Improving adequacy of orthopaedics lumbosacral Spine X-rays and minimizing re-exposure rates: A study in a tertiary hospital

Title

Improving adequacy of orthopaedics lumbosacral Spine X-rays and minimizing re-exposure rates: A study in a tertiary hospital

Author

1. Suman Basel, Lecturer, KIST Medical College and Teaching Hospital, Nepal
2. Pramod Bhandari, Student, KIST Medical College and Teaching Hospital, Nepal
3. Gaurav Bajracharya, Student, KIST Medical College and Teaching Hospital, Nepal
4. Shriraj Shrestha, Professor, KIST Medical College and Teaching Hospital, Nepal

Abstract

Background

Lumbosacral spine (LS) X-rays are essential diagnostic tools in orthopaedic and spinal practice, aiding in the evaluation of conditions such as trauma, degenerative diseases, infections, and deformities. However, inadequate imaging can lead to diagnostic uncertainty, repeat radiographs, increased radiation exposure, delayed clinical decision-making, and unnecessary healthcare costs. This audit aimed to assess the adequacy of LS spine X-rays ordered by the Orthopaedics Department in a tertiary hospital, identify factors contributing to poor-quality imaging, and implement interventions to reduce re-exposure rates.

Aim

This study aimed to improve adequacy rates of Orthopaedic lumbosacral spine X-rays and decrease re-exposure rates.

Methods

This was a three-phase observational audit conducted over 1 year at a tertiary hospital, evaluating all lumbosacral spine X-rays ordered by the Orthopaedics Department. Each phase lasted three months, followed by stakeholder meetings to review findings and implement interventions. Image adequacy was assessed using predefined radiographic criteria based on international guidelines. Interventions included radiographer training, standardized imaging protocols, and a quality control checklist. The primary outcome was the proportion of adequate X-rays, while the secondary outcome was the re-exposure rate. Data were analysed using descriptive statistics (percentage change) to assess improvements across phases.

Results

The adequacy of image improved significantly from 82.5% at the first phase to 95.1% in the final phase, and re-exposure rates dropped from 3.125% to 0%.

Keywords: Lumbosacral spine, Radiograph adequacy, Clinical audit, Re-exposure, Quality improvement

Keywords

Conclusion

This audit validates that methodical interventions in radiographic technique and quality assurance can enhance image adequacy while minimizing patient radiation risk. The progression from 82.5% to 95.1% adequacy and elimination of re-exposures illustrates a successful quality improvement model. Insights from contemporary literature—including dose audits, collimation studies, and EU regulatory standards—support continued refinement of radiographic practices in alignment with international safety protocols.

In summary, this audit illustrates that systematic, collaborative efforts can meaningfully improve the quality of LS-spine radiographs. By focusing on simple interventions, continuous feedback, and adherence to established standards, we were able to enhance both image adequacy and patient safety within a relatively short timeframe. We recommend ongoing periodic audits and refresher training sessions to maintain these improvements.

Author Contrubution

Suman K. Basel: Conceptualization and design, Acquisition and analysis of data, Manuscript drafting and review Pramod Bhandari: Acquisition and analysis of data, Manuscript drafting and review Gaurav Bir Bajracharya: Acquisition and analysis of data, Manuscript drafting and review Shriraj Shrestha: Conceptualization and design, Supervision

Funding

No funding was received for this audit.

Conflict of Interest

None declared.

Data Sharing Statement

Data available on reasonable request from the corresponding author.

Software And Tools Use

SPSS v16.

Acknowledgements

We would like to express our sincere gratitude to the Department of Radiology for their valuable cooperation and support throughout this audit. Their commitment to quality improvement and active participation in training, protocol development, and feedback discussions were instrumental in achieving the outcomes of this study.