographs was performed according to the guidelines of “National Radiological Protection Board”. At dental records were analyzed, 223 belong to CG and 219 belong CE. The records from CE and CG had similar information on the evaluated parameters, except for “presence of rubber dam” and “presence of abbreviature in the description” (Mann-Whitney Test, P = 0.386). The absence of periapical radiographs was higher in CE than CG records (CE = 36.77%; CG = 0.46%). (Mann-Whitney test, P<0.0001). There was a predominance of periapical radiographs with the grades “excellent” and “diagnostically acceptable” in both groups.The quality of records generally obtained good results. The incorporation of new science into the educational program like electronic records and digital imaging techniques, facilitating the constant updating of data related to health and treatment of patients improving the record of the evolution of procedures.

Three-Dimensional printed model for preclinical training in oral radiology.

3D printing is experiencing significant growth in the teaching and learning process. This study aims to present a 3D printed skull model for preclinical intraoral radiographic practice. Two 3D printed mannequins were created. One mannequin used an STL file of a skull that was edited using two 3D modelling software (Meshmixer and Netfabb). The second mannequin was designed directly from a patient's segmented CBCT data and then converted into an STL file. Both mannequins were printed using fused deposition modelling (FDM) technology and polylactic acid (PLA) filament; teeth for the second mannequin were also printed using digital light processing (DLP). The printed skull bones were attached, the mandible was articulated to the articular fossa of the temporal bone, and the teeth were inserted into the alveoli. Intraoral radiographs of both mannequins were taken using a digital sensor (RVG 5100, Carestream). Both 3D printed mannequins showed satisfactory radiographic appearance, allowing geometric representation of each intraoral radiographic projection, regardless of STL file origin. Anatomical structures, such as the periodontal ligament space, zygomatic process of the maxilla and intermaxillary suture, were represented. The material cost of the first and second printed prototype was $34.00 and $39.00, respectively. The use of 3D printed models is presented as an alternative to artificial commercial phantoms for the preclinical training of intraoral radiographic techniques through the combined benefits of superior radiographic projection quality, the possibility of model manipulation and an affordable price.

Automated quality assessment of chest radiographs based on deep learning and linear regression cascade algorithms.

Develop and evaluate the performance of deep learning and linear regression cascade algorithms for automated assessment of the image layout and position of chest radiographs. This retrospective study used 10 quantitative indices to capture subjective perceptions of radiologists regarding image layout and position of chest radiographs, including the chest edges, field of view (FOV), clavicles, rotation, scapulae, and symmetry. An automated assessment system was developed using a training dataset consisting of 1025 adult posterior-anterior chest radiographs. The evaluation steps included: (i) use of a CNN framework based on ResNet - 34 to obtain measurement parameters for quantitative indices and (ii) analysis of quantitative indices using a multiple linear regression model to obtain predicted scores for the layout and position of chest radiograph. In the testing dataset (n = 100), the performance of the automated system was evaluated using the intraclass correlation coefficient (ICC), Pearson correlation coefficient (r), mean absolute difference (MAD), and mean absolute percentage error (MAPE). The stepwise regression showed a statistically significant relationship between the 10 quantitative indices and subjective scores (p < 0.05). The deep learning model showed high accuracy in predicting the quantitative indices (ICC = 0.82 to 0.99, r = 0.69 to 0.99, MAD = 0.01 to 2.75). The automatic system provided assessments similar to the mean opinion scores of radiologists regarding image layout (MAPE = 3.05%) and position (MAPE = 5.72%). Ten quantitative indices correlated well with the subjective perceptions of radiologists regarding the image layout and position of chest radiographs. The automated system provided high performance in measuring quantitative indices and assessing image quality. • Objective and reliable assessment for image quality of chest radiographs is important for improving image quality and diagnostic accuracy. • Deep learning can be used for automated measurements of quantitative indices from chest radiographs. • Linear regression can be used for interpretation-based quality assessment of chest radiographs.

Correction of Motion Artifacts in Dark-Field Radiography of the Human Chest.

Dark-field radiography of the human chest is a promising novel imaging technique with the potential of becoming a valuable tool for the early diagnosis of chronic obstructive pulmonary disease and other diseases of the lung. The large field-of-view needed for clinical purposes could recently be achieved by a scanning system. While this approach overcomes the limited availability of large area grating structures, it also results in a prolonged image acquisition time, leading to concomitant motion artifacts caused by intrathoracic movements (e.g. the heartbeat). Here we report on a motion artifact reduction algorithm for a dark-field X-ray scanning system, and its successful evaluation in a simulated chest phantom and human in vivo chest X-ray dark-field data. By partitioning the acquired data into virtual scans with shortened acquisition time, such motion artifacts may be reduced or even fully avoided. Our results demonstrate that motion artifacts (e.g. induced by cardiac motion or diaphragmatic movements) can effectively be reduced, thus significantly improving the image quality of dark-field chest radiographs.

Utility of Induced Sputum in Assessing Bacterial Etiology for Community-Acquired Pneumonia in Hospitalized Children.

Diagnostic testing for bacterial etiology of community-acquired pneumonia (CAP) is insensitive. Induced sputum (IS) is an attractive option for the evaluation of the lower respiratory tract. Children aged 0-18 years with CAP were enrolled in the Etiology of Pneumonia in the Community (EPIC) study between 2010 and 2012. Blood and respiratory specimens were assessed by culture and polymerase chain reaction (PCR). The radiographic CAP was determined by a study radiologist. Sputum was induced with hypertonic saline. IS specimen was high quality (HQ) if Gram stain showed >25 white blood and <10 epithelial cells per low-powered field; all others were low quality (LQ). We compared IS pathogen prevalence between HQ and LQ IS, and by radiographic pneumonia. Pathogen concordance with EPIC etiology was assessed. Length of stay (LOS) was compared by receipt of IS pathogen-concordant antibiotics. Out of 977 children, 916 (94%) children enrolled in Memphis, Tennessee, produced IS; 794 (87%) had radiographic CAP and 174 (19%) were HQ. HQ IS yielded pathogenic bacteria more often than LQ (64% vs 44%; P < .01); however, pathogens were isolated at similar rates in HQ IS in patients with and without radiographic CAP (64% vs. 63%; P = .6). Pathogens from study specimens matched an IS pathogen in only 9/42 (21%) patients with radiographic CAP. Median LOS was similar among patients with radiographic CAP regardless of receipt of IS pathogen-concordant antibiotics (3.1 days), non-pathogen-concordant antibiotics (2.7 days), or no antibiotics (3.2 days; P = .5). Bacterial pathogens were isolated from most IS cultures regardless of radiographic CAP and quality of IS. IS cultures infrequently corresponded with sterile site cultures. Isolation of pathogens from pediatric IS reflects oropharyngeal carriage and is insufficient to determine bacterial etiology of CAP.

Advances in multiscale image processing and its effects on image quality in skeletal radiography

Multi-frequency processing (MFP) leads to enhanced image quality (IQ) of radiographs. This study is to determine the effect of third generation MFP (M3) on IQ in comparison to standard second-generation MFP (M2). 20 cadavers were examined and post-processing of radiographs was performed with both M2 and M3. Three readers blinded to the MFP used for each image independently compared corresponding image pairs according to overall IQ and depiction of bony structures and soft tissue (+ 2: notably better > 0: equal > − 2: notably worse). A significant deviation of the median grade from grade 0 (equal) (p < 0.01) for each evaluator A, B and C speaks against an equal image quality of M2- and M3-images. M3-images were categorized with better grades (+ 1, + 2) in 87.7% for overall image quality, in 90.4% for soft tissue and 81.8% for bony structures. M3 images showed significant higher averaged SNR and CNR for all investigated lower extremities than that of M2 images (0.031 < p < 0.049). The newest generation of MFP leads to significantly better depiction of anatomical structures and overall image quality than in images processed with the preceding generation of MFP. This provides increased diagnostic accuracy and further decreased radiation exposure.

The effects of manual XCT focusing on extracted surface texture data

X-Ray computed tomography, (XCT) has begun to prove itself as a valid method to quantify internal and external surface metrology of parts. However, the understanding of how a small change in the capture settings of the XCT can affect the surface data extracted from parts needs to be developed so that like all metrology instruments the operating window in which the technology provides repeatable results with minimum uncertainty is understood. For XCT there exists a clear point of uncertainty in the measurement process, this being at the generation point of the x-rays, at this point the electron beam impacts a target material causing the generation of x-rays. As the intensity and size of the electron beam focal spot have direct control of the produced x-rays, it is important to align the filament in such a way that the best quality radiographs are generated. The more optimally focused each individually radiograph is in an XCT scan the better quality the 3D model acquired will be, thus leading to more representative surface data extraction. The present paper details an investigation into the effects of this focusing procedure on the extracted surface data. Further to this, the results of the study were compared to work showing the variation in extracted surface data resulting from a full filament change. The present study found that variance in extracted surface texture parameters resulting from beam refocussing exceeded that when comparing filaments, leading to the conclusion that the installation process is likely to be the main contributing factor to the variance noted in both studies.

CR Image Optimization and Radiation Dose Limitation With Collimation Adjusting on Cervical Radiography

Background: Radiological examination in cervical services, Radiographers often opening the collimation wider of the size of the imaging plate for fear of being cut. This is done because it is supported by the image cropping facility on the CR. So there is a habit of opening the collimation width as wide as the imaging plate, which is often done with the assumption that it is better to widen the collimation than cut off the object. Obviously this will increase the radiation dose in patients with basic limitations. According to ICRP, patient safety must refer to the principle of radiation protection ALARA namely in the shortest possible time to get quality radiographs and patients receive the most minimum radiation exposure as possible.Methods: This research is a descriptive analytic research conducted with a cross sectional approach. The study was conducted by varying the radiation field area to be used for cervical examination. There are 10 variations of collimation area with 3 (three) exposures in each collimation. Then measured contrast, noise and radiation dose. Radiation dose is calculated by means of a babyline device.Results: The results showed that the collimation setting did not affect contrast radiography in CR because collimation was not the main factor that could affect contrast radiography on CR. The collimation setting on cervical radiography has an effect on the radiation dose, so it is necessary to adjust the collimation to get the minimum dose possible. The most optimal collimation area on cervical radiographic examination was obtained at a size of 12 x 24 cm with the smallest noise reception and dose compared to others and had higher contrast. Average contrast value achieved was 0.45 with a dose of 39.23 µGy.Conclusion: The collimation setting on cervical radiography has an effect on the radiation dose, so it is very necessary to adjust the collimation to get the minimum dose possible. The most optimal collimation area on cervical radiographic examination is obtained at a size of 12 x 24 cm with the smallest noise reception and dose compared to others and has a higher contrast.

Evaluation of MR-derived simulated CT-like images and simulated radiographs compared to conventional radiography in patients with shoulder pain: a proof-of-concept study

BackgroundTo evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology.Methods3 T MRI of the shoulder including a 3D T1-weighted gradient echo sequence was performed in 25 patients (mean age 52.4 ± 18 years, 13 women) with suspected shoulder pathology. Subsequently a cone-beam forward projection algorithm was used to obtain intensity-inverted CT-like images and simulated radiographs. Two radiologists evaluated the simulated images separately and independently using the conventional radiographs as the standard of reference, including measurements of the image quality, acromiohumeral distance, critical shoulder angle, degenerative joint changes and the acromial type. Additionally, the CT-like MR images were evaluated for glenoid defects, subcortical cysts and calcifications. Agreement between the MR-derived simulated radiographs and conventional radiographs was calculated using Cohen’s Kappa.ResultsMeasurements on simulated radiographs and conventional radiographs overall showed a substantial to almost perfect inter- and intra-rater agreement (κ = 0.69–1.00 and κ = 0.65–0.85, respectively). Image quality of the simulated radiographs was rated good to excellent (1.6 ± 0.7 and 1.8 ± 0.6, respectively) by the radiologists. A substantial agreement was found regarding diagnostically relevant features, assessed on Y- and anteroposterior projections (κ = 0.84 and κ = 0.69 for the measurement of the CSA; κ = 0.95 and κ = 0.60 for the measurement of the AHD; κ = 0.77 and κ = 0.77 for grading of the Samilson-Prieto classification; κ = 0.83 and κ = 0.67 for the grading of the Bigliani classification, respectively).ConclusionIn this proof-of-concept study, clinically relevant features of the shoulder joint were assessed reliably using MR-derived CT-like images and simulated radiographs with an image quality equivalent to conventional radiographs. MR-derived CT-like images and simulated radiographs may provide useful diagnostic information while reducing the amount of radiation exposure.

Improper patient positioning incidence for panoramic radiographic imaging of pediatric patients: Retrospective study

Background/Aim: Improper positioning of the patient reduces the diagnostic quality of panoramic radiographs. It is important to perfect the panoramic patient positioning technique to avoid unnecessary repeat exposures especially in pediatric patients. In this study, pediatric patient sample of records collected from an oral and dental health center were analyzed to determine the relative incidence of positioning errors of panoramic radiographs. Material and Methods: 3788 (1928 girls, 1860 boys) digital panoramic radiographs obtained from the stored data in the system were selected randomly. The radiographs were evaluated by two radiology specialists, by recording separately. The positioning errors of the images were categorized into ten groups: the chin tipped high, chin tipped low, a slumped position, the patient positioned forward, the patient positioned backward, failure to position the tongue against the palate, patient movement during exposure, the head tilted, and the head turned to one side. The results were statistically analyzed for positioning errors according to age and gender. Results: In 3788 radiographs, 2138 (56.4%) were error-free and 1650 (43.6%) were present with positioning errors. In the improper images, a single positional error was present in 1379 (83.6%); two positional errors were present in 248 (15%) and three or more positional errors in 23 (1.4%). The most common error observed was the tongue not being in contact with the hard palate (32.1%). On the other hand, the least common experienced error was patient movement during exposure (2.0%). Conclusions: The positioning errors of panoramic radiographs were common in the sample group of this study. Careful patient positioning can play a significant role in improving the radiographic quality and reducing the number of retakes.

Evaluation of Radiation Dose Reduction and its Effect on Image Quality for Different Flat-Panel Detectors.

Purpose:To evaluate the image quality of semi-anatomical chest radiographs acquired using low radiation doses from seven different flat-panel detector (FPD) systems.Materials and Methods:Radiographs of a semi-anatomical chest phantom were acquired at 70 and 110 kVp using 7 different FPDs from 5 vendors. Radiation doses were measured using a dose-area-product (DAP) meter. To standardize measurements across all FPDs, DAP value of 51.05 μGym2 obtained at 70 kVp and 9.43 μGym2 at 110 kVp was used as reference in this study. Radiation doses were reduced by manually adjusting mAs for both tube potentials in all FPD systems to achieve acceptable image quality. Contrast-to-noise ratio, signal-to-noise ratio and figure of merit (FOM) in lung, heart, and diaphragm for all images were analyzed.Results:In comparison with set standard protocol, radiation dose reduction of 20%, 21%, 21.6%, 59.5%, 60.7%, 62.2%, and 67.6% with optimal image quality was observed in Prognosys Prorad, GE Definium 8000, Siemens Fusion, Fujifilm FGX, Fujifilm FGXR, Philips Digital Diagnost and Siemens Aristos at 70 kVp. At 110 kVp, dose reduction of 15.7% and 34.8% was possible only for Philips Digital Diagnost and Siemens Aristos. FOM was high at 110 kVp even when radiation doses were reduced by a factor 2 when compared to 70 kVp in all digital radiography systems.Conclusion:This study demonstrates the feasibility of using a semi-anatomical chest phantom in the optimization of radiation dose and image quality. The FOM was a good indicator in assessing image quality between different detectors.

Improved estimates of strength and stiffness in pathologic vertebrae with bone metastases using CT-derived bone density compared with radiographic bone lesion quality classification.

The aim of this study was to compare the ability of 1) CT-derived bone lesion quality (classification of vertebral bone metastases [BM]) and 2) computed CT-measured volumetric bone mineral density (vBMD) for evaluating the strength and stiffness of cadaver vertebrae from donors with metastatic spinal disease. Forty-five thoracic and lumbar vertebrae were obtained from cadaver spines of 11 donors with breast, esophageal, kidney, lung, or prostate cancer. Each vertebra was imaged using microCT (21.4 μm), vBMD, and bone volume to total volume were computed, and compressive strength and stiffness experimentally measured. The microCT images were reconstructed at 1-mm voxel size to simulate axial and sagittal clinical CT images. Five expert clinicians blindly classified the images according to bone lesion quality (osteolytic, osteoblastic, mixed, or healthy). Fleiss' kappa test was used to test agreement among 5 clinical raters for classifying bone lesion quality. Kruskal-Wallis ANOVA was used to test the difference in vertebral strength and stiffness based on bone lesion quality. Multivariable regression analysis was used to test the independent contribution of bone lesion quality, computed vBMD, age, gender, and race for predicting vertebral strength and stiffness. A low interrater agreement was found for bone lesion quality (κ = 0.19). Although the osteoblastic vertebrae showed significantly higher strength than osteolytic vertebrae (p = 0.0148), the multivariable analysis showed that bone lesion quality explained 19% of the variability in vertebral strength and 13% in vertebral stiffness. The computed vBMD explained 75% of vertebral strength (p < 0.0001) and 48% of stiffness (p < 0.0001) variability. The type of BM affected vBMD-based estimates of vertebral strength, explaining 75% of strength variability in osteoblastic vertebrae (R2 = 0.75, p < 0.0001) but only 41% in vertebrae with mixed bone metastasis (R2 = 0.41, p = 0.0168), and 39% in osteolytic vertebrae (R2 = 0.39, p = 0.0381). For vertebral stiffness, vBMD was only associated with that of osteoblastic vertebrae (R2 = 0.44, p = 0.0024). Age and race inconsistently affected the model's strength and stiffness predictions. Pathologic vertebral fracture occurs when the metastatic lesion degrades vertebral strength, rendering it unable to carry daily loads. This study demonstrated the limitation of qualitative clinical classification of bone lesion quality for predicting pathologic vertebral strength and stiffness. Computed CT-derived vBMD more reliably estimated vertebral strength and stiffness. Replacing the qualitative clinical classification with computed vBMD estimates may improve the prediction of vertebral fracture risk.

Evaluation of Chest X-Ray Quality Parameters

Proper control of radiographic quality is important to guarantee the method high sensitivity and specificity, important factors for diagnostic complementation. It is the responsibility of the practitioner performing the radiological techniques to ensure that all chest radiographs are provided for minimal rotation, good radiographic exposure and adequate inspiration.

OPTIMIZACIJA POSEGOV V RADIOLOŠKI TEHNOLOGIJI – SLIKANJE LEDVENE HRBTENICE V SPLOŠNI RADIOLOGIJI

Purpose: Any use of ionizing radiation must be justifi ed and the benefi t must be greater than the harm it causes. Imaging must be performed with the lowest possible dose received by the patient, while maintaining optimal radiographic image quality. Imaging of the lumbar spine is a relatively high dose imaging procedure. This systematic review aims to explore optimisation options to reduce patient exposure, while maintaining radiographic quality during plain lumbar spine imaging. Methods: A systematic review of the literature from the databases Pub Med Central, EBSCOhost including CINAHL, Cochrane Library, Web of Science, Science Direct, DiKUL and Springer Link was conducted. The documents were fully accessible and in the English language. Results: 26 experimental studies were included in the analysis. There are many optimisation methods: changing the tube potential, comparison of diff erent projections, use of shielding, primary beam collimation, increasing the source-to-image receptor distance, compression of the imaged area, using the air gap technique, evaluation of the need for additional projections, and rotating the patient depending on the tube side. On average, the dose is reduced by 44%. Studies that also evaluated the quality of radiographs found all radiographs to be diagnostically acceptable. Conclusion: The results confi rm a reasonable use of methods to optimize radiation exposure and to maintain an optimal image quality of radiographs. A systematic review for each specifi c area in general radiography should be conducted in the future. Keywords: lumbar spine imaging, optimisation, dose reduction, low dose, image quality

RAD_IQ: A free software for characterization of digital X-ray imaging devices based on the novel IEC 62220-1-1:2015 International Standard

Characterization of digital X-ray imaging devices is very important because it can be used to measure and compare the performance of detectors used in Diagnostic Radiology. This characterization is usually made through the calculation of Modulation Transfer Function (MTF), Noise Power Spectrum (NPS) and Detective Quantum Efficiency (DQE). These parameters, especially the DQE, are very important because they quantify the effect of spatial resolution, contrast and noise on Radiographic image quality (IQ). The IEC 62220-1-1:2015 International Standard provides comprehensive guidelines how to capture and analyze X-ray images to characterize digital X-ray detectors. A novel, fast and free MATLAB-based software was developed, named RAD_IQ, to calculate the Signal Transfer Property (STP), perform Noise Component Analysis (NCA), and calculate the parameters MTF, NPS & DQE of X-ray detectors based on the novel IEC 62220-1-1:2015 International Standard for General Radiography and IEC 62220-1-1:2007 for Digital Mammography. Our results were validated against well-established software products used for quantitative image analysis of digital X-ray detectors. The calculated parameters were within 5% difference compared to available software products. The conclusion of our study was that RAD_IQ can be easily used from Medical Physicists, Biomedical Engineers and researchers without any programming experience to characterize the performance of digital X-ray detectors used in Diagnostic Radiology.

FILM REJECT ANALYSIS AS A MEASURE OF QUALITY ASSURRANCE: A CASE STUDY OF SOME SELECTED HOSPITALS IN PLATEAU STATE, NIGERIA

Film reject analysis is a planned and systematic action necessary to provide adequate confidence that a product or service will satisfy the given requirement for quality of image or radiographs. In this research work, reject film analysis as quality assurance element will be carried out in 3 selected hospitals in Plateau state, Nigeria for different rejected film sizes in each case respectively from December, 2018- December, 2019. Rejected radiographs were collected analyzed and categorized based on body parts such as chest, skull, knee, lumbar sacral, shoulder, neck, femur and pelvis. The reasons for rejection were categorized as: Over exposure, Under exposure, Poor processing, Poor positioning, Wrong placing of anatomical marker, Fog, Artifact and Multiple exposure. The three studied hospitals (selected by convenience), H1, H2, and H3 are located in Jos and environs. From this study, it was observed that the anatomical part mostly rejected was the chest and the highest reason for the rejected radiographs was Under exposure. The reject rates of Hospitals H1, H2, and H3 were found to be 8.85%, 6.65% and 5.6% respectively which were above the World Health Organization(WHO) but within the Conference of Radiation Control Program Directorate (CRCPD) recommended permissible values of 5% and (5-10%) respectively. The findings imply that patients may have been exposed to avoidable radiation doses

The Hip Center Rule Can be Used to Decide if Measured Pelvic Incidence is Accurate.

Simulation study. Pelvic incidence (PI) should be considered during surgical planning. The ideal patient position with both hip centers perfectly aligned for a lateral radiograph is rarely obtained. It has been suggested that a radiograph with axial and coronal rotation up to 20° is acceptable to obtain a measured PI within 6 degrees of the actual PI. We seek to: (1) evaluate the effect of variations in PI and patient malpositioning on measured vs true PI, and (2) determine whether the presence of one hip center within the bony acetabular rim of the contralateral hip can serve as a simple clinical decision rule on the accuracy of measured PI. Published anthropometric three-dimensional pelvic landmark coordinates were used in this study. Radiographic projections were generated using linear algebra for combinations of axial and coronal rotation from -20° to +20°. True and measured PIs were compared. Rotation to 20° cannot be uniformly accepted as decision rule. Pelvises with higher PIs are more sensitive to malpositioning with greater PI deviation with smaller amounts of rotation. Diagnostic performance of the hip center rule demonstrated a sensitivity of 25.58% and a specificity of 100.00%. Rather than assessing the quality of radiographs for PI measurement by magnitude of malpositioning, we recommend clinicians use the "hip center rule." As long as at least one hip center is contained within the bony acetabular rim of the contralateral hip, there is high confidence that measured PI will be within 6° of true PI.

1643 Quality Assessment of Intra-Oral Radiography Within Two Hospitals in South Wales, UK: A Two-Cycle Audit and Introduction to The Updated 2020 Public Health England Quality Grading System

Abstract Aim To evaluate the quality of intra-oral radiographs taken within two hospitals in South Wales, United Kingdom, and assess the impact of radiographer training, with the aim of reducing the percentage of undiagnostic radiographs to 10% or less in accordance with national performance targets. Method Details of intra-oral periapical and occlusal radiographs taken in the two hospitals between the 1st July 2015 and the 30th June 2016 were retrieved. 100 radiographs were randomly selected and assessed. Change was then implemented in the delivery of radiographer training workshops, which involved two hours of both didactic teaching and hands-on skills training. There were 10 workshops and 52 attendees. A second audit cycle was completed, with a further 100 radiographs randomly selected from the 1st December 2018 and 30th April 2019. Results There was a 33.2% reduction of undiagnostic radiographs, bringing the total down to 6.3%, meeting the standards of the audit. Feedback from the workshops were also extremely positive; 50% of radiographers grading the quality of the workshops at 10/10. Conclusions The workshops were successful in improving the quality of intra-oral radiographs, therefore improving the quality of this service. This blueprint can be shared amongst other hospitals, to sustainably improve the overall quality of dental radiography in the hospital setting. Recent updated guidance in 2020 introduced a new two-point scale radiograph grading system: ‘Acceptable’ and, ‘not acceptable’. Radiographs graded as, ‘not acceptable’, should account for no more than 5% of radiographs. Future audit cycles will follow this new grading system and standard.

1700 Using Intra-Operative Imaging as A Tool to Provide Peer Review, Scoring, Feedback and Education for Hand and Wrist Trauma Cases - A Quality Improvement Project

Abstract Aim To improve the efficiency of intraoperative hand trauma x-ray review, introduce a scoring system for quality of fixation achieved and use this as an education and feedback tool for trainees. Method A large QI project in 2019 demonstrated that intra-operative images taken using the mini C-arm were not being reviewed. In March 2020 the first QI cycle introduced an Access database to ensure that as cases were removed from the trauma board, they were added to a review list. Each x-ray was also scored in the trauma meeting (good, acceptable, poor) to assess the radiographic quality of fixation. The second QI cycle identified the named surgeon for each case, allowing surgeon specific feedback. Finally, we trained all qualified users of the mini C-arm to upload their own images after each case, reducing the mean time to upload. Results This QI project has improved the review rate of mini C-arm images from 30% to 100% and every x-ray is scored. The mean time to review images has reduced from 4 days to less than 24 hours. All trainees can access their scores for imaged hand and wrist trauma and receive written constructive feedback. Conclusions This project ensures appropriate and prompt review of all hand and wrist trauma cases allowing early identification of any concerns. All x-rays are scored, and this process acts as an educational prompt in the trauma meeting. A final report can be printed for each trainee which can be uploaded to their portfolio to document their surgical progress.

Diagnostic Accuracy of Bedside Lung Ultrasound in Emergency Protocol for the Diagnosis of Acute Respiratory Failure.

Background:The multifactorial etiology of acute respiratory failure (ARF) often complicates diagnosis at an early stage of clinical presentation. Despite being a common life-threatening disorder, accurate and timely diagnosis is hindered by bad quality of bedside radiographs and nonavailability of immediate computed tomography imaging. This study was an attempt to evaluate the diagnostic accuracy of ultrasound in diagnosing ARF.Methods:This hospital-based cross-sectional study investigated the underlying etiological factor in 130 patients presenting with ARF and admitted to the intensive care unit. Lung ultrasound was performed according to the Bedside Lung Ultrasound in Emergency (BLUE) protocol. The diagnostic accuracy of lung ultrasound by emergency protocol was measured against each final diagnosis.Results:The mean age observed was 49.28 ± 14.9 years among the cohort. Of the 130 patients, pneumonia was the most common cause of ARF, seen in 42 patients. Breathlessness (56.15%) and fever accompanied by cough (25.38%) were the chief complaints. Diagnostic accuracy of ultrasound lung emergency protocol was 95.38% in the diagnosis of pulmonary edema, 100% for pneumothorax, 93.85% for pneumonia, 96.92% for chronic obstructive pulmonary disease, 99.23% for pulmonary thromboembolism, and 95.38% for acute respiratory distress syndrome.Conclusion:Lung ultrasound is a reliable modality that provided accurate and timely diagnosis of ARF in this study. Therefore, BLUE protocol is feasible, easily implementable in the intensive care unit, and must be scaled up in respiratory health-care settings.