Radiograph Reject Analysis in a Large Tertiary Care Hospital in Riyadh, Saudi Arabia

Abstract

Background: Analysis of rejected radiographs is an important quality indicator of any radiology department. At King Abdulaziz Medical City (KAMC), about 185,000 radiographs are performed annually. Methods: The rejected radiographs over a period of 5 years were analyzed using a dedicated electronic rejection system. The rejection is performed by a certified radiologist and communicated electronically to the concerned technologist. Results: A total of 455 rejected radiographs were reviewed and analyzed. Of the reviewed rejected radiographs, 247 were adults (60%) whereas 166 were pediatrics (40%). In terms of sex, 231 (56%) of the rejected radiographs were for men and 182 (44%) were for women. The most common reason for rejection was labeling (22%), followed by procedure protocol (20%). Other reasons included positioning (14%), processing (14%), artifacts (13%), wrong documentation (9%), and exposure error (6%). The rejection due to exposure error was very low (6%) owing to the utilization of digital systems that offer a wide exposure latitude. Reported data at hospitals that use analog systems show up to 67% of rejections were due to exposure error. In terms of body parts, the highest rejection was for extremities (43%) followed by chest (31%). The remaining rejected radiographs includes abdomen (9%), spine (8%), pelvis (5%), and head and neck (4%).Conclusion: The outcome of this study can be used to set up training programs to improve radiological services and reduce the unnecessary radiation exposure to the patients.

Analysis of the potential reasons for repeated radiography: a study in a major hospital in south eastern Iran

“…6,7 For a diagnostic radiology department to be able to provide images of high quality with the minimum exposure of patients and staff to the radiation, a program of quality assurance needs to be set and accomplished. 8,9 The reasons for the rejection of images correspond with technical alternated advances. The most common reason to reject images in conventional filmscreen radiology was reported to be exposure errors (that is, too much or too little exposure).…”

Digital radiograph rejection analysis during “Coronavirus disease 2019 (COVID-19) pandemic” in a tertiary care public sector hospital in Khyber Pakhtunkhwa Province of Pakistan

“…Patients might undergo repeated X-ray examinations after their initial X-ray radiographs are rejected due to different reasons such as poor image quality, artifact, anatomical cutoff, patient motion, and equipment malfunction [ 3 ]. Rejected radiographs that are repeated, may lead to extra radiation dose to the patient; reduction in the lifetime of the X-ray machines, which added expenses on the health care system; and long waiting list [ 4 , 5 ].…”

How has the COVID-19 pandemic affect the rejection rates and repeat reasoning of digital radiography?

“…In addition, rejected images lower the adequacy of the department and patient gratification, which, as a result, will raise departmental charges. 6 World Health Organization recommends a rejection rate of 5%; meanwhile, the Committee on Quality Assurance of the Conference of Radiographic Control Program Directorate 7 suggests a rejection rate of 10%. Several studies reported a rejection rate ranging from 2.1% to 33%, and the reasons for these differences include positioning errors, motion errors, or miscellaneous errors.…”