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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: SCI-001
Optimizing chest radiograph collimation in the neonatal intensive care unit: a departmental quality control initiative
Purpose or Case Report: This study implements a practical collimation technique utilizing external body landmarks to produce more consistent and appropriate collimation for portable neonatal intensive care unit (NICU) chest radiographs (CXR).
Methods & Materials: A total of 164 NICU CXR were reviewed from 2014-2016. 51 CXR obtained prior to implementing the external landmark collimation technique were reviewed first. 2 radiographers were then trained in the technique and 8 CXR were assessed for feasibility of the technique. We reviewed 54 CXR from one month following training of all radiographers, and 51 CXR one year after training. Studies were reviewed by a radiology resident (R3) and two pediatric radiologists (5-10 years post-fellowship). All CXR were ordered for indications other than line or enteric tube placement, which requires a larger field of view. The four edges of each chest radiograph were individually assessed as optimal, acceptable, or unacceptable (rated 3, 2, or 1, respectively). Spine levels were utilized as objective parameters for the top and bottom edges. Anatomic parameters were difficult to define for the lateral edges, thus the reviewers rated them subjectively on the same 3 point scale. CXR margin ratings prior to radiographer training were compared to ratings after training utilizing Kruskal-Wallis, Wilcoxon rank (adjusting for multiple comparison by Bonferroni’s method), and Fisher’s exact tests.
Results: A statistically significant improvement was observed in top edge ratings from pre- to immediately post-training (mean 2.29 to 2.65, p<0.0167). While top edge ratings remained improved from pre-training to one year post-training (mean 2.29 to 2.59), the improvement was no longer significant. Bottom edge ratings progressively improved from pre-training to one year post training (mean 2.39, 2.43, 2.59). However, the improvement was not significant. While variably improved from pre- to post-training, right and left edge ratings had returned to near pre-training levels by one year post-training.
Conclusions: Implementation of a CXR collimation technique utilizing external landmarks resulted in improvement in top and bottom edge collimation of NICU CXR, particularly top edge, and in CXR that more consistently approached the international standard. Improvement diminished over time, suggesting repeat radiographer training and individual feedback on performance are necessary.
Methods & Materials: A total of 164 NICU CXR were reviewed from 2014-2016. 51 CXR obtained prior to implementing the external landmark collimation technique were reviewed first. 2 radiographers were then trained in the technique and 8 CXR were assessed for feasibility of the technique. We reviewed 54 CXR from one month following training of all radiographers, and 51 CXR one year after training. Studies were reviewed by a radiology resident (R3) and two pediatric radiologists (5-10 years post-fellowship). All CXR were ordered for indications other than line or enteric tube placement, which requires a larger field of view. The four edges of each chest radiograph were individually assessed as optimal, acceptable, or unacceptable (rated 3, 2, or 1, respectively). Spine levels were utilized as objective parameters for the top and bottom edges. Anatomic parameters were difficult to define for the lateral edges, thus the reviewers rated them subjectively on the same 3 point scale. CXR margin ratings prior to radiographer training were compared to ratings after training utilizing Kruskal-Wallis, Wilcoxon rank (adjusting for multiple comparison by Bonferroni’s method), and Fisher’s exact tests.
Results: A statistically significant improvement was observed in top edge ratings from pre- to immediately post-training (mean 2.29 to 2.65, p<0.0167). While top edge ratings remained improved from pre-training to one year post-training (mean 2.29 to 2.59), the improvement was no longer significant. Bottom edge ratings progressively improved from pre-training to one year post training (mean 2.39, 2.43, 2.59). However, the improvement was not significant. While variably improved from pre- to post-training, right and left edge ratings had returned to near pre-training levels by one year post-training.
Conclusions: Implementation of a CXR collimation technique utilizing external landmarks resulted in improvement in top and bottom edge collimation of NICU CXR, particularly top edge, and in CXR that more consistently approached the international standard. Improvement diminished over time, suggesting repeat radiographer training and individual feedback on performance are necessary.
More abstracts on this topic:
Baby Bellies Gone Bad on Film: Imaging and Approach to Neonatal Gastrointestinal Emergencies.
Uricchio Joseph, Sharma Priya, Rajderkar Dhanashree
In the ER, Look and Listen for Most oBvious Signs! A systematic approach for evaluating pediatric chest radiographs in the acute settingPan Patrick, Roth Antoinette, Chawla Soni
Poster____SCI-001.pdf
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