Letter to the editor regarding Mussman et al. ‘The lateral wrist radiograph – To retake or not to retake’

Snaith, Beverly

doi:10.1016/j.radi.2022.11.010

Cited by 1 publication

(5 citation statements)

References 3 publications

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“…These results strongly support the suggestion that radiographers are focussing on pre‐determined image criteria and the pursuit of the perfect ‘textbook’ image and not the ability to consider clinically driven diagnostic conclusions 3,10 . This supports the call for the radiographic community to invest in general radiography as a specialist modality and take a lead role in better understanding the clinical relevance of their imaging 16,20,36,37 …”

Section: Discussionsupporting

confidence: 71%

“…Importantly, had the images that the radiologists, or even the experienced radiographers, deemed acceptable been accepted initially, the repeat rate for the lateral wrist over this time frame would have been 5.5% and 9.8%, respectively. This highlights that radiographers are performing imaging at acceptable standards, refuting suggestions found in literature 16,17,35 . These results strongly support the suggestion that radiographers are focussing on pre‐determined image criteria and the pursuit of the perfect ‘textbook’ image and not the ability to consider clinically driven diagnostic conclusions 3,10 .…”

Section: Discussionsupporting

confidence: 63%

“…3,10 This supports the call for the radiographic community to invest in general radiography as a specialist modality and take a lead role in better understanding the clinical relevance of their imaging. 16,20,36,37 In an editorial on evidence-based radiography, Snaith 37 describes the term 'practice creep' as 'a gradual, often imperceptible, change in technique occurring with, or without, a grounded theory or evidence base'. 37 Assuming these results are representative of a trend that exists in departments elsewhere, is it, therefore, possible that we are seeing a creep in rejecting adequate imaging?…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 13 , 14 , 15 By extension, this would likely result in limitation of the clinical experience for new graduates. There is concern in the literature that radiographers are less able to produce images of an appropriate standard, 16 , 17 which may be a possible cause for the increase in positioning‐related reject rates.…”

Section: Introductionmentioning

confidence: 99%

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The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging

Steward,

Semsem,

Currie

et al. 2023

J of Medical Radiation Sci

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IntroductionThis study illustrates image rejection rates of the lateral wrist x‐ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images that needed to be repeated based on the clinical indication. This study highlights the difference in subjective image‐repeat decision‐making skills existing between radiologists, experienced radiographers and junior radiographers.MethodsA retrospective review was conducted of all rejected lateral wrist x‐ray images by a panel of three radiologists, three experienced radiographers and six junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A complement of images that had not been rejected were included in the review to create a blinded study.ResultsThe review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers.ConclusionsThis review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists; however, the difference in decision‐making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services and indicates an unnecessary burden to clinical practice. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionsupporting

confidence: 63%