Development of an adult chest imaging protocol for Lodox x-ray systems at trauma units in South Africa

Abstract

The Lodox (Lodox® Systems (Pty) Ltd, South Africa) digital x-ray system was initially developed to assist in the detection of diamonds smuggled by employees in mines but was later adopted as a screening tool at hospital trauma units. Although one-third of patients are sent for additional chest x-ray imaging using a conventional x-ray machine, previous research has shown that the Lodox x-ray system can produce chest images of superior quality. The Lodox x-ray system also produces ten times less harmful radiation, although requesting additional images after a Lodox imaging has been performed increases the radiation dose to the patient. This study aimed at developing an adult chest referral pathway (imaging protocol) guidelines for the Lodox x-ray system used at trauma units in South Africa. The objectives were to assess the diagnostic similarities and quality of images acquired with a Lodox x-ray system compared to those acquired with a conventional x-ray system; then to formulate and verify the referral pathway (imaging protocol) guidelines for adult chest imaging using a Lodox x-ray system in trauma units. This research used a descriptive, correlation design, including content analysis, a structured observation, and an e-Delphi technique. When comparing the two sets of images obtained from the Lodox and conventional x-ray systems respectively, the Lodox images were superior to those from the conventional x-ray images for showing thoracic structures such as lung parenchyma, and thoracic cage, soft tissue outline, and the mediastinal structures. In contrast, conventional x-ray images were better than the Lodox x-ray images for pulmonary effusion, extra-luminal air, and pneumothorax. Both imaging systems were similar for the visualization of other thoracic structures. No significant differences were found in the factors affecting image quality for the two systems. Hence it was recommended that clinical indications should inform the referral of patients for Lodox imaging. The results confirmed that although both x-ray systems produced chest images of high quality, the Lodox x-ray system produced images of superior quality to conventional images for the viewing of some the thoracic structures such as fractures of the clavicle, nodules, effusions, retro-cardiac structures, mediastinum structures, pneumothorax, interstitial diseases, and fractures of ribs, fractures of clavicle and lung parenchyma. Additionally, following the e-Delphi process, a referral pathway (imaging protocol) for patients undergoing Lodox imaging was developed. The referral pathway (imaging protocol) suggested that after chest imaging with the Lodox x-ray system, computed tomography (CT) imaging of the chest and Ultrasound imaging should be requested. However, for certain cases, the patient could be referred directly for CT- and Ultrasound imaging of the chest, particularly in critically injured patients, where the rapid initiation of treatment could be lifesaving. The study confirmed that adult chest images obtained using the Lodox x-ray system in trauma units were of diagnostic quality. Hence, it was recommended that not all patients should automatically be referred for additional imaging with a conventional x-ray system. Instead, the Lodox images together with the clinical condition of the patient should inform the referral of the patient for additional imaging. Following these results, a referral pathway (imaging protocol) was developed for Lodox imaging at trauma units at hospitals in South Africa.