The level of quality of radiology services in Turkey: a sampling analysis

To determine the quality of radiographs, which have been referred from 40 different institutions for consultation, to discuss the causes of wasted resources, and to present possible solutions.

Five experienced radiology instructors determined the types of radiological examinations referred for consultation (conventional radiography, mammography, computed tomography and magnetic resonance imaging), the institutions at which they were performed (university or state hospital, private health center), and assessed the coverage area, field of vision (FOV), and dosage of x-ray. They also investigated problems in film processing, defects in sequence-printing windows, checked window levels, and checked the amount and timing of contrast material used. According to these criteria, the reviewers subjectively classified each radiograph as: 1. Poor, examination should be completely repeated, 2. Fair, examination should be partially repeated, 3. Good, accepted as adequate, no need for an additional examination, 4. Excellent, examination was as it should be.

We reviewed 120 radiological examinations from 40 different institutions in 4 reference centers. Frequency of problems determined for each category was as follows: coverage area 32.5% (39/120), FOV 16% (14/86), X-ray dosage 16% (15/94), film processing 31% (37/120), sequence or window 65% (53/81), window level 44% (36/81); contrast material 51% (25/49), timing of contrast material 61% (30/49). Only 22% of the examinations were classified as excellent, whereas 47% required complete or partial repetition.

Approximately half of the radiological examinations in our sampling required partial or complete repetition. Health, ethical, and economic aspects of the problem necessitates the prompt application of measures to establish radiological quality control and standardization procedures.