An Analysis of the Rate and Reasons for Rejected Radiographs in Emergency and Non-Emergency Radiology Departments in Yasuj, Iran
Abstract
Purpose: Utilizing imaging to improve physicians' diagnostic accuracy is one of the primary priorities of radiology departments. When the image is of poor quality, it is likely to be rejected, and its repetition will expose patients and staff to unnecessary ionizing radiation. Given the significant nature of this issue, the current study aimed to evaluate the rate and reasons for radiograph rejections in emergency (public practice) and non-emergency (private practice) radiology departments of Yasuj, Iran.
Materials and Methods: This cross-sectional study was carried out over 14 days in Yasuj, Iran, in the accident and emergency (round-the-clock) and non-emergency (day) medical imaging departments. In terms of quality, a total of 7,006 images were classified into the following three grades; A (Good), B (Fair), and C (rejected). The grade C radiographs were categorized into 9 classes according to the reasons for rejection.
Results: During this study, 7,006 radiographs were examined, of which 6,458 (92.2%) were categorized as grade A. Additionally, 401 radiographs (5.7%) were categorized as grade B, and 147 radiographs (2.1%) were considered to be grade C, which means that they were rejected. Out of the rejected radiographs, 69 (1.9%) were from emergency departments, while 78 (2.3%) were from non-emergency radiology departments. The most common reasons for the rejection of radiographs were the patient's incorrect positioning in 45 cases (30.6%) and the patient's motion in 43 cases (29.3%).
Conclusion: In comparison to previous research, the current study's percentage of rejected images was deemed acceptable. Radiologists are advised to frequently assess the reason and rate for rejecting radiographs to enhance the effectiveness of their radiology unit.
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18- R. Roohi Shalemaei, "Films reject analysis for conventional radiography in Iranian main hospitals." (in eng), Radiat Prot Dosimetry, Vol. 147 (No. 1-2), pp. 220-2, Sep (2011).
19- I. Piotrowski et al., "Carcinogenesis Induced by Low-dose Radiation." (in eng), Radiol Oncol, Vol. 51 (No. 4), pp. 369-77, Dec (2017).
20- A. A. Almalki, R. Abdul Manaf, M. Hanafiah Juni, H. Kadir Shahar, N. M. Noor, and A. Gabbad, "Educational Module Intervention for Radiographers to Reduce Repetition Rate of Routine Digital Chest Radiography in Makkah Region of Saudi Arabia Tertiary Hospitals: Protocol of a Quasi-Experimental Study." (in eng), JMIR Res Protoc, Vol. 6 (No. 9), p. e185, Sep 26 (2017).
21- F. Fintelmann et al., "Repeat rates in digital chest radiography and strategies for improvement." (in eng), J Thorac Imaging, Vol. 27 (No. 3), pp. 148-51, May (2012).
22- S. Rastegar et al., "Reject analysis in digital radiography: A local study on radiographers and students' attitude in Iran." (in eng), Med J Islam Repub Iran, Vol. 33p. 49, (2019).
23- S. Atkinson, M. Neep, and D. Starkey, "Reject rate analysis in digital radiography: an Australian emergency imaging department case study." (in eng), J Med Radiat Sci, Vol. 67 (No. 1), pp. 72-79, Mar (2020).
24- G. Bantas, R. J. Sweeney, and S. Mdletshe, "Digital radiography reject analysis: A comparison between two radiology departments in New Zealand." (in eng), J Med Radiat Sci, Jan 19 (2023).
25- Yazeed Alashban, Nasser Shubayr, Abdulrahman A. Alghamdi, Sami A. Alghamdi, and Sami Boughattas, "An assessment of image reject rates for digital radiography in Saudi Arabia: A cross-sectional study." Journal of Radiation Research and Applied Sciences, Vol. 15 (No. 1), pp. 219-23, 2022/03/01/ (2022).
26- A. Ali and M. Yaseen, "Digital radiograph rejection analysis during "Coronavirus disease 2019 (COVID-19) pandemic" in a tertiary care public sector hospital in Khyber Pakhtunkhwa Province of Pakistan." (in eng), Chin J Acad Radiol, Vol. 4 (No. 2), pp. 133-40, (2021).
27- Elin Kjelle and Catherine Chilanga, "The assessment of image quality and diagnostic value in X-ray images: a survey on radiographers’ reasons for rejecting images." Insights into Imaging, Vol. 13 (No. 1), p. 36, 2022/03/04 (2022).
28- J Mount, "Reject analysis: A comparison of radiographer and radiologist perceptions of image quality." Radiography, Vol. 22 (No. 2), pp. e112-e17, (2016).
29- C Saade et al., "To repeat or not to repeat: Radiologists demonstrated more decisiveness than their fellow radiographers in reducing the repeat rate during mobile chest radiography." Radiography, Vol. 27 (No. 2), pp. 304-09, (2021).
30- J. Owusu-Banahene, E. O. Darko, F. Hasford, E. K. Addison, and J. Okyere Asirifi, "Film reject analysis and image quality in diagnostic Radiology Department of a Teaching hospital in Ghana." Journal of Radiation Research and Applied Sciences, Vol. 7 (No. 4), pp. 589-94, 2014/10/01/ (2014).
31- B. Stephenson-Smith, M. J. Neep, and P. Rowntree, "Digital radiography reject analysis of examinations with multiple rejects: an Australian emergency imaging department clinical audit." (in eng), J Med Radiat Sci, Vol. 68 (No. 3), pp. 245-52, Sep (2021).
32- Wen-Sheng Tzeng, Kuang-Ming Kuo, Chung-Feng Liu, Huan-Chung Yao, Chin-Yu Chen, and Huang-Wei Lin, "Managing Repeat Digital Radiography Images—A Systematic Approach and Improvement." Journal of Medical Systems, Vol. 36 (No. 4), pp. 2697-704, 2012/08/01 (2012).
33- W. Alsharif, M. Davis, A. McGee, and L. Rainford, "An investigation of Saudi Arabian MR radiographers' knowledge and confidence in relation to MR image-quality-related errors." (in eng), Radiography (Lond), Vol. 23 (No. 2), pp. e27-e33, May (2017).
34- D. Waaler and B. Hofmann, "Image rejects/retakes--radiographic challenges." (in eng), Radiat Prot Dosimetry, Vol. 139 (No. 1-3), pp. 375-9, Apr-May (2010).
35- Jian Tong and Tom K. Hei, "Aging and age-related health effects of ionizing radiation." Radiation Medicine and Protection, Vol. 1 (No. 1), pp. 15-23, 2020/03/01/ (2020).
36- E. Somasundaram, S. L. Brady, and K. J. Strauss, "Achievable dose reductions with gonadal shielding for children and adults during abdominal/pelvic radiographic examinations: A Monte Carlo simulation." (in eng), Med Phys, Vol. 47 (No. 11), pp. 5514-22, Nov (2020).
37- Nicholas Taylor, "The art of rejection: Comparative analysis between Computed Radiography (CR) and Digital Radiography (DR) workstations in the Accident & Emergency and General radiology departments at a district general hospital using customised and standardised reject criteria over a three year period." Radiography, Vol. 21 (No. 3), pp. 236-41, 2015/08/01/ (2015).
38- G. J. Bansal, "Digital radiography. A comparison with modern conventional imaging." (in eng), Postgrad Med J, Vol. 82 (No. 969), pp. 425-8, Jul (2006).
39- S. Robertson, E. E. Olanloye, Y. Hon, A. England, H. McNair, and S. Cruickshank, "Are radiographers suffering from symptoms of compassion fatigue due to occupational stress: A systematic review." (in eng), Radiography (Lond), Vol. 28 (No. 3), pp. 857-64, Aug (2022).
40- G. D. Eslick and V. V. Raj, "Occupational stress amongst radiographers: does working in private or public practice make a difference?" Radiography, Vol. 8 (No. 1), pp. 47-53, 2002/02/01/ (2002).
41- C. P. West, L. N. Dyrbye, and T. D. Shanafelt, "Physician burnout: contributors, consequences and solutions." (in eng), J Intern Med, Vol. 283 (No. 6), pp. 516-29, Jun (2018).
42- M. Agarwal, C. B. van der Pol, M. N. Patlas, A. Udare, A. D. Chung, and J. Rubino, "Optimizing the radiologist work environment: Actionable tips to improve workplace satisfaction, efficiency, and minimize burnout." (in eng), Radiol Med, Vol. 126 (No. 10), pp. 1255-57, Oct (2021).
2- S. Wirth et al., "European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version)." (in eng), Insights Imaging, Vol. 11 (No. 1), p. 135, Dec 10 (2020).
3- Suzanne T Chong et al., "Emergency radiology: current challenges and preparing for continued growth." Journal of the American College of Radiology, Vol. 16 (No. 10), pp. 1447-55, (2019).
4- R. Smith-Coggins, K. B. Broderick, and C. A. Marco, "Night shifts in emergency medicine: the american board of emergency medicine longitudinal study of emergency physicians." (in eng), J Emerg Med, Vol. 47 (No. 3), pp. 372-8, Sep (2014).
5- T. N. Hanna et al., "Emergency Radiology Practice Patterns: Shifts, Schedules, and Job Satisfaction." (in eng), J Am Coll Radiol, Vol. 14 (No. 3), pp. 345-52, Mar (2017).
6- S. M. Erturk, S. Ondategui-Parra, and P. R. Ros, "Quality management in radiology: historical aspects and basic definitions." (in eng), J Am Coll Radiol, Vol. 2 (No. 12), pp. 985-91, Dec (2005).
7- M. Zewdu, E. Kadir, and M. Berhane, "Analysis and Economic Implication of X-Ray Film Reject in Diagnostic Radiology Department of Jimma University Specialized Hospital, Southwest Ethiopia." (in eng), Ethiop J Health Sci, Vol. 27 (No. 4), pp. 421-26, Jul (2017).
8- C Maccia, M Ariche-Cohen, X Nadeau, and G Severo, "The 1991 CEC trial on quality criteria for diagnostic radiographic images." Radiation protection dosimetry, Vol. 57 (No. 1-4), pp. 111-17, (1995).
9- A Kyle Jones et al., "Ongoing quality control in digital radiography: report of AAPM Imaging Physics Committee Task Group 151." Medical physics, Vol. 42 (No. 11), pp. 6658-70, (2015).
10- K. J. Strauss and S. C. Kaste, "The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients--a white paper executive summary." (in eng), Pediatr Radiol, Vol. 36 Suppl 2 (No. Suppl 2), pp. 110-2, Sep (2006).
11- J. S. Whaley, B. D. Pressman, J. R. Wilson, L. Bravo, W. J. Sehnert, and D. H. Foos, "Investigation of the variability in the assessment of digital chest X-ray image quality." (in eng), J Digit Imaging, Vol. 26 (No. 2), pp. 217-26, Apr (2013).
12- Chih-Sheng Lin, Po-Chou Chan, Kuang-Hua Huang, Chun-Feng Lu, Yung-Fu Chen, and Yun-O Lin Chen, "Guidelines for reducing image retakes of general digital radiography." Advances in Mechanical Engineering, Vol. 8 (No. 4), p. 1687814016644127, (2016).
13- J. Nol, G. Isouard, and J. Mirecki, "Digital repeat analysis; setup and operation." (in eng), J Digit Imaging, Vol. 19 (No. 2), pp. 159-66, Jun (2006).
14- B. Hofmann, T. B. Rosanowsky, C. Jensen, and K. H. Wah, "Image rejects in general direct digital radiography." (in eng), Acta Radiol Open, Vol. 4 (No. 10), p. 2058460115604339, Oct (2015).
15- D. H. Foos, W. J. Sehnert, B. Reiner, E. L. Siegel, A. Segal, and D. L. Waldman, "Digital radiography reject analysis: data collection methodology, results, and recommendations from an in-depth investigation at two hospitals." (in eng), J Digit Imaging, Vol. 22 (No. 1), pp. 89-98, Mar (2009).
16- M. Y. Arbese, T. D. Abebe, and B. A. Mesele, "Determination and Analysis of Film Reject Rate at Eight Selected Governmental Diagnostic X-Ray Facilities in Tigray Region, Northern Ethiopian." (in eng), J Med Phys, Vol. 43 (No. 4), pp. 270-76, Oct-Dec (2018).
17- A Kyle Jones, Raimund Polman, Charles E Willis, and S Jeff Shepard, "One year’s results from a server-based system for performing reject analysis and exposure analysis in computed radiography." Journal of Digital Imaging, Vol. 24pp. 243-55, (2011).
18- R. Roohi Shalemaei, "Films reject analysis for conventional radiography in Iranian main hospitals." (in eng), Radiat Prot Dosimetry, Vol. 147 (No. 1-2), pp. 220-2, Sep (2011).
19- I. Piotrowski et al., "Carcinogenesis Induced by Low-dose Radiation." (in eng), Radiol Oncol, Vol. 51 (No. 4), pp. 369-77, Dec (2017).
20- A. A. Almalki, R. Abdul Manaf, M. Hanafiah Juni, H. Kadir Shahar, N. M. Noor, and A. Gabbad, "Educational Module Intervention for Radiographers to Reduce Repetition Rate of Routine Digital Chest Radiography in Makkah Region of Saudi Arabia Tertiary Hospitals: Protocol of a Quasi-Experimental Study." (in eng), JMIR Res Protoc, Vol. 6 (No. 9), p. e185, Sep 26 (2017).
21- F. Fintelmann et al., "Repeat rates in digital chest radiography and strategies for improvement." (in eng), J Thorac Imaging, Vol. 27 (No. 3), pp. 148-51, May (2012).
22- S. Rastegar et al., "Reject analysis in digital radiography: A local study on radiographers and students' attitude in Iran." (in eng), Med J Islam Repub Iran, Vol. 33p. 49, (2019).
23- S. Atkinson, M. Neep, and D. Starkey, "Reject rate analysis in digital radiography: an Australian emergency imaging department case study." (in eng), J Med Radiat Sci, Vol. 67 (No. 1), pp. 72-79, Mar (2020).
24- G. Bantas, R. J. Sweeney, and S. Mdletshe, "Digital radiography reject analysis: A comparison between two radiology departments in New Zealand." (in eng), J Med Radiat Sci, Jan 19 (2023).
25- Yazeed Alashban, Nasser Shubayr, Abdulrahman A. Alghamdi, Sami A. Alghamdi, and Sami Boughattas, "An assessment of image reject rates for digital radiography in Saudi Arabia: A cross-sectional study." Journal of Radiation Research and Applied Sciences, Vol. 15 (No. 1), pp. 219-23, 2022/03/01/ (2022).
26- A. Ali and M. Yaseen, "Digital radiograph rejection analysis during "Coronavirus disease 2019 (COVID-19) pandemic" in a tertiary care public sector hospital in Khyber Pakhtunkhwa Province of Pakistan." (in eng), Chin J Acad Radiol, Vol. 4 (No. 2), pp. 133-40, (2021).
27- Elin Kjelle and Catherine Chilanga, "The assessment of image quality and diagnostic value in X-ray images: a survey on radiographers’ reasons for rejecting images." Insights into Imaging, Vol. 13 (No. 1), p. 36, 2022/03/04 (2022).
28- J Mount, "Reject analysis: A comparison of radiographer and radiologist perceptions of image quality." Radiography, Vol. 22 (No. 2), pp. e112-e17, (2016).
29- C Saade et al., "To repeat or not to repeat: Radiologists demonstrated more decisiveness than their fellow radiographers in reducing the repeat rate during mobile chest radiography." Radiography, Vol. 27 (No. 2), pp. 304-09, (2021).
30- J. Owusu-Banahene, E. O. Darko, F. Hasford, E. K. Addison, and J. Okyere Asirifi, "Film reject analysis and image quality in diagnostic Radiology Department of a Teaching hospital in Ghana." Journal of Radiation Research and Applied Sciences, Vol. 7 (No. 4), pp. 589-94, 2014/10/01/ (2014).
31- B. Stephenson-Smith, M. J. Neep, and P. Rowntree, "Digital radiography reject analysis of examinations with multiple rejects: an Australian emergency imaging department clinical audit." (in eng), J Med Radiat Sci, Vol. 68 (No. 3), pp. 245-52, Sep (2021).
32- Wen-Sheng Tzeng, Kuang-Ming Kuo, Chung-Feng Liu, Huan-Chung Yao, Chin-Yu Chen, and Huang-Wei Lin, "Managing Repeat Digital Radiography Images—A Systematic Approach and Improvement." Journal of Medical Systems, Vol. 36 (No. 4), pp. 2697-704, 2012/08/01 (2012).
33- W. Alsharif, M. Davis, A. McGee, and L. Rainford, "An investigation of Saudi Arabian MR radiographers' knowledge and confidence in relation to MR image-quality-related errors." (in eng), Radiography (Lond), Vol. 23 (No. 2), pp. e27-e33, May (2017).
34- D. Waaler and B. Hofmann, "Image rejects/retakes--radiographic challenges." (in eng), Radiat Prot Dosimetry, Vol. 139 (No. 1-3), pp. 375-9, Apr-May (2010).
35- Jian Tong and Tom K. Hei, "Aging and age-related health effects of ionizing radiation." Radiation Medicine and Protection, Vol. 1 (No. 1), pp. 15-23, 2020/03/01/ (2020).
36- E. Somasundaram, S. L. Brady, and K. J. Strauss, "Achievable dose reductions with gonadal shielding for children and adults during abdominal/pelvic radiographic examinations: A Monte Carlo simulation." (in eng), Med Phys, Vol. 47 (No. 11), pp. 5514-22, Nov (2020).
37- Nicholas Taylor, "The art of rejection: Comparative analysis between Computed Radiography (CR) and Digital Radiography (DR) workstations in the Accident & Emergency and General radiology departments at a district general hospital using customised and standardised reject criteria over a three year period." Radiography, Vol. 21 (No. 3), pp. 236-41, 2015/08/01/ (2015).
38- G. J. Bansal, "Digital radiography. A comparison with modern conventional imaging." (in eng), Postgrad Med J, Vol. 82 (No. 969), pp. 425-8, Jul (2006).
39- S. Robertson, E. E. Olanloye, Y. Hon, A. England, H. McNair, and S. Cruickshank, "Are radiographers suffering from symptoms of compassion fatigue due to occupational stress: A systematic review." (in eng), Radiography (Lond), Vol. 28 (No. 3), pp. 857-64, Aug (2022).
40- G. D. Eslick and V. V. Raj, "Occupational stress amongst radiographers: does working in private or public practice make a difference?" Radiography, Vol. 8 (No. 1), pp. 47-53, 2002/02/01/ (2002).
41- C. P. West, L. N. Dyrbye, and T. D. Shanafelt, "Physician burnout: contributors, consequences and solutions." (in eng), J Intern Med, Vol. 283 (No. 6), pp. 516-29, Jun (2018).
42- M. Agarwal, C. B. van der Pol, M. N. Patlas, A. Udare, A. D. Chung, and J. Rubino, "Optimizing the radiologist work environment: Actionable tips to improve workplace satisfaction, efficiency, and minimize burnout." (in eng), Radiol Med, Vol. 126 (No. 10), pp. 1255-57, Oct (2021).
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| Issue | Vol 12 No 1 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v12i1.17737 | |
| Keywords | ||
| Rejection Rate Rejection Reasons Radiograph Analysis Radiograph Quality | ||
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How to Cite
1.
Moradian SA, Zamani H, Dalvand S. An Analysis of the Rate and Reasons for Rejected Radiographs in Emergency and Non-Emergency Radiology Departments in Yasuj, Iran. Frontiers Biomed Technol. 2025;12(1):91-100.
