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EP30638
Abstract: BACKGROUND: ICU patients typically undergo numerous chest X-rays during admission, and are often unable to be properly positioned to ensure adequate imaging. We present a completed audit cycle of quality of CXRs in ICU.
STANDARDS: All chest X-Rays should be of good quality, answer the clinical question, and contain all expected anatomy.
METHOD: Initial data collection May 2016, second data set February 2018. CXRs were reviewed by a single radiologist, who reviewed both data sets. Assessment on: whether a clinical question was asked; and an overall assessment of quality. The 2018 data set was also rated on: inspiration/rotation/exposure, and whether all expected anatomy was included in the CXR.
INTERVENTION: Educational session for both radiographers and clinicians.
RESULTS: 193 CXRs in 2016 data set, 131 in 2018 data set. 85% 2018 requests contained a clinical question vs 59% in 2016. 12% requests blank in 2016 vs 0% in 2018. 2016: 79% CXRs rated as ‘adequate’ overall, vs 2018 82%. Inadequacy due to (2018 only): 74% field of view too small, 13% occlusion with tubing/defibrillator pads, 13% inadequate exposure
.
DISCUSSION: ICU patients are a difficult population to obtain adequate CXRs in. Our intervention improved the quality of CXR request forms, but had little impact on the overall quality of X-rays performed on the ward. CXR quality can be improved by ensuring the field of view is adequate, removing occluding objects if possible, and ensuring exposure is satisfactory.
Summary: Patients in intensive care undergo numerous chest radiographs throughout admission. These are technically difficult due to patient positioning, and often result in sub-optimal imaging.References: Nil
STANDARDS: All chest X-Rays should be of good quality, answer the clinical question, and contain all expected anatomy.
METHOD: Initial data collection May 2016, second data set February 2018. CXRs were reviewed by a single radiologist, who reviewed both data sets. Assessment on: whether a clinical question was asked; and an overall assessment of quality. The 2018 data set was also rated on: inspiration/rotation/exposure, and whether all expected anatomy was included in the CXR.
INTERVENTION: Educational session for both radiographers and clinicians.
RESULTS: 193 CXRs in 2016 data set, 131 in 2018 data set. 85% 2018 requests contained a clinical question vs 59% in 2016. 12% requests blank in 2016 vs 0% in 2018. 2016: 79% CXRs rated as ‘adequate’ overall, vs 2018 82%. Inadequacy due to (2018 only): 74% field of view too small, 13% occlusion with tubing/defibrillator pads, 13% inadequate exposure
.
DISCUSSION: ICU patients are a difficult population to obtain adequate CXRs in. Our intervention improved the quality of CXR request forms, but had little impact on the overall quality of X-rays performed on the ward. CXR quality can be improved by ensuring the field of view is adequate, removing occluding objects if possible, and ensuring exposure is satisfactory.
Summary: Patients in intensive care undergo numerous chest radiographs throughout admission. These are technically difficult due to patient positioning, and often result in sub-optimal imaging.References: Nil
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