X-ray film reject analysis as a quality indicator

Purpose Reject analysis has been used as a quality indicator of radiology services and has been recommended as a quality indicator for purchasers. The aim of the study was to measure the reject and repeat rate and also to evaluate its use as a quality indicator. Methods The reject rate was measured for each plain film examination using a form given to radiographers to record each rejected film. The results were then collected and entered into a database for analysis. Results The reject rate has been measured for a large department across all plain film examinations. Analysis has shown the overall reject rate to be 8% in approximately 33 000 examinations. Individual examination results were chest=6.5%, abdomen=4%, knees=26%, lumbar spine=14.3%, thoracic spine=18.6%, and cervical spine=10%. Chest X-rays account for approximately 50% of all examinations and dominate the overall reject rate. Twenty-five percent of films reassessed by radiologists were considered to be of diagnostic quality. Conclusion Reliance upon the overall reject rate may camouflage problems in individual examinations. As a result of this study care is recommended when using reject rates as a global quality indicator for radiology services, but its use is supported in local, examination specific, audits for quality.