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FILM REJECT ANALYSIS AND IMAGE QUALITY IN DIAGNOSTIC RADIOLOGY DEPARTMENT OF NNAMDI AZIKWE TEACHING HOSPITAL NNEWI
CHAPTER ONE
INTRODUCTION
1.1 Background of the study
An imaging modality can be characterized by its spatial contrast and temporal resolutions. The capabilities of computed tomography (CT) to other imaging modalities can be understood in these terms. Computed tomography has become a valuable tool in medicine, industry, archaeology and other fields. Therefore, various types of CT artefacts will need to be effectively removed in order not to compromise resolutions
An image artefact is a visualized structure in the reconstructed data that is not present in the object under investigation. In CT, the term is applied to any systematic discrepancy between the CT numbers in the reconstructed image and the true attenuation coefficients of the object [5].
Artefacts are commonly encountered in clinical Computed Tomography (CT), and may obscure or simulate pathology. They also degrade the quality of the image tremendously, often obscuring valuable details and detracting from its usability [7]. There are many different types of CT artifacts, including noise, beam hardening, scatter, pseudo enhancement, motion, cone beam, helical, ring and metal artifacts.
Many sources can be the origin of CT artefacts. Most artefacts can be prevented by using new designs in scanner technology, by careful positioning of patients during scanning, and by optimum selection of scanner parameters (pitch, filter kind and delivered energy). Some others can be reduced by addressing the problem in software developments. Most artefacts appear as streak effects in CT images and some of the causes are metallic objects, beam hardening, photon starvation and motion.
It is also possible to group the origins of these artefacts into four categories: (a) physics-based artefacts, which result from the physical processes involved in the acquisition of CT data; (b) patientbased artefacts, which are caused by such factors as patient movement or the presence of metallic materials in or on the patient; (c) scanner-based artifacts, which result from imperfections in scanner function; and (d) helical and multisection artefacts, which are produced by the image reconstruction process
A diagnostic radiology facility is any facility in which an X-ray system is used to irradiate any part of the human body for the purpose of diagnosis or visualization. In radiological procedures involving X-rays both patients and staffs are exposed to varying degrees of radiation doses. The quality of information obtained from radiographs is dependent on a number of factors.
The aim of radiology is to obtain images which are adequate for the clinical purpose with minimum radiation dose to the patient. If optimum performance is to be achieved, assessment of image quality must be made to balance against patient dose. X-rays are known to cause malignancies, skin damage and other side effects and therefore are potentially dangerous. It is therefore essential and mandatory to reduce the radiation dose to patients in diagnostic radiology to the barest minimum (Watkinson, Moores, & Hill, 1984).
The radiation dose to a patient is linked to image quality and should not be lowered to jeopardize the diagnostic outcome of a radiographic procedure. In order to produce a good quality image of anatomical structures for diagnostic purposes, both quality assurance program and quality control measures are of great importance (Dunn and Rogers, 1998, Watkinson et al., 1984).
. The nature and extent of this program will vary with the size and type of the facility and the type of examinations conducted. The main goal of a diagnostic quality assurance program is to produce radiographs of consistent high quality (ICRP, 1990). Patient radiographs therefore serve as a quality control check and should be factored into any departmental evaluation program (Almén et al., 1996, Beir, 1990). Quality control techniques are those techniques used in either monitoring or testing and maintenance of the components of an X-ray system (Geijer et al., 2001, Verdonck et al., 2001).
It is very common to encounter patients undergoing several repeat X-ray examinations after the initial X-ray examinations are rejected due to poor image quality, hence subjecting patients to extra cost and excess radiation exposure. This has necessitated the need to explore the causes of film reject and repeat of X-ray examinations. Reject analysis provides information that would assist to achieve a sound reduction in extra cost and over radiation exposure of patients. Film reject analysis has therefore become a major parameter as a quality control tool in diagnostic radiography service delivery.
1.2 Statement of the problem
Poor knowledge of the types and origin of artefacts encountered in clinical practice might lead to repeat investigations with the attendant radiation risks. Also, patients wait for longer hours and waste valuable man hours in the hospital. There is also more stress imposed on the machine as well as on the radiographers themselves. In the centre in focus, since the installation of a CT scanner in 2011, hundreds of CT investigations had been carried out. However, no study is known to have been done to analyze the images for artefacts. This study was therefore, planned to address that issue.
1.3 Objective of the study
The objective of this study is to assess the reject or repeat rate of X-ray films in order to obtain information for further recommendations on image quality, cost and radiation exposure at the radiology department of a selected teaching hospital in Ghana. The Film Reject Analysis (FRA) method will be used to assess the causes of poor image quality. The results obtained from the study will also be useful for the diagnostic radiology department to identify problem areas, scrutinize the reasons for these problems and finding ways of rectifying them.
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