Radiographic Quality Assurance and Patient Radiation Safety: A Repeat and Reject Analysis of Plain Radiographs at a Tertiary Hospital in Kano, Nigeria

Abstract

Background: Rejected radiographs necessitate repeat examinations, thereby increasing patient radiation dose, operational costs, waiting times, and occupational exposure for personnel. Film reject analysis (FRA) is an essential quality control tool in conventional medical imaging departments that provides valuable assessment of imaging quality and patient dose.

Methods: A prospective cross-sectional study was conducted over a six-month period at a tertiary hospital. A total of 3,021 plain radiographic films were examined, of which 193 were rejected. Rejected radiographs were collected daily and analysed weekly by senior radiographers using a viewing box. Data on film size, examination type, patient age group, and cause of rejection were recorded on a data capture sheet. Data were analysed and computed.

Results: The overall film reject rate was 6.39% (95% confidence interval: 5.57%–7.32%). The lumbosacral spine radiographs had the highest number of rejected films (n = 38, 19.7%), while the abdominal radiographs had the lowest (n = 1, 0.5%). The commonest causes of rejection were overexposure (n = 57, 29.5%) and underexposure (n = 53, 27.5%). The most frequently rejected film sizes were 35 × 35 cm (n = 69, 35.8%) and 35 × 43 cm (n = 62, 32.1%). Adults accounted for 172 (89.1%) of rejected films, compared with 21 (10.9%) for paediatric patients.

Conclusion: The overall reject rate of 6.39% exceeds the 5% threshold recommended by the World Health Organization. Overexposure and underexposure were the predominant causes of rejection. These findings underscore the need for strengthened quality assurance programs, including technique chart implementation, equipment quality control testing, and regular reject analysis monitoring at the study facility.