Survey of chest X-ray imaging in Iran: A comparative quality-control study

Background: quality and safety have become hallmarks for efficient and successful medical interventions. the most common type of plain film is the chest x-ray, a basic evaluation in the staging for almost all cancer patients. although several recent articles have been dedicated to quality control in diagnostic medical imaging, this is the first such report from iran. methods: in this cross-sectional study, the quality of electively-obtainedposteroanterior chest x-ray (pa cxr) examinations at the cancer institute of imam khomeini hospital, tehran, iran, was evaluated according to the european guidelines on quality criteria for diagnostic radiographic images (eur 16260, brussels 1996). for each criterion of the european guidelines, each x-ray projection was graded as good, fair or poor. finally, the overall quality of the radiographs for the intended clinical purpose was assessed. the significance of the differences between the three scores for each criterion and overall quality for diagnosis was determined. these results were then compared to those ofsimilar studies from other countries. results: a total of 300 chest x-ray films were randomly considered in this study. of these, 57%, 31%, and 12% were rated good, fair and poor, respectively. we obtained the highest frequencies of good scores in the categories of side marker and visualization of the vascular pattern (91% and 74.6%, respectively). the lowest quality was found in the categories of visibility of the spinal column and paraspinal structure and ' visibility of retrocardiac lung and mediastinum for which poor ratings were given to 33.4% and 32.1% of the radiographs, respectively. the lowest quality was significantly related to the exposure parameters and film processing, although all ten criteria had significant statistical correlations with the overall quality of the film. conclusions: our results reveal that the practice of radiography in the cancer institute of iran is not optimal. this observation supports the supposition that significant improvements can be achieved with modest investments, especially in the categories of ''patient information and correct anatomical side marker and (tpatient positioning this can be achieved with more precise supervision of radiographic technicians, as well as periodic film scoring and retraining programs.