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    Reject Analysis: A Low Tech Solution?

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    Irham Fathurrahman
    The document discusses analyzing reject and repeat rates in radiology to identify opportunities to reduce radiation dose. It defines reject and repeat rates and outlines how to collect relevant data and analyze trends. Literature shows reject rates vary significantly between organizations but can often be reduced by 40-90% through quality improvement programs. While analyzing reject rates is a low-cost way to optimize imaging practices, the document estimates it may only reduce collective radiation dose by 1% nationally based on typical reject rates and achievable reductions.

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    Reject Analysis: A Low Tech Solution?

    Uploaded by

    Irham Fathurrahman
    43 views19 pages
    The document discusses analyzing reject and repeat rates in radiology to identify opportunities to reduce radiation dose. It defines reject and repeat rates and outlines how to collect relevant data and analyze trends. Literature shows reject rates vary significantly between organizations but can often be reduced by 40-90% through quality improvement programs. While analyzing reject rates is a low-cost way to optimize imaging practices, the document estimates it may only reduce collective radiation dose by 1% nationally based on typical reject rates and achievable reductions.

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    reject analysis

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    RejectAnalysisBIRPresentation.doc

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    The document discusses analyzing reject and repeat rates in radiology to identify opportunities to reduce radiation dose. It defines reject and repeat rates and outlines how to collect relevant data and analyze trends. Literature shows reject rates vary significantly between organizations but can often be reduced by 40-90% through quality improvement programs. While analyzing reject rates is a low-cost way to optimize imaging practices, the document estimates it may only reduce collective radiation dose by 1% nationally based on typical reject rates and achievable reductions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    43 views19 pages

    Reject Analysis: A Low Tech Solution?

    Uploaded by

    Irham Fathurrahman
    The document discusses analyzing reject and repeat rates in radiology to identify opportunities to reduce radiation dose. It defines reject and repeat rates and outlines how to collect relevant data and analyze trends. Literature shows reject rates vary significantly between organizations but can often be reduced by 40-90% through quality improvement programs. While analyzing reject rates is a low-cost way to optimize imaging practices, the document estimates it may only reduce collective radiation dose by 1% nationally based on typical reject rates and achievable reductions.

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    REJECT ANALYSIS

    A Low Tech Solution?

    Andy Rogers
    Head of Radiology Physics
    Nottingham City Hospital NHS Trust
    OVERVIEW

    • Definition of terms
    • Literature review
    • Potential dose reduction
    • Incidental issues
    • Summary
    • Lunch
    DEFINITIONS

    • A Reject – a film deemed useless &


    discarded, with another film being
    taken.
    • A Repeat – a film retaken to provide
    extra/missing diagnostic information.
    Sent with the original for reporting.
    DEFINITIONS

    Reject Rate (%):


    (# rejects / # examinations) x 100 %

    Repeat Rate (%):


    (# repeats / # examinations) x 100 %
    DATA COLLECTION
    • Collect rejects & repeats for defined
    time period
    • Assign reasons for reject/repeat e.g.:
    – exposure (over/under)
    – positioning
    – movement
    – processing
    DATA COLLECTION
    • Assign reference data for analysis e.g.:
    – date/time
    – Operator ID code
    – room
    – exam type
    – reject or repeat?
    • Data to be collected depends upon output
    required from reject/repeat analysis – when
    planning, specify data analysis strategy then
    know ‘up-front’ what data to collect
    DATA ANALYSIS
    • Depends what you want!
    • Single global figure
    – quick & easy
    – hides specific problems

    • Rate by exam type, reason for reject etc


    – more complicated data collection/analysis
    – may be more productive in terms of useful results
    LITERATURE REVIEW

    • Quick Medline search yields ~ 20 papers


    • One review claims 11 reports of 48 studies
    • Most recent studies tend to be comparative
    e.g. film/CR comparison
    • Older ones focus on role of reject analysis
    providing info for local quality improvement
    programs
    LITERATURE REVIEW

    • Reject rates quoted, 6.4% – 28%


    • Reject rate reductions of 40% – 90%
    • Reject rates of 5% - 10% for DGH-type
    organisation seem ‘satisfactory’
    • Less in smaller & private organisations?
    [~3%]
    Examples (1)

    • ‘Analysis of an image quality assurance


    program’ (1985)
    – QA led to 45% reduction in reject rate!!
    – 4.5% reduction in operational/maintainance
    costs!
    – I deduce about a 10% reject rate prior
    to QA
    Examples (2)
    • ‘Comparative reject analysis in
    conventional film -screen & digital
    storage phosphor radiography’ (1999)
    – 28% film-screen reject rate!!!
    – 2.3% digital reject rate
    – most of film-screen rejects were exposure
    and processing issues
    – most digital retakes were ‘positioning’
    [hardly surprising!]
    Examples (3)

    • ‘Continuing reject-repeat film analysis


    program’ (1989)
    – rate dropped from 15% to 6.4% over 9
    years
    – diminishing returns
    Examples (last one)
    • ‘X-ray film reject analysis as a quality
    indicator’ (1998)
    – Overall rate ~ 8%
    – hid specifics of:
    » knees = 26%
    » all spines > 10%
    » chests = 6.5%
    – chest rate dominated overall rate due to
    being about 50% total exams!
    Examples (last one)

    Exam Reject Main Reason for Second reason Third reason


    Type / reject/repeat
    repeat
    rate
    Chest 6.5 position 54% exposure 29% other 15%
    Abdomen 4.0 position 47% exposure 21% other 7%
    Knee 26.4 position 85% other 9% exposure 7%
    Pelvis 5.9 position 52% exposure 10% other 10%
    C Spine 10.0 exposure 44% position 30% other 18%
    T Spine 18.6 exposure 67% other 13% movement 6%
    L Spine 14.3 position 67% other 18% exposure 16%
    DOSE REDUCTION

    • Model the dose reduction capabilities:


    – Use NRPB Report W-4 (for exam
    frequencies & collective doses)
    – Use literature search to show general rates
    and rate reductions
    – Use my local situation to see if any
    different
    DOSE REDUCTION
    • Only use plain film radiography (~20%
    collective dose, ~60% exams)
    • Input Parameters
    – 10% reject rate (about right)
    – 50% reject rate reduction (optimistic)
    • Results
    – < 1% collective dose reduction
    – ~ 5% time saving in plain film radiography
    effort
    Nottingham Dose Reduction
    • Input Parameters
    – local reject rates & doses
    – 50% reject rate reduction
    – 2002 examination frequencies/doses
    • Results
    – 4% time/cost savings
    – spines/abdo/pelvis, 20% rejects, 95% dose
    savings (0.2 man.Sv)
    – chests, 50% rejects, 5% dose savings
    SIDE ISSUE
    • Locally, 0.2 man.Sv potential reject
    saving annually by:
    – few £1k project costs
    – ongoing training, monitoring, device
    purchase etc

    • BaE dose reduction project:


    – £10k project costs (including
    publication/presentation)
    – 0.3 man.Sv savings annually
    SUMMARY
    • It’s certainly ‘low tech’ & NOT the whole
    solution
    • It’s cost-effectiveness seems commensurate
    with other local projects
    • Continuing reject analysis may yield less
    effective results, so maybe move from
    ‘specific’ to ‘global’ analysis as time passes?
    • Provides useful info to local quality
    improvement programs
    • However – is 1% collective UK dose saving
    worth the effort?

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