X-ray reject analysis in Tikur Anbessa and Bethzatha Hospitals

Abstract

Abstract
Background: It is not uncommon to encounter patients undergo repeat x-ray examinations after their initial x-rays are
rejected for poor image quality thereby subjecting them to excess radiation exposure and avoidable extra cost. This
creates a situation which necessitates the need to explore causes of reject and repeat of x-ray examinations. The
employment of reject analysis as part of overall Quality Assurance (QA) programmes in clinical radiography and
radiology services in the evaluation of image quality is a well established practice. The role of reject analysis in
providing relevant information that would help achieve sound reduction in radiation exposure and cost as well as
develop acceptable image quality was explored in this study.
Objective: To assess the reject rate of x-ray films and obtain information for further recommendation on quality, cost,
and radiation exposure in the two hospitals.
Methods: Prospective and cross-sectional study approaches were employed. Reject rate was measured for two x-ray
departments (one from public and the other from private) across all plain x-ray films examinations using a structured
format on which relevant data for reject were recorded by investigators (radiologists and a medical physicist). Results
were then collected and entered into a database for analysis.
Results: Reject rate along with exposure rate was measured across all plain film exams for the hospitals. Analysis has
shown that the overall reject rate was 4.94% in 4470 and 0.83% in 1870 exposed films for the public and private
hospitals, respectively.
Conclusion: The study has shown the highest reject to be that of chest x-ray in both adults and children with
overexposure and patient motion, respectively being the major causes. Although the overall reject rate is well within
the accepted range, individual causes of reject have given light into some of the most common problems of quality of
radiography service and we recommend that regular and cyclic QA programmes should be instituted at all levels of
the x-ray department and that of hospital management for effective and sustained service delivery, x-ray dose
reduction to patients and personnel as well as economic management of scarce resource. [Ethiop.J.Health Dev.
2008;22(1):63-67]