Enhancing patient safety through radiograph rejection analysis: Insights from a diagnostic imaging department audit

Assessment of actual radiograph rejection was the primary goal of this investigation in the imaging facility of a public sector hospital, which was noticeably high during the pandemic as staff members were afraid of infection.

This retrospective study was carried out in the department of Radiology, LRH from July 2023 to March 2024 during which a total of 47,300 radiographic examinations were conducted. Analysis was performed for the rejected radiographs and their causes respectively.

Our rate of 11% is comparable to the global range of 3.4-14.1 % respectively. Of the total rejection, 46.1% rejection was observed in males and 53.9% in females while 69.5 % & 30.5 % rejection was noticed in adults and pediatric age group respectively. Artifacts (26.2%) was the prime cause of rejection followed by motion (18.8%), positioning (14%), improper collimation (11.7%), exposure errors (8.4 %), wrong labeling (6.6%), machine faults (5.7 %), detector errors (4.5%), PACS issues (2.5 %) and re-requests from referring physician (1.6%). The highest rejection with respect to anatomical body parts was observed in chest radiography (29.9%), followed by extremities (28.8%), spine (11.4%), KUB (9.9%), skull (8.4%), abdomen (5.5%), pelvis (4.4%), and neck (1.7%) respectively.

Radiograph rejection has reduced considerably but still is a common problem within the facility due to many contributing factors. Implementation of rejection analysis as an integral part of the quality assurance program as well as focusing on staff-centered skill and knowledge upliftment training programs can result in a significant reduction enhancing patient safety.