Image rejects in general direct digital radiography

Area of Science:

• Radiology
• Medical Imaging
• Quality Improvement

Background:

• Image reject analysis is crucial for assessing image quality and identifying unnecessary procedures in radiology.
• While common in the film era, reject analysis has seen fewer studies since the transition to digital radiography.
• A misconception exists that digitalization has eliminated the issue of image rejects.

Purpose of the Study:

• To quantify the rate of deleted images in direct digital radiography (DR).
• To evaluate the extent of image rejects and unnecessary imaging in DR.
• To identify the causes of image deletions to enhance radiological services.

Main Methods:

• Review of all exposed images from two direct digital radiography laboratories over January 2014.
• Registration of examination types, total exposed images, and deleted images.
• Individual analysis of each deleted image to determine the specific reason for deletion.

Main Results:

• A deletion rate of 11% was observed, with 596 out of 5417 exposed images being deleted.
• Positioning errors accounted for 51.3% of deletions, followed by centering errors at 31.0%.
• Highest deletion rates were found in knee (20.6%), hip (18.5%), and ankle (13.8%) examinations.

Conclusions:

• The reject rate in digital radiography is as high as in previous film-based systems.
• Reasons for image rejection differ significantly between digital and film systems, challenging the assumption that digitalization eliminates rejects.
• High rates of deleted (unnecessary) images necessitate improvements in management, training, and quality assurance within radiology departments.