A national review of X-ray imaging protocols in Irish hospital radiology departments

Introduction

Projection radiography remains the most commonly used imaging modality in Irish hospitals. This study reviewed X-ray imaging protocols nationwide, assessing their structure, consistency, and alignment with clinical guidelines by comparing documentation, listed projections, and associated clinical indications.

Method

A descriptive comparative design was used to evaluate X-ray imaging protocols from 23 Model 3 and Model 4 Irish hospitals. With permission from respective Radiology Services Managers, X-ray protocols were analysed for format, anatomical coverage, projection listings, and clinical indications. Data were coded using binary and categorical systems. Descriptive statistics, one-way ANOVA, Chi-square, and multiple regression analyses were applied to assess patterns and associations.

Results

Protocols varied significantly in format, content, and number of projections (range: 65–110; mean = 91). Only 30 % used the national Health Service Executive template, and 35 % lacked comprehensive clinical indications. A total of 178 distinct projections were identified. No significant association was found between hospital type, size, or orthopaedic services and protocol comprehensiveness. Discrepancies emerged in the use of lateral chest, bone age, temporomandibular joint, and sinus imaging, with some protocols diverging from iRefer recommendations. Significant inconsistency was also observed in trauma shoulder and weight-bearing lower limb protocols.

Conclusion

This study offers the first comprehensive analysis of X-ray imaging protocols in Ireland, revealing significant variations. While generally aligning with iRefer guidelines, these protocols show a clear lack of national standardisation in structural elements, clinical indications, and specific projection choices for less common examinations.

Implications for practice

These findings offer valuable insights for standardising X-ray protocols across Ireland.