Inadequate pelvic radiographs: implications of not getting it right the first time

Area of Science:

• Radiology
• Orthopaedics
• Patient Safety

Background:

• Pelvic radiography is a common diagnostic procedure.
• European guidelines exist for appropriate use and quality standards.
• Inadequate initial images necessitate repeat radiographs, impacting patient safety and healthcare economics.

Purpose of the Study:

• To evaluate the adequacy of pelvic imaging in three UK orthopaedic centers.
• To identify factors contributing to suboptimal pelvic radiographs.
• To quantify the financial and patient safety costs associated with inadequate imaging.

Main Methods:

• Review of 1,531 sequential pelvic radiographs using Picture Archiving and Communication System (PACS).
• Assessment of images against European guidelines.
• Analysis of repeat imaging indications and associated costs.

Main Results:

• 51.9% of pelvic radiographs were suboptimal, with no significant difference between hospitals.
• Repeat radiographs were performed in 6.3% to 19.7% of cases.
• Suboptimal imaging rates were higher for out-of-hours (69.1%) versus normal working hours (51.3%) and increased in patients over 60.
• Annual cost of repeat radiographs was estimated at £56,200 per hospital.

Conclusions:

• High rates of suboptimal pelvic radiographs pose risks of missed pathology and incur significant patient safety and financial costs.
• Older age and out-of-hours imaging are identified risk factors for inadequate pelvic radiographs.
• Improving image quality is crucial for accurate diagnosis and efficient healthcare delivery.