Report of an image quality and dose audit according to directive 97/43/Euratom at Spanish private radiodiagnostics facilities

European guidelines on quality criteria for diagnostic radiographic images of the lumbar spine - an intra- and inter-observer reproducibility study

Background

The Commission of the European Communities has published guidelines to be used as a gold standard for quality assessment of diagnostic radiographic images. Image quality and radiation dose must be monitored and optimally balanced for diagnostic purposes on patients. The objective of the current study was to assess intra- and inter-observer reproducibility in less experienced observers using the proposed European Guidelines on Quality Criteria for Diagnostic Radiographic Images in a quality assessment of lumbar spine radiographs in primary chiropractic practice in Denmark.

Methods

Two observers initially evaluated lumbar spine radiographs randomly selected from fifty chiropractic clinics, all connected to the national PACS server (KirPACS) in Denmark. All evaluations were performed twice by both observers using a four-week interval and for compliance with the European Quality Criteria for Diagnostic Radiographic Images. Inter- and intra-observer reproducibility was calculated using kappa statistics. In the interpretation of the kappa coefficient, the standards for strength of agreement reported by Landis and Koch were followed.

Results

The strength of the inter-observer agreement of general image quality at baseline ranged from moderate agreement (k = 0.47) to substantial agreement (k = 0.68). After four weeks, the inter-observer agreement still ranged from moderate agreement (k = 0.59) to substantial agreement (k = 0.71), but with increased agreement for both kappa coefficients. In relation to intra-observer agreement of general image quality, the strength for observer A ranged from moderate (k = 0.58) to substantial (k = 0.72) and the strength for observer B overall was substantial (k = 0.63–0.75).

Conclusion

The European Guidelines on Quality Criteria for Diagnostic Radiographic Images are considered a gold-standard and used in a method for quality assurance within the Danish chiropractic profession. The inter-rater and intra-rater agreements in this study, using the CEC-criteria, were found mostly acceptable. With appropriate attention to clear understanding of the individual criteria and sufficient training, this method is found to be reliable, even using less experienced observers, to carry out Diagnostic Radiographic Image Quality-assurance in primary care settings.

Electronic supplementary material

The online version of this article (10.1186/s12998-019-0241-3) contains supplementary material, which is available to authorized users.

CLINICAL AUDIT OF IMAGE QUALITY IN RADIOLOGY USING VISUAL GRADING CHARACTERISTICS ANALYSIS

The aim of this work was to assess whether an audit of clinical image quality could be efficiently implemented within a limited time frame using visual grading characteristics (VGC) analysis. Lumbar spine radiography, bedside chest radiography and abdominal CT were selected. For each examination, images were acquired or reconstructed in two ways. Twenty images per examination were assessed by 40 radiology residents using visual grading of image criteria. The results were analysed using VGC. Inter-observer reliability was assessed. The results of the visual grading analysis were consistent with expected outcomes. The inter-observer reliability was moderate to good and correlated with perceived image quality (r(2) = 0.47). The median observation time per image or image series was within 2 min. These results suggest that the use of visual grading of image criteria to assess the quality of radiographs provides a rapid method for performing an image quality audit in a clinical environment.

Diagnostic reference levels in digital mammography: a systematic review

This study aims to review the literature on existing diagnostic reference levels (DRLs) in digital mammography and methodologies for establishing them. To this end, a systematic search through Medline, Cinahl, Web of Science, Scopus and Google scholar was conducted using search terms extracted from three terms: DRLs, digital mammography and breast screen. The search resulted in 1539 articles of which 22 were included after a screening process. Relevant data from the included studies were summarised and analysed. Differences were found in the methods utilised to establish DRLs including test subjects types, protocols followed, conversion factors employed, breast compressed thicknesses and percentile values adopted. These differences complicate comparison of DRLs among countries; hence, an internationally accepted protocol would be valuable so that international comparisons can be made.

Impact of a training course on the quality of chest radiography to diagnose pulmonary tuberculosis

SETTING

Socio-economically underprivileged urban areas in the Philippines.

OBJECTIVE

To assess the performance of radiological technicians (RTs) 3 years after their participation in a training course to improve the quality of chest X-ray (CXR) and to test a monitoring visit after the course.

DESIGN

A cross-sectional and observational study including on-site monitoring of X-ray facilities in Manila and Quezon City and assessment of CXR films taken by 23 RTs who previously attended a training course in 2009 or 2010. The sum of the assessment scores for each of six assessment factors at four points, i.e., before and after the training course that had been previously analysed, and before and after the monitoring visits that were currently analysed, were compared.

RESULTS

Two assessment sum scores, identification mark or patient positioning, did not show significant differences. However, assessment of density, contrast, sharpness and artefact significantly improved after the training course, and before and after the monitoring visit, compared with before the training. There were no significant differences in any of the assessment factors before and after the monitoring visits.

CONCLUSION

The training course appears to have had a long-term effect on maintaining CXR quality. The post-training monitoring visit did not significantly improve CXR quality.

Reconstruction of absorbed doses to fibroglandular tissue of the breast of women undergoing mammography (1960 to the present)

The assessment of potential benefits versus harms from mammographic examinations as described in the controversial breast cancer screening recommendations of the U.S. Preventive Task Force included limited consideration of absorbed dose to the fibroglandular tissue of the breast (glandular tissue dose), the tissue at risk for breast cancer. Epidemiological studies on cancer risks associated with diagnostic radiological examinations often lack accurate information on glandular tissue dose, and there is a clear need for better estimates of these doses. Our objective was to develop a quantitative summary of glandular tissue doses from mammography by considering sources of variation over time in key parameters, including imaging protocols, X-ray target materials, voltage, filtration, incident air kerma, compressed breast thickness, and breast composition. We estimated the minimum, maximum and mean values for glandular tissue dose for populations of exposed women within 5-year periods from 1960 to the present, with the minimum to maximum range likely including 90% to 95% of the entirety of the dose range from mammography in North America and Europe. Glandular tissue dose from a single view in mammography is presently about 2 mGy, about one-sixth the dose in the 1960s. The ratio of our estimates of maximum to minimum glandular tissue doses for average-size breasts was about 100 in the 1960s compared to a ratio of about 5 in recent years. Findings from our analysis provide quantitative information on glandular tissue doses from mammographic examinations that can be used in epidemiological studies of breast cancer.

Relevant training issues for introduction of digital radiology: results of a survey

Council Directive 97/43/Euratom establishes the need for adequate training of radiology staff. The transition to digital radiology implies changes in various imaging aspects, which are not sufficiently covered by current institutional training programmes. This work aimed to assess how professionals, experienced in digital imaging, acquired their expertise and hence, what form institutional training should take. Within DIMOND III, a survey on training and resources was performed among radiology professionals. A lack of institutional education for digital radiology was found. In the transition to digital radiology, 30-35% train on the job and another 23-28% receive training from digital equipment vendors. A general agreement exists on the need for new quality criteria and strategies for dose management. Issues relevant for conventional/digital transition are only sparsely covered in EC training programmes. Based on these results, a set of training issues was produced, to be included in future European guidelines.

Local diagnostic reference levels in standard X-ray examinations

The national diagnostic reference levels (NDRLs) form an efficient, concise and powerful standard for optimising radiation protection of a patient. However, in a large hospital, where many radiological departments are present, it is also possible to calculate and define lower dose values as local diagnostic reference levels (LDRLs). In our hospital there are eight radiological departments; in each of these, the entrance skin dose (ESD) distributions were determined for 10 standard projections (AP Abdomen, PA and LAT Chest, AP and LAT Lumbar Spine, LAT Lumbo-Sacral Joint, AP Pelvis, PA and LAT Skull and AP Urinary tract) and then the ESDs were compared with data previously published and with Italian NDRLs. All ESD values were below the corresponding NDRLs. The maximum/minimum ratio of ESDs ranged from 3.9 (LAT Skull) to 34.3 (AP Abdomen) for individual adult patients and from 2.1 (PA Skull) to 6.5 (Urinary tract) across the mean values of the radiological departments. Finally, it is shown how LDRLs can be proposed to obtain a more fully optimised radiation protection of patients.

Reference doses in dental radiodiagnostic facilities

The present work describes an experiment undertaken using thermoluminescent dosemeters to obtain a local reference dose level in orthopantomography, based on patient measurements in 11 dentistry installations. In addition, a critical audit of the dose recommended by the International Atomic Energy Agency for intraoral X-ray diagnostics is performed, based on data gathered from over 300 intraoral X-ray facilities. The provisional local reference levels proposed are 0.7 mGy entrance surface dose at the occipital region for orthopantomography and 3.5 mGy entrance surface dose for intraoral radiology.