An examination of practice during radiography of the clavicle

Background: Variation in techniques is a well reported phenomenon in Radiography that can lead to dose discrepancies. Radiography of the clavicle is an examination which can result in a scattered extra-focal radiation dose to the radiosensitive organs of the thyroid, breast and eyes. Techniques for imaging the clavicle are examined and causal factors of repeats examined. Given the recent increase of the tissue weighting factor of breast tissue, an increased importance is placed upon dose reduction techniques to this area. Aims: This study aims to investigate the variation in techniques used in imaging of the clavicle and to investigate whether AP or PA position resulted in a higher level of repeat imaging. Method: To investigate current practice amongst hospitals a sample of large teaching hospitals was chosen (n=5). An interview with radiographers was carried out along with an examination of the stated protocols in each of these hospital plus retrospective analysis of the images produced in each of these hospitals. Results: Variations in practice were established, significant differences in collimation and vertical centring were found. AP coned view of the clavicle was performed by 80% of radiographers interviewed with 20% of radiographers performing an AP shoulder. This variation being 100% correlated with country of training. 60% of radiographers were found to perform AP15° cranial angulation clavicle as a second projection with 28%, 8% and 4% of those interview performing AP25°, AP20°, and AP30° cranial angulation, respectively. The comparison of error and repeat rates study demonstrated a lack of confidence, reduced employment of collimation and reduced accuracy while centring in the PA position and it was deemed necessary to repeat in 30% of cases compared to 40% repeats were necessary. Conclusion: Wide variation exists in technique and PA imaging is not being implemented. The author recommends training and information on PA technique be disseminated and the local protocols address variations in practice.