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ISRRT | Book Of Abstracts

27 clinical audit’s specialist team’s recommendation no. 7 functioned as a guideline (Ref 1). The self-assessment project team gathered wrist selfassessment radiographs taken in the Emergency Radiography Unit altogether three times. The first two times we gathered 18 wrist radiographs of patients and the last time, 10 radiographs. The staff of the Emergency Radiography Unit assessed the radiographs using OUH’s criteria for a good radiograph. Results: The first time the implementers of the self-assessment project randomly gathered 18 wrist radiographs taken in the Emergency Radiography Unit and we created an Excel table for the assessment. Together with the staff we assessed the radiographs according to five different criteria for a good radiograph given in the imaging instructions, one criterion at a time. We assessed whether or not each criterion was met. We used a strict assessment scale: either the radiograph met the criteria or it did not. As an outcome, 63 % of the assessed images met the criteria for a good radiograph. The self-assessment clearly indicated that the criteria for a good radiograph which we used were not sufficient. The leaders of the self-assessment project informed the team in charge of OUH’s imaging instructions about this and the criteria for a good radiograph and the imaging instructions were modified. Now the criteria became more precise, concrete and supportive of the radiographer’s work. Now there were 11 criteria for a good radiograph. 8.10. The effect of body morphology, source image distance and patient orientation on perceived rotation on chest radiographs Presenter: Maryann Hardy, University of Bradford, UK Authors: Maryann Hardy, Blake Scotland, Lisa Herron Introduction: Chest radiography is a commonly undertaken radiographic examination but achievement of reference standard images can be challenging due to patient condition and positioning compliance. One common positioning fault reported is patient rotation around the sagittal plane. Traditionally, this has been assessed by examining the distance between the medial end of the clavicles and a line drawn through spinous processes at level of the clavicles. Where the distances between the medial end of clavicles and spinous process line are not equal, patient rotation around the sagittal plane is assumed with a greater variation in distance implying a greater degree of rotation. However, no identified published study has compared radiographic appearances of rotation with actual known rotation or considered the impact of body morphology, in particular the antero-posterior (AP) diameter of the thoracic cavity, or source image distance on radiographic appearance and assessment of rotation. Neither was it clear from the literature what the average AP diameter of the thorax at the level of the clavicles was in adult populations. This 3 phase experimental study was undertaken to estimate the AP diameter variation in adult populations and establish the effect of changes in body morphology, source image distance and patient orientation on radiographic appearances of rotation. Methods: A prototype model was used. The model could be rotated about the centre to replicate clinical practice. Images were acquired at 0°/2°/5°/7°/10°/15° rotation and at 100/150/180cm SID with model in both AP and PA orientation. Results: For the same degree of actual rotation, a wider AP diameter, shorter source image distance and AP orientation increased the radiographic appearance of rotation. The clinical importance of this finding is in questioning the continued appropriateness of the clavicle-spinous process measure for assessing rotation and recognising the possible impact that variations in body morphology, source image distance and patient orientation may have on the rotational threshold for repeating examinations. 8.11. The number of inappropriate spine radiographs in a primary care setting is decreased by active guideline implementation Presenter: Heljä Oikarinen, Oulu University Hospital Authors: Oikarinen H, Tahvonen P, Niinimäki J, Liukkonen E, Mattila S, Tervonen O Introduction: It has been estimated that over 100 million European citizens suffer from chronic musculoskeletal pain. Radiographs of the spine are common. However, they are of limited value and do not improve outcome unless there are clinical “red flags” present suggesting serious pathology, such as fracture, infection, cancer, or inflammatory disease. Furthermore, the radiation doses of spine radiographs, especially of the lumbar spine, are among the highest in conventional x-rays and radiation is delivered to some of the most radiosensitive organs. Imaging guidelines have been published in several countries, but their implementation has been inadequate and unjustified spine radiographs are a universal problem. The role of both practitioners and radiographers is fundamental in assessing justification of spine x-rays. It is known that guideline implementation may be improved by well-focused interventions. In some studies, distribution of guidelines with an educational message or lectures and feedback has succeeded in reducing general practitioners’ spine radiograph referrals. The purpose of this study was to find out whether active guideline implementation with education can reduce the number of spine radiographs in a city health centre. Furthermore, justification of the examinations performed was also in focus. Methods: Guidelines for spine x-rays and educational lectures were provided to referring practitioners, radiographers and radiologists. The number of spine radiographs and justification of examinations performed before and after interventions were surveyed. Results: The number of spine radiographs decreased by 51%. The level of justification was poor even after interventions, with only justification of the lumbar spine x-rays improving significantly. The number of spine radiographs can be decreased significantly without an increase in the number of spine MRI examinations. As a result, radiation burden is decreased and resources are released for appropriate examinations. However, evaluation of justification is not easy and more education is needed. 8.12. Unidentified lung lesions in chest images Presenter: Borgny Ween, Oslo and Akershus University College of Applied Sciences, Norway Author: Ween, Borgny Background: Chest radiography is used as the primary examination for a range of clinical questions, including lung cancer. Unidentified lung lesions are one of the most frequent causes of malpractice issues, caused by several reasons; among them suboptimal radiography. To document the localization of primarily unidentified, and later diagnosed, locations of lung lesions; might be a help for the radiographer while as the image quality of patients images is to be reviewed. The aim was to identify the frequency and localization of primarily unidentified, and later diagnosed, locations of lung lesions. Methods: A literature review was conducted for unidentified, missed, overlooked or undiagnosed lung lesions, wherefrom only studies containing figures illustrating the localization of lung lesions were chosen. The different papers’ localizations of lung lesions are summed up and illustrated. Results: will be presented as frequency and also the image distribution of missed lesions. Findings and their implications will be discussed in relation to specific criteria in the quality criteria assessments of chest images. Conclusion: We propose that the study can be followed up by a systematic mentor-guided training program that links perception of image quality to feedback about the image retake decisions, if required. 8.13. Fluoroscopic rotational radiography vs. plain digital radiographs in patients with a total ankle replacement in regards to periprosthetic cysts Presenter: Janni Jensen, Odense University Hospital, Denmark Authors: J. Jensen, L. Ludvigsen, J. Frøkjær, O. Gerke, T. Torfing Introduction: Idiopathic, post-traumatic or inflammatory osteoarthritis in the ankle joint may in end stages cause severe pain, malalignment or subluxation. The surgical options for this patient group are restricted primarily to arthrodesis or a total ankle replacement (TAR). Although preserving range of motion, a TAR is not without possible complications, with long-term studies indicating, that manifestation of periprosthetic bone cysts are a frequent occurrence for these patients. The presence, exact magnitude and etiology of periprosthetic cysts are a topic of varying disagreement in the literature, as is the choice of best postoperative imaging modality although plain radiographs seem to be the preferred or most used modality. The purpose of this prospective study was to assess the diagnostic value of weight bearing rotational radiography (fluoroscopy with 3D multi planar reconstructed images much like computed tomography (CT) images) in patients with a Scandinavian total ankle


ISRRT | Book Of Abstracts
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