THE PATTERNS OF CHEST X-RAY REFERRALS, FINDINGS AND THE DISTRIBUTION OF THE REFERRING UNITS IN THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ITUKU-OZALLA, ENUGU

Background:  Chest x-ray remains a major tool for diagnosis and management of many diseases ravaging mankind.

Aim:  To assess the chest-x-ray referral patterns and findings in the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu.

Patient and Method:  A retrospective study of 377 patients who underwent chest x-ray examination at the University of Nigeria Teaching Hospital, Ituku-Ozalla.

Result: Chest x-ray (6,592) constituted above half of the total referrals(11,306) to the Radiology department in year 2012.  More females, (58.62%, n = 221) were referred for chest x-ray than the males, (41.38%, n = 156).  The highest indication for chest x-ray in the University of Nigeria Teaching Hospital is HTN, (35%, n = 132).  Patients between the age bracket of (41 – 50) have the highest referral for chest x-ray.  Most of the chest x-ray referrals are on out patients, GOPD (61.27% n = 231), MOP (11.14%, n = 42).  More than half of the chest x-ray referrals (52.79%, n = 199) appear radiologically normal while the remainder (46.15%, n = 174) were abnormal.  The chest radiographs of 92.86% (n = 14) of those for medical exam/Routine check appeared radiologically normal

Conclusion

Conventional chest x-ray remains the primary diagnostic tool for most diseases of the chest region.  However appropriate clinical diagnosis should always be conducted to reduce the  number of normal chest-x-rays diagnosed.  Routine chest x-ray should be discouraged as it almost amounts to unnecessary irradiation of patients with low diagnostic yield.  

Key words:  Chest, x-ray, referrals, indications, patterns of findings, UNTH Ituku-Ozalla, referring units.                                    

CHAPTER ONE:  Introduction

CHAPTER TWO:  Theoretical Background

CHAPTER THREE:  RESEARCH METHODOLOGY

CHAPTER FOUR:  DATA ANALYSIS AND PRESENTATION

CHAPTER FIVE:  DISCUSSION, SUMMARY OF FINDINGS, 

RECOMMENDATION, LIMITATION OF THE STUDY, CONCLUSION AND AREA OF FURTHER STUDY

References

Appendix

Chest x-ray is a radiological investigation that makes use of x-radiation to obtain diagnostic information about the chest region.1, 2, 3. Chest x-ray is the commonest radiologic examination4. The chest examinations are done because of certain clinical indications which include, tuberculosis, pneumonia, to visualize air-fluid level in trauma cases, preoperative chest x-ray, cancer, cardiac bypass, surgical empyema, hypertensive heart disease, bronchitis, broncholitis, routine chest x-ray to check for inserted lines, chest wall and mediastinum5,.At some other times they are done for screening ,pre-admission and medical examination purposes.Chest x-ray has overtime served as a veritable tool for the diagnosis of many pathologic conditions6.The main regions where a chest x-ray may identify problems may be categorized as;A,B,C,D,E,F by their letters.These include Airways(hilar adenopathy or enlargement) ,Breast shadows,Bones e.g fractures and lytic bone lesions,      Cardiac silhouette, detecting cardiac enlargement, Costophrenic angles, including pleural effusions . Others include Diaphragm, e.g showing evidence of free air edges such as apices for fibrosis,pneumothorax,pleural thickening or plaque fields(lung parenchyma being evidence of alveolar filling) and  then Failure e.g alveolar air space disease with prominent vascularity with or without pleural effusions1. Patients are often referred to the radiology unit for chest x-rays.These come from different medical/surgical units like ICU,MOPD,GOPD,A&E, Oncology, Paediatric, Casualty, Neurology, Enterology, etc. The extent of the usage of the radiology department by these units is not known. There is need, therefore, to establish the degree of these referrals, as well as the extent of usage of the chest radiography by the different units.

Most of the time, chest x-rays are done without any significant abnormality detected.This could be as a result of referrals done without critical and adequate clinical diagnosis by the referring clinicians.Noting how many chest x-ray examinations undertaken which were able to point to any abnormality will help to weigh this out.It is also necessary, to find out how often the chest x-rays are done, the indications as well as the nature of the results of such examinations. How many come out normal, negative or abnormal? Is there actually any correlation between clinical indications and radiologic findings? Are chest x-ray examinations necessary in all conditions? The Nigerian Federal University Teaching Hospitals have higher number of patients of varying social strata.This is because it is believed that medical services are offered at a relatively lower cost there than is obtainable in other  hospitals.As a result, The University Of Nigeria Teaching Hospital, Ituku-Ozalla was chosen for this study because it is a Nigerian University Teaching Hospital that has high patient through put. Patients are referred to the hospital from the neighbouring rural communities and States, with varying pathological conditions. Specialist, private and state-owned hospitals were not considered in this research as they may not have enough data for the research purpose.

Many other imaging modalities like MRI, CT etc can be employed to obtain most of this diagnostic information but routine conventional chest x-ray still offers primary information about a greater number of them7