Interobserver and intra-observer agreement among radiographers in assessing the quality of chest radiograph

Chest radiography is a commonly performed examination for screening, clinical assessment, and preintervention evaluation. Image quality plays an important role in supporting diagnostic interpretation. After image acquisition, radiographers decide whether the image should be accepted or repeated. Variation in these decisions may affect patient radiation exposure and radiology workflow. This study aimed to evaluate variation and agreement among radiographers in accepting or rejecting chest radiographs.

This cross-sectional study involved 91 certified radiographers in Indonesia. Thirty de-identified chest radiographs representing technical-quality categories were selected by an expert panel, and 12 duplicate images were added to assess intra-observer consistency. The resulting 42 images were presented in random order. The acceptance and rejection criteria were classified into 8 factors: accepted, artifact, blurring, mispositioning, incorrect body part, body part cut-off, exposure failure, and under/over exposure. Data were analysed using Cohen's kappa for duplicated image pairs and Fleiss' kappa for interobserver agreement.

There were radiographer's perception variations in accepting or rejecting X-ray chest images. Intra-observer agreement for duplicated image pairs ranged from κ=0.027 to κ=0.727, with a simple mean Cohen's kappa of κ=0.525, indicating moderate agreement. Overall inter-observer agreement across the 42 images was fair (Fleiss' κ=0.337). Category-specific Fleiss' kappa values were highest for artifact-related rejection (κ=0.474) and image acceptance (κ=0.436), and lowest for blurring (κ=0.068), exposure failure (κ=0.076), incorrect body part (κ=0.107), and incorrect positioning (κ=0.173).

Radiographers showed moderate intraobserver consistency but only fair inter-observer agreement when evaluating chest radiograph quality. The findings demonstrate variation in accepting or rejecting chest X-ray image. Collaboration between radiographers and radiologists is recommended to align evaluation standards.