The role of continuing education in improving the quality of chest radiography images based on experiences in three Asian countries

This article summarises our experiences in improving the quality of chest radiography (CXR) images in resource-constrained settings in Asia. CXR is the most commonly used examination for initial diagnosis of pulmonary diseases, including respiratory infection with tuberculosis (TB). The role of CXR in TB diagnosis has become increasingly important; unfortunately, even the most basic X-ray equipment is scarcely available in many developing countries, and/or the quality of CXR images is often unacceptable for diagnosing TB patients. The quality of CXR images mainly depends on the skills of the radiological technologists (RTs) who manipulate the X-ray units. Considering the global need for improving the quality of CXR images, the Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association has conducted semi-standardised training for RTs in Asian and African countries since 2009. The course contents are based on a handbook developed by the Tuberculosis Coalition for Technical Assistance in 2008. At the pre- and post-training, the quality of CXR images performed by the RTs who underwent the training was assessed, and the results statistically confirmed that the quality of CXR images improved in the Philippines, Laos, and Vietnam. Although modern medical imaging technology is drastically expanding worldwide, RTs working in developing countries have limited opportunities to receive appropriate professional education on CXR image quality and assessment. Our experiences imply that technical assistance in the form of semi-standardised training could be an option for continuing education to improve and maintain the quality of CXR images, especially in resource-constrained settings.