The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging

Introduction

This study illustrates image rejection rates of the lateral wrist x-ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images where image repeat was required based on the clinical indication. This study highlights the difference in subjective image-repeat decision-making skills existing between radiologists, experienced radiographers and junior radiographers.

Methods

A retrospective review was conducted of all rejected lateral wrist x-ray images by a panel of 3 radiologists, 3 experienced radiographers and 6 junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A compliment of images that had not been rejected were included in the review.

Results

The review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers.

Conclusion

This review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists, however, difference in decision making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs.