To reject, or to accept? A study on radiographers' perspectives on diagnostic radiographs

The overall reject rate (RR) of our newly set up Radiology department was an average of 14%, higher than the recommended 8% target and 10% threshold set by the American Association of Physicists in Medicine (AAPM). An analysis done to identify potential causes of a high RR suggested that radiographers might have been rejecting images of diagnostic value. A lack of consistency in the definition of a diagnostic value image amongst radiographers may be a possible cause in the higher overall RR. This study aims to investigate potential discrepancies among radiographers in defining a diagnostic radiograph.

An online survey composed of an image bank with a questionnaire was created, participants grade each image as either accepted or rejected. Fleiss Kappa was used to determine the level of agreement between the radiographers in accepting or rejecting the images in the image bank.

Twenty radiographers with varying years of experience participated in this study. There was fair agreement amongst the radiographers' judgements, k=.277 (95% CI, .277 to .278), p < .005. Individual kappa for the "Accept" and "Reject" categories were both 0.277. There is no significant difference in the agreement level across the junior (k=.278), intermediate (k=.371) and senior (k=.275) radiographers.

The result suggests that there is discrepancy in the radiographers' definition of a diagnostic radiograph and this misalignment of radiographers' perception might be one of the underlying causes of high RR.

This study has provided the researchers with a better insight on the underlying cause of the department high RR. By calibrating the radiographers' definition of a diagnostic radiograph, it will help realign the radiographer's agreement on when a radiograph should be rejected. This will reduce the overall RR and patient's overall dose. A lower RR translates to a more efficient turnaround time in General Radiography services, ensuring quality service is provided without further strain on our limited resources.