Understanding reasons for image rejection by radiologists and radiographers

Abstract

Introduction: A core element of a radiographer's role is the decision on whether a radiograph is sufficient for diagnosis, or a repeat examination is needed. Studies illustrate the disagreement on the diagnostic value of radiographs between radiographers and radiologists, which may influence repeat examinations. This study investigates if parameters contributing to image quality are possible determinants to explain the difference between professions. Methods: A total of 74 radiographers and radiologists from three different countries assessed three data sets (chest PA, hip HBL, c-spine lateral), each containing 25 radiographs. All observers scored image quality in terms of anatomical visualisation, positioning, collimation, detector exposure and judged the diagnostic value using the ACR RadLex classification. All assessments were performed on a clinically relevant display. Visual grading characteristics were used to compare image quality evaluations between groups. Results: Radiographers scored the visualisation of anatomical structures lower than radiologists though the difference was not statistically significant. A difference in classification using the RadLex categorieswith radiographers rejecting more radiographswas demonstrated. Only the subjective evaluation of the detector exposure correlated statistically with RadLex ratings. There was no difference between radiographers and radiologists when reviewing patient positioning and collimation. Conclusion: Radiographers and radiologists agree on the visualisation of anatomical structures, but radiographers are more critical towards the diagnostic value. Within the criteria studied, the evaluation of anatomical structures does not explain the difference. Radiographs have a higher change of being rejected if the observer (subjectively) assessed the detector exposure as inappropriate. This correlation is stronger for radiographers.

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

“…It is suggested that more emphasis is now placed on repeating for perfection rather than clinical acceptability 3 . This ease of image rejection comes with the burden of greater patient dose, 4 particularly rejection of an image that is considered diagnostically acceptable 5 …”

“…The difference is exacerbated when comparing the decisions on image acceptability between radiographers and radiologists. Studies demonstrate large discrepancies between images rejected by radiologists and radiographers, 5,10 with radiologists being up to 46% less likely to repeat images compared to radiographers 10 . Moreover, one study reports that radiologists are likely to accept up to 50% more images with positioning errors than radiographers 11 .…”

“…3 This ease of image rejection comes with the burden of greater patient dose, 4 particularly rejection of an image that is considered diagnostically acceptable. 5 A rejected radiographic image is an image that a radiographer deems as clinically unacceptable in terms of image quality. 6 The term 'reject rate' is used when the total number of acquired images is divided by the number of rejected images and expressed as a percentage.…”

“… 3 This ease of image rejection comes with the burden of greater patient dose, 4 particularly rejection of an image that is considered diagnostically acceptable. 5 …”

Making the most of X‐ray reject analysis in the digital age

“…In addition to the radiographer's assessment of image quality, radiologists tend to differ with variable tolerances of image quality acceptability. In this edition of JMRS, Decoster et al 5 conducted a multisite study involving three countries that sought to explore the difference between radiographers and radiologists based on their judgement on the quality of a radiograph. They found that radiographers were more critical in their assessment of radiographs compared to radiologists.…”