Monitoring the Use of Extra Images on Chest Radiography Examinations.

BACKGROUND

A large number of chest radiography studies in our department include extra images due to incompletely imaged anatomy (eg, extra frontal view to include a truncated costophrenic angle). Negative impacts include: increased radiologist review time due to disruption of search pattern and the need to review additional films in slightly different obliquities, additional radiation exposure, and increased technologist time expenditure.

PURPOSE

To determine the chest radiograph repeat rate, collaborate with technologists on a process to decrease the frequency, and incorporate the process into our quality control program.

METHODS

Data collection was performed by using coded dictation macros to indicate the type of extra view (frontal, lateral) and whether the extra image was necessary due to patient habitus. Twelve weeks after the macro was instituted, baseline data were collected by querying the macro codes with a search engine (MONTAGE Search and Analytics). Intervention consisted of in-person tutorials of basic radiographic positioning principles with x-ray technologists and posting of checklists in all diagnostic radiology exam rooms. Twelve weeks of postintervention data were collected.

RESULTS

Baseline data included 5645 examinations, of which 335 (5.9%) included extra images. Postintervention, 5943 examinations were performed and 295 (5.0%) included extra images. A significant decrease in the frontal view repeat rate was noted, decreasing from 4.6%-3.3% (P = 0.001). The repeat rate of lateral images did not change significantly (3.1%-3.2%).

CONCLUSIONS AND IMPLICATIONS

Data monitoring and interprofessional collaboration led to a significant decrease in unnecessary extra radiographs. Ongoing monitoring may lead to sustained improvement and further reductions.