An assessment of image reject rates for digital radiography in Saudi Arabia: A cross-sectional study

Repeat radiographs are necessary to obtain the required diagnostic information, which increases the patient's radiation dose and detracts from the “as low as reasonably achievable” (ALARA) principle. The aim of this study was to analyse the reject rate for digital radiography, causes of repetition, the most commonly repeated types of examinations for fixed and portable radiography and reject rate variations between different technologists. The data were collected from major medical imaging departments in Saudi Arabia (n = 27,238 x-ray images). Of the 27,238 images acquired, 2,682 were rejected, resulting in an overall reject rate of 8.96%. Remarkably, when rejected images of individual anatomical areas were evaluated, some areas were observed to have reject rates as high as 20% and 66% for fixed and portable digital radiography, respectively. For fixed and portable radiography, pelvic and lumbar spine procedures had the highest reject rates, respectively. Additionally, the projections with the highest reject rates for fixed and portable radiography were the shoulder axial and lumbar spine cross-table lateral projections, respectively. This study recommends initiating more consistent criteria for image quality along with a feedback scheme within the medical imaging departments to guide internal education programs.