Design and evaluate a standardized protocol for pediatric chest radiography

Thesis Abstract

Pediatric chest radiography is a critical diagnostic tool, yet variability in imaging techniques often results in inconsistent image quality, increased radiation exposure, and diagnostic inaccuracies, highlighting the need for standardized protocols tailored to pediatric populations. This study aims to design and evaluate a comprehensive, evidence-based standardized protocol for pediatric chest radiography to enhance image quality, reduce unnecessary radiation doses, and improve diagnostic accuracy. The specific objectives include reviewing existing protocols, developing an evidence-based standardized framework, implementing the protocol in clinical settings, and assessing its impact on radiographic outcomes. The research adopts a mixed-methods approach, combining qualitative and quantitative methodologies within a pragmatic research design grounded in the Theory of Reasoned Action, which emphasizes behavioral intent and the influence of social norms on clinical practice. The study population comprises radiographers, radiologists, and pediatric patients at two tertiary hospitals with active pediatric radiology units. A stratified random sampling technique will select 60 radiographers and 30 radiologists, while a sample of 300 pediatric chest radiographs will be used for quantitative analysis. Data collection instruments include a structured questionnaire assessing radiographers’ compliance with existing protocols, a checklist for evaluating image quality parameters, and radiation dose measurement devices. Validity and reliability of the data collection instruments will be established through content validation by expert panels and pilot testing with Cronbach's alpha coefficients exceeding 0.85, signifying high internal consistency. The qualitative component involves thematic analysis of interviews with radiographers and radiologists to uncover barriers and facilitators of protocol adherence. Quantitative data analysis will utilize descriptive statistics to depict baseline practices, paired t-tests to compare pre- and post-intervention image quality and radiation doses, and multiple regression analysis to identify predictors of protocol adherence and image quality outcomes. Data will be managed and analyzed using SPSS version 26.0, ensuring rigorous statistical validation. Implementation of the standardized protocol is expected to result in statistically significant improvements in image quality scores and reductions in patient radiation doses without compromising diagnostic efficacy. It is anticipated that the standardized approach will reduce variability in image acquisition techniques, improve radiation safety, and align practices with established international guidelines such as those from the World Health Organization and the American College of Radiology. The findings will also elucidate contextual factors influencing protocol adherence, informing targeted interventions for sustained practice change. The study significantly contributes to knowledge by providing a validated, contextually applicable protocol for pediatric chest radiography, filling existing gaps caused by the lack of standardized procedures tailored specifically to pediatric needs within resource-limited settings. It offers a practical framework for radiology departments seeking to optimize pediatric imaging practices, integrating behavioral theories with clinical standards to promote adherence and improve patient outcomes. The main conclusion indicates that implementation of a standardized pediatric chest radiography protocol considerably enhances image quality, minimizes radiation exposure, and encourages adherence among radiographers. Based on the findings, recommendations include adopting the protocol across similar clinical settings, conducting ongoing training programs to ensure compliance, and establishing continuous quality improvement mechanisms. Future research should explore longitudinal outcomes, patient safety impacts, and the integration of new imaging technologies into standardized pediatric radiography practices.