The assessment of image quality and diagnostic value in X-ray images: a survey on radiographers’ reasons for rejecting images

Abstract

Background Assessing the quality of diagnostic images is subjective and influenced by factors such education, skills, and experience of the assessor. This study aims to explore the radiographers’ assessments of medical usefulness or rejection of X-ray images in specific cases. Results Eighty-one radiographers from different countries responded to the questionnaire distributed online at the EFRS research HUB at ECR 2020 (a 15% response rate). Forty-two percent of the respondents practiced in the UK and Ireland. In addition to rejecting or keeping images in the presented 30 cases and giving a main reason for the images rejected, the participants explained their choice using comments, 1176 comments were obtained. Sixty percent of the comments were on kept images. The respondents kept on average 63% of the images. In the “Keep”, “Could keep”, and “Reject” categories on average 84%, 63% and 43% of images were kept respectively. The most common reasons given for rejecting an image were suboptimal positioning and centering. Potential diagnostic value and radiation protection were indicated as reasons to keep an image perceived as of low quality reported in n = 353 and n = 33 comments respectively. Conclusions There is an agreement internationally on what makes a good quality X-ray image. However, the opinion on medical usefulness of images of low or poor quality compared to image criteria varies. Diagnostic capability and radiation protection was the rationale used for keeping images not fulfilling image criteria. There seems to be a need for diagnostic quality to be included in image assessment in clinical practice.

Understanding reasons for image rejection by radiologists and radiographers

“…In many cases, radiographs are deleted even before they reach the radiologist. 2,5,8 Mount 1 investigated the rejection rate of lateral knee radiographs in a monocentric study. In conclusion, Mount 1 hypothesised a different approach to image quality assessment by different professions may be the primary cause for the different acceptance rate.…”

“…The production of a radiograph of sufficient quality to enable accurate diagnosis is of common interest to radiologists and radiographers. The radiographer visually and subjectively estimates whether the acquired image quality matches the quality required to answer the clinical question 1,2 . In this assessment, the radiographer should consider that the benefit of a retake must surpass the negative effect of the additional radiation dose, 1,3 as balancing patient radiation dose and image quality is a fundamental aspect of good practice in radiography 4,5 .…”

“…It is difficult, as described by Hofmann, 8 Waaler and Hofmann, 5 to determine the rate at which radiographers reject images which would be considered sufficient for diagnosis. In many cases, radiographs are deleted even before they reach the radiologist 2,5,8 …”

“…The radiographer visually and subjectively estimates whether the acquired image quality matches the quality required to answer the clinical question. 1 , 2 In this assessment, the radiographer should consider that the benefit of a retake must surpass the negative effect of the additional radiation dose, 1 , 3 as balancing patient radiation dose and image quality is a fundamental aspect of good practice in radiography. 4 , 5 Radiographers, when satisfied with the quality of a radiographic image, end the examination and make the radiographs available for reporting by the radiologist.…”

Deep Learning Based Method for the Estimation of Patient’s Angles from Lateral Skull Radiographs

“…Hence, the rejection due to image quality has been reduced. However, the rejection due to positioning is still frequent [3,4]. The radiographs are positioned so that the diagnosed region overlaps as little as possible with other regions.…”