Since the emergence of digital imaging, there have been questions about the necessity of continuing reject analysis programs in imaging departments to evaluate performance and quality. As a marketing strategy, most suppliers of digital technology focus on the supremacy of the technology and its ability to reduce the number of repeats, resulting in less radiation doses given to patients and increased productivity in the department. On the other hand, quality assurance radiographers and radiologists believe that repeats are mainly related to positioning skills, and repeat analysis is the main tool to plan training needs to up-skill radiographers. A comparative study between conventional and digital imaging was undertaken to compare outcomes and evaluate the need for reject analysis. However, digital technology still being at its early development stages, setting a credible reject analysis program became the major task of the study. It took the department, with the help of the suppliers of the computed radiography reader and the picture archiving and communication system, over 2 years of software enhancement to build a reliable digital repeat analysis system. The results were supportive of both philosophies; the number of repeats as a result of exposure factors was reduced dramatically; however, the percentage of repeats as a result of positioning skills was slightly on the increase for the simple reason that some rejects in the conventional system qualifying for both exposure and positioning errors were classified as exposure error. The ability of digitally adjusting dark or light images reclassified some of those images as positioning errors.
A study was undertaken to identify the causes of unnecessary repeated medical imaging examinations. The repeat analysis study investigated repeated medical imaging examinations at two medium sized hospitals in Sydney, Australia. The analytical part of the study was conducted jointly by a radiologist and a radiographer. Overall there were 9.3% and 7.2% of total films repeated respectively at the two hospital sites. Unnecessary repeats were found to have been caused by numerous factors including: poor technical judgement, the adoption of unconventional techniques, non availability of radiologist for advice, patient movement or motion, equipment mishandling, disorganised practice and poor supervision of students. At both of the sites, senior radiographers were associated with 70.2% and 84.5% respectively of dark and light film errors, and 59.7% and 85.5% respectively of the repeated cases had students' involvement. On the other hand, junior radiographers were involved with 70.3% and 86.1 % respectively of positioning errors. It was recommended that major changes be introduced to radiographer practice including, quality control, radiological techniques, training, supervision and continuing professional development. It was also recommended that the radiologist takes a more active role in future guidance and training of radiographers.
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