Page 32 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
OP-18

Improving the Image Quality of Cervical Spine Radiographs in the Radiology Department,
Hospital Melaka

Nyin LY, Siti Nurhamimah Y, Nurul Amani N, Goh JH, Nur Samila S, Nur Aziera AA
Radiology Department, Hospital Melaka, Melaka

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
A suboptimal cervical spine radiograph may result in delayed diagnosis. Thus, the quality of cervical spine
radiographs can be improved by implementing certain measures.

KEY MEASURES FOR IMPROVEMENT:
Our indicator is the percentage of optimal cervical spine radiographs with a standard of 70%.

PROCESS OF GATHERING INFORMATION:
This was a cross-sectional study in two phases. Pre-remedial was from 21 September 2020 to 2 October
st
nd
2020. All the cervical spine radiographs were included (47 cases), using two checklists. The patient’s
understanding was assessed based on the ability of a patient to follow >50% of the instructions during the
procedure. This was followed by a post-remedial study from 1 May 2022 to 6 May 2022, with 30 cases
th
st
collected.
ANALYSIS AND INTERPRETATION:
There were 70.3% of suboptimal cervical spine radiographs. The percentage of optimal lateral (LAT)
radiographs was low (29.8%), but the percentage of optimal anteroposterior (AP) radiographs was acceptable
(70.2%). The contributing factors for the suboptimal study were the rotated position of the patients in LAT
(61.7%), selection of supine position (81.8%), patient’s body weight >60 kg (93.3% - 100%) and poor patient
understanding of the procedure (72.2%).

STRATEGIES FOR CHANGE:
We introduced a Neck Board with a Flexible Strap and Power Tank to improve the techniques of performing
radiographs. Explanatory videos/flip charts are introduced to the patients to improve understanding.

EFFECT OF CHANGE:
The optimal cervical spine radiograph improved from 29.7% to 46.7%. The Achievable Benefit Not Achieved
(ABNA) reduced from 40.3% to 23.3%. The percentage of LAT radiographs with the rotated position was
reduced (from 61.7% to 10.0%). The percentage of optimal radiographs on standing/sitting was improved
(32.0% to 92.3%) with no improvement in the supine position. The optimal radiographs improved (6.7% to
53.9%) in patients >60-80 kg. In patients with good understanding, the percentages of optimal radiographs
improved (31.0% to 78.6%).

THE NEXT STEP:
We have introduced additional remedial measures and more detailed steps in the process of care.

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