Evaluation of Diagnotic Quality of Chest Radiographs in selected Radiologic Units in

Tuguegarao City

Background of the study

Radiology is a key part of clinical practice across a wide range of medical practice. It is
usually the finest, less invasive way of monitoring, treating or diagnosing disease and even
injury. According to Nordqvist (2015) radiology is a specialty of medicine that uses ionizing and
non-ionizing radiation for the diagnosis and therapeutic treatment of disease. He further wrote
that there are many medical modalities available in the Radiology Department, such as magnetic
resonance imaging (MRI), X-ray radiography, nuclear medicine, computed tomography (CT),
ultrasound, and positron emission tomography (PET) to see within the human body in order to
diagnose disease and abnormalities. Imaging means creating a picture of the inner configuration
of a thick organ, which is in radiology typically, means a part of the human body with the use of
radiation.

Introduction

Chest radiographic examinations are the most common of all radiographic procedures. Student
radiographers typically begin their clinical experience taking chest radiographs. Chest x-ray is
the most commonly performed diagnostic x-ray examination. It uses a very small dose of
ionizing radiation to evaluate the lungs, heart and chest wall. X-ray images of chest provide
important information establishing diagnosis, treatment and follow-up procedure. Since chest x-
ray is fast and easy, it is particularly useful in emergency diagnosis and treatment. Since the
discovery of x-rays, advances in technology have yielded numerous improvements in thoracic
imaging. Equipment typically used a wall-mounted, box-like apparatus containing the x-ray film,
or a special plate that records the image digitally. Recently, the European Union has published a
set of objective guidelines for good radiographic techniques corresponding on the level of image
quality. The guideline has proved to be useful tool to unify the practice in Europe. For the film
critique of the chest, diagnostic standard for imaging is dependent not only on routine imaging
but also on clinical information. The purpose of this study is to present achievable standard
criteria of chest radiograph which will be used as a basis for further development by the
radiological community. The study is an attempt to quantify the quality of chest radiographs by
evaluating the quality of depiction of the anatomical and physical details

Statement of the Problem

The study seeks to evaluate the diagnostic quality of chest radiographs in selected Radiologic
Units in Tuguegarao City
Specifically, the study will answer the following questions:

1. What is the profile of the chest radiographs used in the study in terms of:
a. Age
b. Gender
c. Radiologic unit
2. what is the quality of all collected chest radiographs evaluated under five criteria:
2.1 Anatomical coverage (include entire lung fields from apex to dome of diaphragm,gastric
fundus)
2.2 Arrested respiration (at least 6 anterior ribs and 10 posterior ribs above the right dome of
diaphragm)
2.3 Adequate penetration (slightly visible lower intervertebral disc below T9)
2.4 No rotation (equidistant between spine of vertebra and sterno-clavicular joints)
2.5 Scapula out of lung fields(medial border of scapula out of lung)
3. Is there a significant difference in the extent of diagnostic quality of chest radiographs
and the profile variables of chest radiographs used in the study?

Hypothesis:
Ho1: There is no significant difference in the extent of diagnostic quality of chest radiographs in
selected radiologic units in Tugegarao City.

Ho2: There is significant difference in the extent of diagnostic quality of chest radiographs in
selected radiologic units in Tugegarao City.

Significance of the study

The purpose of this study is to evaluate diagnostic quality of chest radiographs in selected
radiologic units in Tugegarao City.

Scope and limitation

This study is limited only to three selected Radiologic units in Tuguegarao City like Saint Paul
Hospital, Divine Medical Center and Cagayan Valley Medical Center. The size of image
receptor is 14”x14” with use of vertical stand. Those patients who had thoracic deformities such
as pectus excavatum, scoliosis and kyphosis were excluded and age group of patient ranged from
15-60 years in both sexes. All radiographs were reviewed by radiographers with the help of
radiologist.
Conceptual Framework

Input Process Output

Data gathering Evaluated chest

1. Chest
Radiographs in three
Radiograph profile
All collected chest radiographs will be selected Radiologic
variables
evaluated based on the five criteria units in Tuguegarao
a. Age City
1. Anatomical coverage (include entire
b. Gender
lung fields from apex to dome of
c. Radiologic unit
diaphragm)

2. Arrested respiration (at least 6

anterior ribs and 10 posterior ribs above
the right dome of diaphragm)

3.Adequate penetration (slightly visible

lower intervertebral disc below T9)

4.No rotation (equidistant between

spine of vertebra and sterno-clavicular
joints)

5.Scapula out of lung fields(medial

border of scapula out of lung)
Chapter 2

Review of Related literature

The goal of every technologist should be to take the “optimal” radiograph. These criteria provide
a definable standard by which every chest radiographic image can be evaluated to determine
where improvements can be made. Review of related literature is based on Radiographic
Positioning and Related Anatomy 8th Edition by Kenneth L. Bontrager, MA John P.
Lampignano, MEd, RT(R)(CT) and European guidelines on quality criteria for diagnostic
radiographic images

Evaluation of Chest Radiographs

 Anatomical coverage

An enormous amount of medical information can be obtained from a properly exposed and
carefully positioned PA chest radiograph. Although the technical factors are designed for optimal
visualization of the lungs and other soft tissues, the bony thorax can also be seen. The clavicles,
scapulae, and ribs can be identified through careful study of the chest radiograph .Include entire
lung fields from apex to dome of diaphragm.

The apex of each lung is the rounded upper area above the level of the clavicles. The apices of
the lungs extend up into the lower neck area to the level of T1 (first thoracic vertebra). This
important part of the lungs must be included on chest radiographs.

The carina shown as the point of bifurcation, the lowest margin of the separation of the trachea
into the right and left bronchi. The base of each lung is the lower concave area of each lung that
rests on the diaphragm.

The diaphragm is a muscular partition that separates the thoracic and abdominal cavities.

Gastric fundus, an air bubble under the left hemidiaphragm.

The costophrenic angle which refers to the extreme outermost lower corner of each lung, where
the diaphragm meets the ribs. When positioning for chest radiographs, you should know the
relative locations of the uppermost and lowermost parts of the lungs— the apices and the
costophrenic angles, respectively—to ensure that these regions are included on every chest
radiograph.Pathology, such as a small amount of fluid collection, would be evident at these
costophrenic angles in the erect position.
The hilum (hilus), also known as the root region, is the central area of each lung, where the
bronchi, blood vessels, lymph vessels, and nerves enter and leave the lungs.

 Degree of Inspiration

To determine the degree of inspiration in chest radiography, one should be able to identify and
count the rib pairs on a chest radiograph. The first and second pairs are the most difficult to
locate. When a chest radiograph is taken, the patient should take as deep a breath as possible and
then hold it to aerate the lungs fully. A general rule for average adult patients is to “show” a
minimum of 10 on a good PA chest radiograph. To determine this, start at the top with the first
rib and count down to the tenth or eleventh rib posteriorly.

 Adequate penetration(slightly visible lower intervertebral disc below T9)

 No rotation

Equidistant between spine of vertebra and sterno-clavicular joints, to prevent rotation, ensure that
the patient is standing evenly on both feet with both shoulders rolled forward and downward.
Also, check the posterior aspect of the shoulders and the lower posterior rib cage and the pelvis
to ensure no rotation. On a true PA chest without rotation, both the right and the left sternal ends
of the clavicles are the same distance from the center line of the spine

 Scapula out of lung fields(medial border of scapula out of lung)