Is reject analysis necessary after converting to computed radiography?

Area of Science:

• Radiology
• Medical Imaging
• Quality Assurance

Background:

• Computed radiography (CR) has challenged traditional reject analysis due to low reported reject rates and lack of clear criteria for improper exposures.
• CR systems often have quality control (QC) workstations that can alter or delete images before analysis, potentially masking issues.
• Existing Picture Archival and Communication Systems (PACS) and QC workstations are not designed for comprehensive reject analysis.

Purpose of the Study:

• To design and implement a system for identifying, isolating, and archiving repeated medical imaging examinations within a CR/PACS environment.
• To adapt existing radiologist critique codes for use in a reject analysis workflow.
• To establish a data collection and analysis process for repeated examinations in CR.

Main Methods:

• Developed a system to append radiologist critique codes to rejected images at the QC workstation.
• Modified system routing tables to prevent release of rejected images while ensuring their availability for review.
• Utilized existing electronic imaging systems and transcription codes for data capture and archiving.

Main Results:

• The developed system successfully identified, isolated, and archived repeated examinations.
• The frequency and reasons for repeated examinations were comparable to existing literature on reject analysis.
• Mis-positioning was identified as the most frequent cause of repeated examinations.

Conclusions:

• Reject analysis remains crucial for quality assurance in CR, even with advanced imaging systems.
• A customized system can effectively capture and analyze data on repeated examinations in CR/PACS environments.
• Feedback of reject analysis results to management and staff is essential for implementing improvements and targeted training.