Image rejects in digital skeletal radiography in two public hospitals in Norway

Abstract

Introduction The proportion of diagnostic images not applied for diagnostic purposes is an indicator of image quality, safety, and efficiency in radiography. Despite increased awareness, image reject is still a substantial problem and needs continued observation and targeted measures. Accordingly, the objective of this study is to estimate the extent, variation, and characteristics of image rejects, in order to improve the quality, safety, and efficiency in radiography.

Methods All skeletal images at two digital X-ray rooms at two public hospitals in Norway were reviewed for four weeks in 2020. The number of exposed images, type of examination, and number of deleted images were registered. For each deleted image the deduced reasons for deleting the image were recorded.

Results 2183 and 1467 X-ray images were taken at Hospital 1 and 2 respectively. The corresponding reject rates were 14.2% and 9.1%. The reject rate varied greatly from day to day (from 0% to 22%), and the examinations with the highest reject rate were X-ray of extremities (knee, elbow, ankle, wrist) (12–25%) and of the spine (14–19%). The two clearly dominating reasons for image rejects were positioning and centering errors.

Conclusion The reject rate is high and reduces quality, safety, and efficiency of imaging services. The reasons for image rejects are typical professionally reducible errors indicating great potential for improvement.

Implications for practice Monitoring and assessing image rejects are of great importance to management, training, education, patient safety, and for quality improvement of imaging services.