Occupational Health | Bulletin | No.OH0010 V 1 | 02 July 2024
Chest X-ray image quality and reporting
Key points
- An ongoing review of coal miners’ chest X-rays showed common quality issues with imaging.
- RSHQ has published a guide for improving chest X-ray image quality.
- A B-Reader Summit was held earlier this year to further improve the way we test for dust lung disease in Queensland.
Issue explained
To support imaging practices identifying and addressing quality issues, Lungscreen Australia provides practices performing chest X-rays under the Coal Mine Workers’ Health Scheme (the Scheme) with quarterly data on chest X-rays graded 3 or 4.
RSHQ works with imaging practices where image quality is consistently over the 5 per cent technical quality 3 or 4 threshold, to implement strategies to address quality issues. This engagement has resulted in improvements to image quality at these practices.
The review of chest X-rays performed under the Scheme has identified several areas for improvement that are consistent across many imaging practices, including position, mottle, underexposure, underinflation and excessive edge enhancement.
Learnings
RSHQ has published A practical guide to improving chest X-ray image quality to provide technical considerations when seeking to improve image quality. The guide contains information for both radiologists and radiographers on addressing issues such as noise, contrast and resolution.
Imaging practices must undertake ongoing image quality review to address image quality issues and consider:
- Part 2 of the Standards for acquiring digital chest radiography images for medical surveillance of Queensland mine and quarry workers (the Standards), which provides information on technical quality grading of images, along with further information on common quality defects.
- Guidelines for the use of the ILO International Classification of Radiographs of Pneumoconioses, which provides notes on technical quality.
- Review of imaging practice ILO protocols, including the provision of education and awareness to improve quality.
- Exposure index and deviation index to ascertain cause of quality issue and potential solutions.
- Automatic exposure control is set up correctly and calibrated.
- Contact application specialists for chest X-ray imaging equipment, as the vendor may have a specific protocol for ILO images.
- Contact Lungscreen Australia to discuss any issues specific to the imaging practice.
B-Reader Summit 2024
To further improve the acquisition and reporting of chest X-rays, RSHQ hosted a B-Reader Summit on 4 March 2024 where radiologists and radiographers gathered to hear from leading Australian and international experts on the latest evidence and best-practice to improve chest X-ray image quality.
The summit covered reporting guidelines, technical considerations to improve quality, as well as clinical pathway requirements for reporting high-resolution computed tomography (HRCT). Attendees also took part in an interactive workshop, where participants examined a selection of real-world chest X-ray images, for practical application of their knowledge and skills.
Recordings of each session delivered during the summit are available below to enable clinics to consider what image quality improvement strategies are applicable for their practice.
Further information
The Standards detail requirements for practices performing chest X-ray imaging for Queensland mine and quarry workers. Sections 5.13 and 5.14 of the Standards outline the requirements for image quality:
- Images be ILO quality grade 1 or 2, as determined by the single final ILO Classification report, that has included the chest X-ray being read by at least two NIOSH certified B-Readers.
- Whilst chest X-rays of ILO quality 3 are acceptable, less than 5 per cent of chest X-rays should be graded technical quality 3 or 4.
- Imaging practices have evidence of on-going image quality review.
For further information or questions about chest X-ray image quality, please call (07) 3199 7967 or email minershealth@rshq.qld.gov.au.
Contact: RSHQ Occupational Health division, minershealth@rshq.qld.gov.au
Issued by Resources Safety & Health Queensland
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