Project materials for Assessment Of Paediatric X-Ray Examination Practices In Two Tertiary Health Institutions from chapter one to five with references and abstract
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TABLE OF CONTENTS
Title Page
Dedication
Approval Page
Certification
Acknowledgement
Table of Contents
List of tables
List of figures
Abstract
CHAPTER ONE:
INTRODUCTION
1.1 Background of study
1.2 Statement of the problems
1.3 Purpose of the study
1.4 Significance of the study
1.5 Statement of hypotheses
1.6 Scope of the study
1.7 Literature review
CHAPTER TWO:
THEORITICAL BACKGROUND
2.0 Paediatric radiography
2.1 Child development and psychological considerations
2.2 Environment
2.3 Challenges
2.4 Paediatric radiation protection issues
2.5 Equipments
2.6 Justification of radiological exposures
2.7 Optimization for paediatric radiation protection
2.8 X-Radiation
2.9 General recommendations for paediatric radiology
CHAPTER THREE: RESEARCH METHODOLOGY
Research design
3.2 Target population
3.3 Sources of data collection
3.4 Method of data collection
3.5 Method of data analysis
CHAPTER FOUR:
DATA ANALYSIS AND PRESENTATION
4.1 Frequency distributions of common paediatric x-ray examinations
4.2 Radiographic techniques and image quality
4.3 Image quality audit
4.4 Causes of film reject
CHAPTER FIVE:
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
5.1 Discussion
5.2 Summary of findings
5.3 Recommendations
5.4 Limitations of the Study
5.5 Areas of Further Research
References Appendix
ABSTRACT
Justification and optimization are the key principles in the protection of patients exposed to ionization radiation from diagnostic purposes. This is more important in the imaging of children because they are more susceptible to the effect of ionizing radiation and they have longer life expectancy compared to adults.
As a result of this, there is also recent requirement for diagnostic radiology department to demonstrate compliance with these principles. A study was carried out to assess and compare the paediatric x-ray examination practices in two tertiary institutions in Enugu metropolis, UNTH and NOHE, with the aim of determining the frequency of paediatric x-ray examinations, quality of radiographic techniques and image quality, practice of image quality criteria and feedback to staff, and causes of film reject.
The departmental registers were used to determine the frequency of common paediatric x-ray examinations. Retrospectively, 40 radiographs were collected from the medical records of the two radiological departments studied, to determine the quality of radiographic techniques and image quality, while 34 rejected radiographs were collected over a period of 3 weeks at UNTH to determine the causes of film rejects in this department. Some radiographers were interviewed to ascertain the practice of image quality audit.
All the radiographs collected were assessed by a radiographer from each department. The data was analyzed and the result showed that the paediatric x-ray examination request patterns are not the same in the two departments studied.
While UNTH has high number of chest request which accounts 62.1%, with higher percentage of males (57.7%) under the age groups of 0-5 years, NOHE has extremities as the most common requested x-ray examination which accounts 71.2%, with higher percentage of females (50.5%) but higher percentage of males are under the age group of 0-5 years (41.4%).
In both departments, more than half of films of the film assessed satisfied most of the European image criteria; 69.3% at UNTH displayed excellent radiographic techniques, and 65.7% at NOHE. The image quality audit and feedback to staff is not fully practiced. Also, the common cause of film reject at UNTH is “underexposure” which accounts 52.94% of the rejected radiographs.
The result of the hypotheses stated showed that examination type/projection requested affects poor radiographic techniques and image quality in each department and there is a significant difference in some radiographic techniques between UNTH and NOHE.
With all these findings, there is need for self-audit and re-evaluation of procedures where necessary in both departments studied.
CHAPTER ONE
INTRODUCTION
BACKGROUND OF STUDY
Paediatric radiography is a subspecialty of radiology involving the imaging of fetuses, children, adolescents and young adults. In radiography, paediatrics constitutes patients within the age range of 0-15years.
For diagnostic purposes they can be divided into six main groups as follow: (a) Birth-6months, (b) Infancy (6months-3years), (c) Early childhood (3-6years), (d) Middle childhood (6-12years), and adolescent (12-15years). Each of these groups has a peculiar need towards obtaining diagnostic quality images at the least attainable risks.
Paediatric radiography involves the use of X-rays in the diagnostic examination of a child for clinical conditions related to the different parts of the body.It has been identified as one of the most common diagnostic procedures in paediatrics, both the sick and the healthy (2).
To successfully diagnose a paediatric condition, high quality images are needed. Children can be uncooperative and obstructive when undergoing radiography and often challenge the very technique and ability of the imaging staff within whose custody they have been temporarily placed. Therefore,paediatric radiography comes with many challenges.
Medicine has used ionizing radiation for decades to help diagnose or treat children (and adults). There isno doubt that imaging has saved lives. Medical imaging use has also grown exponentially in the past few years, (3) particularly in paediatric radiography. Thus, thereis frequent demand of x- ray examinations for diagnosis of a number ofpaediatric pathologies.
The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR, 2008), estimated that worldwide, there were 3.6 billion imaging studies per year (survey covering period of 1997- 2007) using ionizing radiation comparing the previous report of 2.4billion per year (survey covering period of 1991 – 1996) – an increase of approximately 50%(3).
It was also reported by Arroe that the frequency of examinations changes, depending on the neonatal birth weight (BW), age and disease of the child (4).
In addition, there is substantial evidence to suggest that children are more susceptible to the effects of ionizing radiation than adults (5), which places an added burden on radiographers to attain the best possible result every time.
The United Nations Scientific Committee on the effects of Atomic radiation (UNSCEAR)(3) also, emphasized that risks from exposure to ionizing radiation are dependent on the age at which exposure occurs and that exposure during childhood results in a likely two to three (2-3) fold increase in life time risk for certain detrimental effects (including solid cancers) compared with that in adults: children, therefore need more careful evaluation with regard to the frequency of examinations and radiographic technique needs to be even more exacting.
European Commission has recognized the need for special treatment of children in the x-ray department, in both the “European guideline on quality criteria for diagnostic radiographic images in paediatrics” (5)and more recently in the Council Directive 97/43/Euratom(6) on the protection of individuals against the dangers of ionizing radiation.
The guidelines suggest examples of good radiographic techniques and present useful image quality criteria for a number of common paediatric examinations, with the aim of producing high quality images at lowest possible dose to the patient.
The Council Directive 97/43/Eurotom(6) recommends that special consideration be given to diagnostic radiographic procedures involving children.
Until now, researches on common routine radiological investigations ofpediatrics were mainly on radiation protection, radiation dose to paediatric patients, estimation of radiation induced cancers to patients, justification and optimization of radiological requests, and others related to the after effects of common routine paediatric x- ray examinations (8-17),
but no research to the best of the researcher’s knowledge has been carried out on the assessment of paediatric radiographic practices and request patterns in Nigeria.
Therefore the aim of this study is to assess and compare fpaediatric x–ray examination practices and request pattern in two tertiary health institutions in Enugu metropolis.
1.2 STATEMENT OF PROBLEMS
- X-ray imaging is being increasingly used for diagnosis of paediatricpathologies2. Unfortunately, there is substantial evidence to suggest that children are more susceptible to the effects of ionizing radiation than adults(3).
- Evaluation of the frequency distribution of paediatric examinations therefore becomes very essential
- addition, there is no documented evidence of audit of paediatric radiography practice in our environment to ensure safe and standard practice.
- The researcher in the course of clinical postings observed that common routine paediatric x-ray examination practices in theradiology departments being studied were not properly documented.
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