• Doktor K
• Lind Vilholm M
• Hardardóttir A
• Christensen HW
• Lauritsen J

• Affiliation / Odense University Hospital. Orthopedic Department
• Affiliation / Private Practice
• Affiliation / University of Southern Denmark. Institute of Clinical Medicine
• Affiliation / University of Southern Denmark. Nordic Institute of Chiropractic and Clinical Biomechanics
• Affiliation / University of Southern Denmark. Research Unit for Clinical Biomechanics
• Affiliation(G) / Denmark / Herning
• Affiliation(G) / Denmark / Odense
• Affiliation(G) / Iceland / Reykjavik
• Diagnostic Imaging / standards
• Lumbar Vertebrae / diagnostic imaging
• Open Access Document
• Osteoarthritis, Spine
• Practice Guidelines as Topic
• Primary Care
• Quality Assurance, Health Care
• Radiation Dosage
• Radiography

Background: The Commission of the European Communities (CEC) has published: European Guidelines on Quality Criteria for Diagnostic Radiographic Images. These guidelines are considered a gold standard, recommended for use in quality assurance protocols.

The objectives of this study: 1) Propose a graded classification format for Danish chiropractic clinics according to the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. 2) Propose a reporting principle for quality of radiographic images. 3) Document variation in radiation exposure among clinics.

Methods: This is a cross-sectional study of image quality based on random sampling from 148 chiropractic clinics. Clinics were included if using: 1) Digital radiography and 2) The chiropractic picture and archiving system (KirPACS) at the Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB) in Denmark. A sample of 296 lumbar spine series were randomly collected from KirPACS (January 2018). Two independent observers reviewed 50 lumbar spine series twice with a 4-week interval, testing intra- and inter-observer reproducibility. The same observers then reviewed the remaining 246 radiographic studies. All studies were evaluated using the CEC Quality Criteria. Patient radiation dose values were retrieved from KirPACS (First quarter of 2020).

Results: A reporting and classification principle of diagnostic image quality was used in 148 chiropractic clinics. Compliance with the 22 CEC Quality Criteria had proportions ranging from 0.72–0.96 for 18 criteria, while 4 criteria specifying detail and definition ranged between 0.20–0.66. The proposed rating system (A to E) revealed: 18 A clinics, 28 B clinics, 32 C clinics, 25 D clinics and 45 E clinics (A = highest quality; E = lowest quality). The patient radiation reference dose in Denmark is 7 mGy for the AP/PA lumbar spine. Very few clinics exceed the reference dose value, approximately 50% of clinics were below 5 mGy.

Conclusion: A reporting principle is proposed for a graded classification format based on the CEC-quality criteria for diagnostic radiographic images of the lumbar spine. The Quality Criteria are for the most part met satisfactorily in 148 Danish chiropractic clinics, but important image details are compromised, in most cases, because of low patient radiation doses. The results of a patient radiation dose survey enabled documentation of variation in radiation exposure among chiropractic clinics.

Author keywords: Image quality - Quality assurance - Guidelines - Lumbar spine - Radiograph - Primary care - Radiation dose

Author affiliations: KD: Research Unit for Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; KD, MLV: Private Chiropractic Practice, Back Center Midwestern Jutland, Herning, Denmark; KD, HWC: Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; AH: Private Chiropractic Practice, Reykjavik, Iceland; JL: Institute of Clinical Medicine, University of Southern Denmark and Orthopedic Department, Odense University Hospital, Odense, Denmark
Corresponding author: KD—k.doktor@kiroviden.sdu.dk

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