Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections. (September 2020)

• Record Type: Journal Article
• Authors: Snaith, Beverly; Raine, Scott; Fowler, Lynsey; Osborne, Christopher; House, Sophie; Holmes, Ryan; Tattersall, Emma; Pierce, Emma; Dobson, Melanie; Harcus, James W
• Is Part Of: Hand therapy. Volume 25:Number 3(2020)
• Page Start: 107
• Page End: 113
• Publication Date: 2020-09
• Subjects: Wrist -- radiography -- X-ray -- quality improvement -- education; Hand -- Wounds and injuries -- Treatment -- Great Britain -- Periodicals; Hand -- Wounds and injuries -- Patients -- Rehabilitation -- Great Britain -- Periodicals; 617.57506
• DOI: 10.1177/1758998320935920
• Languages: English
• ISSNs: 1758-9983

Abstract

Introduction: In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied. Method: This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late). Results: Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% ( n = 40/238), and this improved to 47.8% ( n = 77/161) post-intervention, but declined to 32.8% ( n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort ( p < 0.001) and the late post-intervention group ( p = 0.002) but not in the examinations performed two weeks after staff education ( p = 0.239). Conclusion: Assessment of image quality is critical for diagnosis and treatment monitoring. Yet poor compliance with standard anatomical principles was evident. A simple educational intervention resulted in a transient improvement in wrist positioning, but the impact was not sustained over time.