Title : Improving standards of long leg alignment radiographs at a UK District general hospital – A quality improvement project
Abstract:
Introduction: Radiography is considered the current gold standard for diagnosing leg length discrepancy and informing surgical decision making. Inadequate imaging poses a risk of inaccurate interpretation and therefore has the potential to negatively impact clinical outcomes. Repeated X-rays results in excess radiation exposure, potentially resulting in serious complications especially in a paediatric population. There is also an associated increased cost and waste of resources.
Aim: Our aim is to perform a quality improvement project, to improve standards in performing long leg radiography.
Methods: Patients imaged between 01/11/2023 and 01/11/2024 under the age of 18 were included. Standards for performing long leg x-rays used were 1) the use of block under the foot where there is clear leg length discrepancy and 2) patellae facing forwards.
Results: 243 eligible leg length radiographs were included and reviewed by 2 independent consultants. Only 48% radiographs were performed with patella facing forwards. Of 110/243 with clear leg length discrepancy requiring blocks, none were used.
Conclusion: We concluded that there is poor compliance when taking long leg radiographs, making interpretation unreliable. Next steps will involve establishing protocols and instituting training to improve standards, reduce the number of unusable films requiring repeats and in turn reducing the risk of unnecessary excess radiation to patients.
