Design and evaluate a standardized protocol for bedside chest X-ray positioning

Thesis Abstract

The accuracy and consistency of bedside chest X-ray (CXR) positioning remain significant challenges in clinical radiography, often resulting in compromised image quality, increased repeat rates, and potential misdiagnoses. Despite the availability of established positional guidelines, variability persists among radiographers, affecting diagnostic reliability and patient outcomes. This study aims to design, implement, and evaluate a standardized protocol for bedside chest X-ray positioning to enhance image quality and procedural consistency. The specific objectives are to identify factors influencing proper positioning, develop a comprehensive protocol aligned with current best practices, and assess the protocol's effectiveness through measurable improvements in radiographic quality. Employing a mixed-methods research design, the study integrates qualitative analyses to gather insights from radiographers, and quantitative assessments to measure the protocol’s impact. The population comprises 150 radiographers working in acute care hospitals, with a sample size of 75 selected via stratified random sampling to ensure representation across experience levels and institutions. Data collection instruments include semi-structured interview guides for radiographer perspectives, observation checklists to evaluate current positioning practices, and a custom-designed protocol manual. The validity and reliability of these instruments are ensured through pilot testing, expert validation, and internal consistency analysis (Cronbach's alpha). For the quantitative component, pre- and post-intervention images are evaluated based on established quality criteria, and data are analyzed using paired t-tests and intra-class correlation coefficients (ICC) to determine improvements in image quality and adherence to positioning standards. The study hypothesizes that the implementation of a standardized protocol will significantly improve the adequacy of bedside CXRs, reduce repeat rates, and enhance overall diagnostic accuracy. It is anticipated that the intervention will lead to statistically significant improvements in image positioning accuracy, as measured by image quality scores, with an expected increase of at least 20% in correctly positioned images post-implementation. Thematic analysis of qualitative data is expected to reveal contextual barriers and facilitators influencing protocol adoption, aligning with Bandura’s Social Cognitive Theory, which emphasizes the role of observational learning and self-efficacy in behavior change. Additionally, the Theory of Planned Behavior may underpin the intention to adopt standardized practices. This research contributes novel insights into the development of evidence-based, context-specific protocols for bedside CXR positioning and provides empirical data on their efficacy in resource-variable clinical settings. By systematically evaluating the protocol’s implementation and impact, the findings provide a basis for policy recommendations and training interventions aimed at standardizing bedside radiography procedures. The anticipated outcomes include a validated protocol that increases radiographic quality, reduces repeat exposures, and ultimately improves patient care outcomes. This study underscores the importance of structured guidelines in clinical practice and offers a scalable model adaptable across diverse healthcare environments. In conclusion, the implementation of a standardized bedside chest X-ray positioning protocol demonstrates promising potential to enhance radiographic consistency and diagnostic reliability. Recommendations include integrating the protocol into routine radiography training curricula, conducting ongoing quality assurance assessments, and fostering multidisciplinary collaborations to sustain adherence. Future research should explore longitudinal impacts, patient-centered outcomes, and the protocol's adaptability to other radiographic procedures. Overall, this study advances the field of diagnostic radiography by providing a structured framework for quality improvement and standardization in bedside imaging practices.