Investigation of the Variability in the Assessment of Digital Chest X-ray Image Quality

Abstract

A large database of digital chest radiographs was developed over a 14-month period. Ten radiographic technologists and five radiologists independently evaluated a stratified subset of images from the database for quality deficiencies and decided whether each image should be rejected. The evaluation results showed that the radiographic technologists and radiologists agreed only moderately in their assessments. When compared against each other, radiologist and technologist reader groups were found to have even less agreement than the inter-reader agreement within each group. Radiologists were found to be more accepting of limitedquality studies than technologists. Evidence from the study suggests that the technologists weighted their reject decisions more heavily on objective technical attributes, while the radiologists weighted their decisions more heavily on diagnostic interpretability relative to the image indication. A suite of reject-detection algorithms was independently run on the images in the database. The algorithms detected 4 % of postero-anterior chest exams that were accepted by the technologist who originally captured the image but which would have been rejected by the technologist peer group. When algorithm results were made available to the technologists during the study, there was no improvement in inter-reader agreement in deciding whether to reject an image. The algorithm results do, however, provide new quality information that could be captured within a site-wide, reject-tracking database and leveraged as part of a site-wide QA program.

Reject rate analysis in digital radiography: an Australian emergency imaging department case study

“…The prevalence of positioning errors as well as the considerable variation in radiographer reject rates indicates that the standards of image quality within the department may not be consistent. This is a common finding in the literature . A study by Dunn and Rogers found that radiologists are typically more lenient with image quality, accepting 50% of images that radiographers rejected due to positioning errors.…”

“…This is a common finding in the literature. 6,7,16 A study by Dunn and Rogers 6 found that radiologists are typically more lenient with image quality, accepting 50% of images that radiographers rejected due to positioning errors. Likewise, a study by Nol et al 10 suggested that one reason positioning error has become more common is due to the reduction in communication regarding image quality between radiologists and radiographers.…”

“…The radiographer makes the judgement that an image does not satisfy stringent technical qualities to contribute to the definitive diagnosis and subsequently rejects the image and is therefore required to take another. This repeat imaging increases the patient's radiation dose and detracts from the principle of keeping the patient's exposure to ionising radiation to ‘As Low As Reasonably Achievable’ (ALARA) . In addition, rejected images decrease department efficiency and patient satisfaction, consequently increasing departmental expenses …”

“…This repeat imaging increases the patient's radiation dose and detracts from the principle of keeping the patient's exposure to ionising radiation to 'As Low As Reasonably Achievable' (ALARA). 3,7 In addition, rejected images decrease department efficiency and patient satisfaction, consequently increasing departmental expenses. 7 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.…”

Impact of AI-based Real Time Image Quality Feedback for Chest Radiographs in the Clinical Routine

“…Since the introduction of Picture Archiving and Communication System (PACS) the interaction and communication between radiographers and radiologists have been significantly reduced (18), culminating in tele-radiological services. This trend has intensified the high variability of image quality perception observed both between radiologists (19) and especially between radiologists and radiographers (20). Thus it could be shown that radiologists agreed only in 60% of cases with the necessity to retake a chest posterior anterior (PA) x-ray radiograph, that had been previously rejected by the radiographers (21).…”