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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 107-108

Does a quality assurance training course on chest radiography for radiological technologists improve their performance in Laos?


1 Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis/ Anti-Tuberculosis Association, Tokyo, Japan
2 Department of Radiology, Gat Andres Bonifacio Memorial Hospital, Manila, Philippines
3 Department of Healthcare Management, College of Healthcare Management, Fukuoka, Japan

Date of Web Publication7-Mar-2018

Correspondence Address:
Dr Akihiro Ohkado
Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Matsuyama 3-1-24, Kiyose, Tokyo
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_203_17

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How to cite this article:
Ohkado A, Mercader M, Date T. Does a quality assurance training course on chest radiography for radiological technologists improve their performance in Laos?. Int J Mycobacteriol 2018;7:107-8

How to cite this URL:
Ohkado A, Mercader M, Date T. Does a quality assurance training course on chest radiography for radiological technologists improve their performance in Laos?. Int J Mycobacteriol [serial online] 2018 [cited 2019 Jul 22];7:107-8. Available from: http://www.ijmyco.org/text.asp?2018/7/1/107/226787



A letter to the editor by Sookaromdee and Wiwanitkit[1] highlighted some critical points on the quality assurance training course on chest radiography (CXR) that we reported in the previous issue of the journal.[2]

First, regarding the method of teaching, which we described briefly in the report on the Philippines,[3] we intended to assess the effectiveness of the training course not from the learners' point of view but through the outputs of the training participants, that is, the six assessment scores of the quality of CXRs comparing before and after the training course among the course participants.

Second, we do agree the sustainability of the quality, that is, maintaining the skills to take quality CXRs, is of critical importance. We tried to investigate the effectiveness of monitoring visits by senior radiological technologists (RTs) after the training course in the Philippines.[4] We observed that the training course showed a relatively long-term effect in maintaining the skills of the RTs, but we failed to show the positive impact of post-training monitoring visits. Postgraduate continuous training in addition to undergraduate training is essential for the RTs. Continuing professional development has been practiced in some industrialized countries, but it has not been implemented well in developing countries like Laos.[5]

Third, as far as we know, there are no systematic training materials on how to check and maintain the quality of CXRs of pediatric patients, while there is a guide for tuberculosis (TB) in children.[6] It is one of the most challenging areas for RTs to take quality CXRs among pediatric patients, who tend to cry and move. As a result, a physically normal pediatric patient's CXR may possibly be interpreted as abnormal.[7] The handbook we used as a key reference to conduct the CXR quality training was developed mainly based on the experiences of the annual CXR assessment meeting conducted by the Japan Anti-Tuberculosis Association.[8] The CXRs assessed during the meeting were of adults, and the handbook focused on CXRs of adults.

Finally, we agree that laboratory errors occur even in a highly controlled environment. For instance, there is bacterial cross-contamination in quite a few TB laboratories across the world.[9] Possibly, this unnecessarily puts non-TB patients through anti-TB treatment. Errors due to insufficient quality of CXRs by RTs or due to incorrect reading of CXRs by physicians may also unnecessarily put non-TB patients through anti-TB treatment when overdiagnosis of active TB is made. On the other hand, errors in underdiagnosis of infectious TB may put the community at risk of transmission. The skill of physicians in reading CXRs must also be improved and maintained for making correct TB diagnosis. Quite a few guidebooks on reading CXRs of both adults and children have been published so far,[10],[11] but those on taking quality CXRs for RTs have not been developed well. We would like to emphasize that both areas, that is, taking quality CXRs as well as accurately reading them must go together to minimize laboratory errors related to CXRs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sookaromdee P, Wiwanitkit V. Quality assurance training course on chest radiography in Laos. Int J Mycobacteriol 2017;6:414.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Ohkado A, Mercader M, Date T. Does a quality assurance training course on chest radiography for radiological technologists improve their performance in Laos? Int J Mycobacteriol 2017;6:302-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Ohkado A, Poblete R, Mercader M, Querri A, Agujo P, Tang F, et al. Effectiveness of a training course on the quality assurance of chest radiography in the Philippines. Int J Tuberc Lung Dis 2012;16:379-83.  Back to cited text no. 3
[PUBMED]    
4.
Ohkado A, Luna P, Querri A, Mercader M, Yoshimatsu S, Coprada L, et al. Impact of a training course on the quality of chest radiography to diagnose pulmonary tuberculosis. Public Health Action 2015;5:83-8.  Back to cited text no. 4
[PUBMED]    
5.
Elshami W, Elamrdi A, Alyafie S, Abuzaid M. Continuing professional development in radiography: Practice, attitude and barriers. Int J Med Res Health Sci 2016;5:68-73.  Back to cited text no. 5
    
6.
World Health Organization. Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children. 2nd ed. Geneva, Switzerland: World Health Organization; 2014.  Back to cited text no. 6
    
7.
Swishuk L, editor. Respiratory system. In: Imaging of the Newborn, Infant, and Young Child. 3rd ed. Baltimore, USA: Williams & Wilkins; 1989. p. 1-206.  Back to cited text no. 7
    
8.
Chen-Yuan C, van Cleeff M, Daley C, Date T, Enarson DA, Getahun H, et al. Handbook for District Hospitals in Resource Constrained Settings on Quality Assurance of Chest Radiography: For Better TB Control and Health System Strengthening. Hague: The Tuberculosis Coalition for Technical Assistance (TBCTA); 2008.  Back to cited text no. 8
    
9.
Burman WJ, Reves RR. Review of false-positive cultures for Mycobacterium tuberculosis and recommendations for avoiding unnecessary treatment. Clin Infect Dis 2000;31:1390-5.  Back to cited text no. 9
[PUBMED]    
10.
Daley C, Gotway M, Jasmer R. Radiographic Manifestations of Tuberculosis: A Primer for Clinicians. 2nd ed. San Francisco, USA: Curry International Tuberculosis Center; 2011.  Back to cited text no. 10
    
11.
Gie R. Diagnostic Atlas of Intrathoracic Tuberculosis in Children. A Guide for Low Income Countries. Paris, France: International Union Against Tuberculosis and Lung Disease; 2003.  Back to cited text no. 11
    




 

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