Keywords:
Quality assurance, Kv imaging, Education and training, Radiation safety, Radiation effects, Education, Digital radiography, Conventional radiography, Radioprotection / Radiation dose, Professional issues, Paediatric
Authors:
G. NG1, D. Tse1, V. Lee1, Y.-L. Li1, M. CHEUNG2, L. CHIN1, S. Lau1, W. M. W. Lam1, P. W. T. Lam1; 1Department of Radiology, Queen Mary Hospital/HK, 2Hong Kong/HK
DOI:
10.26044/ecr2019/C-1836
Results
Total 158 examinations were included from September 2017 to March 2018 (Phase I).
Gonad protection were only present in 27.2% (43/158),
with overall accuracy of placement of 51.2% (22/43).
In view of the unsatisfactory performance,
changes were implemented (to be discussed below).
The re-audit phase (Phase II) was conducted in June 2018 to September 2018,
including total 111 examinations.
Gonad protection were used in 60.4% (67/111),
which showed significant interval improvement compared to previous phase,
though overall correct placement rate remained similar at 55.2%.
Details of results are listed in Table 1 and Figure 2,
with key results summarized as below:
- After evaluation with radiographers,
we believe that the most significant contributing factor for our low compliance of using gonad protection in pediatric patients is the lack of awareness among the radiographers.
Uncooperative patients or difficult patient positioning is another common reason.
Radiographers may also find localization of gonads challenging,
especially for female patients,
thereby intentionally omit shielding more often in female patients for fear of obscuring bony anatomy,
and subsequently lead to repeat examination and resultant increased radiation exposure.
- The overall presence of gonad protection on radiographs has increased from 27.2% in phase I to 60.4% in Phase II.
Although both did not meet our target percentage,
such increase in compliance is still statistically significant (p<0.01).
In both phases,
it is demonstrated that gonad protection were used in more frequently in male patients than in female patients (p<0.01).
- In both phases,
it is demonstrated that gonad protection were used in more frequently in male patients than in female patients (p<0.01).
- Besides,
it is observed that the compliance on gonad protection for male patients has reached 89.1% in phase II (versus 52.0% in phase I),
which is very close to our target percentage.
We therefore foresee that with further training and continuous reminder to radiographers,
we may be able to achieve our target percentage for male patients in the near future.
- When assessing the subgroup of patients with gonad protection correctly placed,
it was observed that they are of an older age group than the subgroup without gonad protection (10.2 years old vs 4.3 years old for boys,
p=0.02; 15.0 years old vs 9.1 years old for girls,
p=0.03; Table 1),
such results helped to reveal the potential area and population that needs further effort and improvement.