山东省地方性氟中毒病区X线检查成像质量的评价

Evaluation of imaging quality of X-ray films of endemic fluorosis in Shandong Province

目的评价山东省地方性氟中毒（地氟病）病区x线检查成像质量，为正确实施x线检查提供依据。方法在山东省20个地氟病县（市、区）各选择3个病村作为调查点，X线拍摄村民的前臂（包括肘关节）和小腿（包括膝关节）正位片，每村拍摄20张，每张包括2个拍摄部位。其中14个县（市、区）的42个病村X线检查由山东省地方病防治研究所承担，共拍摄X线片840张，编为A组，其余6个县（市、区）由当地医院拍摄X线片360张，编为B组。依照检查技术要求和诊断指标来确定X线片审片项目，分照片表面缺陷、结构缺陷、综合质量三个层面对比观察A与B组X线片质量差异。结臬在照片表面缺陷评定中，A组缺陷指标总检出率前臂片为7．98％（67／840），小腿片为9．77％（82／840）；B组分别为35．27％（127／360）和39．16％（141／360），两组比较差异有统计学意义（x。值分别为138．6、144．0，P均〈0．01）。在照片结构缺陷评定中，A组结构缺陷总检出率前臂片为7．14％（60／840），小腿片为8．33％（70／840）；B组分别为27．22％（98／360）和31r38％（113／360）。两组比较差异有统计学意义（x。值分别为88．867、103．6，P均〈0．01）。在照片综合质量评定中，A组优质率前臂片为72．73％（611／840），小腿片为71．67％（602／840），而质差率分别为9．89％（83／840）和11．43％（96／840）：B组优质率为44．14％（159／360）和42．22％（152／360），质差率为34．74％（125／360）和38．06％（137／360），两组比较差异有统计学意义（Z值分别为-20．161、-16．229，P均〈0．01）。结论由县（市、区）自拍摄的X线片缺陷较多、图像较差，其原因与当地医院X线技师技术水平参差不齐，照片质量要求不严有关，应定期成立上级专业技师监管队伍，到现场督导摄片和审片，推行以防治单位为主体的流动X线检查，以便提供可靠的技术保障。

Objective To evaluate the photo quality of X-ray films of endemic fluorosis in Shandong Province, and to provide a basis for correct implementation of X-ray examination. Methods Three villages were selected as survey sites in each of the 20 endemic fluorosis counties （cities, districts） of Shandong Province; anteroposterior X-ray films of the villagers forearm （including elbow） and leg （including knee） were taken; 20 films were taken in each village, each film comprising two recording sites. X-ray examination carried out in the 42 patients＇ villages of 14 counties（cities, districts） were undertaken by the Institute for Endemic Disease Control, Shandong Province, a total of 840 X-ray films shoot, which was edited group A, and the remaining six counties （cities, districts） were undertaken by the local Hospital, shooting X-ray films 360 copies, compiled for group B. The quality of X-ray film examination was determined in accordance with technical requirements and diagnostic indicators. The difference of photo quality between group A and group B was compared at three levels ： sub-surface defects photos, structural defects and comprehensive quality. Results In evaluation of surface defects in the photo, the total detection rate of the defects indicators in group A of forearm was 7.98%（67/840）, while the rate of leg was 9.77% （82/840）. And the rates of group B were 35.27% （127/360） and 39.16% （141/360）, respectively, and the differences were statistically significant between the two groups（xforearm = 138.6, P 〈 0.01 ; Xleg = 144.0, P 〈 0.01 ）. In assessment of structural defects, the total forearm defection rate of group A was 7.14%（60/840）, and the leg was 8.33%（70/840）. And the rates of group B were 27.22% （98/360） and 31.38%（113/360）, respectively. The differences were statistically significant（x2 forearm = 88.867, P 〈 0.01; X2leg = 103.6, P 〈 0.01）. In the photo quality comprehensive assessment, the excellent rate of forearm in group A was 72.73%（611/840）, and the leg was 71.67%（602/840）, while the poor quality rates in the same parts were 9.89%（83/840） and 11.43%（96/840）, respectively. And the excellent rates of Group B were 44.14% （159/360） and 42.22% （152/360）, poor quality rates were 34.74%（125/360） and 38.06%（137/360）. The differences were statistically significant（Z value were - 20.161 and - 16.229, respectively, P 〈 0.01）. Conclusions X-ray films taken in the counties （cities, districts） have more defects, and image is poor. The reason for that is that the skill levels of local hospital X-ray technician are low, and photos quality is not strictly followed requirements. Supervision team of professional technicians should be established to provide professional supports. It is more important to take mobile X-ray examination by the provincial institutes, and to provide a reliable technical support.