To keep or reject, that is the question - A survey on radiologists and radiographers’ assessments of plain radiography images

Abstract

Introduction: This study aimed to survey radiographers and radiologists' assessment of plain radiographs to identify the imaging clinicians’ differences in acceptance of image quality. Method: An online, questionnaire was distributed among radiographers (n = 116) and radiologists (n = 76) in a hospital trust in Norway, including 30 clinical cases (one image and a short referral text) that were divided into 3 categories; keep, could keep and reject, based on European guidelines. When rejecting, the respondents identified the main reason by ticking a list (positioning, collimation, centering, artifact or exposure error). Group differences were explored using 2-tailed chi-squared test. Inter-subjectivity was measured using Cohen's kappa for multi-rater sample. Results: In total, 36% of the radiographers (n = 42) and 14% of the radiologists (n = 14) responded to the survey. Total response rate was 30% (56/192). Analysis showed significant difference between radiographers and radiologists in the categories of Reject (χ2 = 6.3, df = 1, p = 0.01), and Could keep (χ2 = 6.3, df = 1, p = 0.01), identifying radiologists as keeping more images compared to radiographers. Agreement among radiographers (Cohen's κ: 0,39; 95% CI: 0.30–0.48; p < 0.001) and radiologists (Cohen's κ: 0,23; 95% CI: 0.09–0.37; p < 0.001) respectively, is fair. The most common reason for rejecting an image is suboptimal positioning. Suboptimal collimation constituted 15% of the rejected images among radiographers, compared to 5% among radiologists. Centering, artifacts and exposure error showed quite similar rates as reasons for rejection. Conclusion: Radiographers and radiologists seem to agree on the assessment of good quality images, however, radiographers seem more reluctant to accept images of lower quality than radiologists. Implications for practice: Further research on reasons for differences in image quality assessment between radiographers and radiologists is needed. This could enable reduction in reject rates and increase image quality in conventional X-ray examinations.