1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
AJR Am J Roentgenol. 2017 Dec;209(6):1297-1301. doi: 10.2214/AJR.17.18030. Epub 2017 Sep 12.
Radiologic technologists may repeat images within a radiographic examination because of perceived suboptimal image quality, excluding these original images from submission to a PACS. This study assesses the appropriateness of technologists' decisions to repeat musculoskeletal and chest radiographs as well as the utility of repeat radiographs in addressing examinations' clinical indication.
We included 95 musculoskeletal and 87 chest radiographic examinations in which the technologist repeated one or more images because of perceived image quality issues, rejecting original images from PACS submission. Rejected images were retrieved from the radiograph unit and uploaded for viewing on a dedicated server. Musculoskeletal and chest radiologists reviewed rejected and repeat images in their timed sequence, in addition to the studies' remaining images. Radiologists answered questions regarding the added value of repeat images.
The reviewing radiologist agreed with the reason for rejection for 64.2% of musculoskeletal and 60.9% of chest radiographs. For 77.9% and 93.1% of rejected radiographs, the clinical inquiry could have been satisfied without repeating the image. For 75.8% and 64.4%, the repeated images showed improved image quality. Only 28.4% and 3.4% of repeated images were considered to provide additional information that was helpful in addressing the clinical question.
Most repeated radiographs (chest more so than musculoskeletal radiographs) did not add significant clinical information or alter diagnosis, although they did increase radiation exposure. The decision to repeat images should be made after viewing the questionable image in context with all images in a study and might best be made by a radiologist rather than the performing technologist.
放射技师可能会因为认为图像质量不理想而在放射检查中重复拍摄图像，从而将这些原始图像排除在 PACS 提交之外。本研究评估了放射技师重复拍摄肌肉骨骼和胸部 X 光片的决定是否恰当，以及重复 X 光片在解决检查临床指征方面的作用。
我们纳入了 95 例肌肉骨骼 X 光片和 87 例胸部 X 光片，其中由于认为图像质量存在问题，技师重复拍摄了一张或多张图像，从而将原始图像从 PACS 提交中排除。从放射科单位检索并上传被拒绝的图像，以便在专用服务器上查看。肌肉骨骼和胸部放射科医师按照时间顺序查看被拒绝和重复的图像，以及研究中其余的图像。放射科医师回答了有关重复图像附加值的问题。
在 64.2%的肌肉骨骼 X 光片中，审查放射科医师同意拒绝的原因；在 60.9%的胸部 X 光片中，审查放射科医师同意拒绝的原因。对于 77.9%和 93.1%的被拒绝的 X 光片，不需要重复拍摄图像就可以满足临床询问。对于 75.8%和 64.4%的 X 光片，重复拍摄的图像显示出改善的图像质量。只有 28.4%和 64.4%的重复图像被认为提供了有助于解决临床问题的额外信息。
大多数重复的 X 光片（胸部 X 光片比肌肉骨骼 X 光片更明显）并没有增加显著的临床信息或改变诊断，尽管它们确实增加了辐射暴露。重复拍摄图像的决定应该在查看有问题的图像，并结合研究中的所有图像后做出，最好由放射科医师而不是执行技师做出。
