Department of Radiology, Sengkang General Hospital, 110 Sengkang East Way, Singapore Singapore.
Department of Radiology, Sengkang General Hospital, 110 Sengkang East Way, Singapore Singapore.
J Med Imaging Radiat Sci. 2024 Dec;55(4):101720. doi: 10.1016/j.jmir.2024.101720. Epub 2024 Jul 23.
The overall reject rate (RR) of our newly set up Radiology department was an average of 14%, higher than the recommended 8% target and 10% threshold set by the American Association of Physicists in Medicine (AAPM). An analysis done to identify potential causes of a high RR suggested that radiographers might have been rejecting images of diagnostic value. A lack of consistency in the definition of a diagnostic value image amongst radiographers may be a possible cause in the higher overall RR. This study aims to investigate potential discrepancies among radiographers in defining a diagnostic radiograph.
An online survey composed of an image bank with a questionnaire was created, participants grade each image as either accepted or rejected. Fleiss Kappa was used to determine the level of agreement between the radiographers in accepting or rejecting the images in the image bank.
Twenty radiographers with varying years of experience participated in this study. There was fair agreement amongst the radiographers' judgements, k=.277 (95% CI, .277 to .278), p < .005. Individual kappa for the "Accept" and "Reject" categories were both 0.277. There is no significant difference in the agreement level across the junior (k=.278), intermediate (k=.371) and senior (k=.275) radiographers.
The result suggests that there is discrepancy in the radiographers' definition of a diagnostic radiograph and this misalignment of radiographers' perception might be one of the underlying causes of high RR.
This study has provided the researchers with a better insight on the underlying cause of the department high RR. By calibrating the radiographers' definition of a diagnostic radiograph, it will help realign the radiographer's agreement on when a radiograph should be rejected. This will reduce the overall RR and patient's overall dose. A lower RR translates to a more efficient turnaround time in General Radiography services, ensuring quality service is provided without further strain on our limited resources.
我们新成立的放射科的整体拒收率（RR）平均为 14%，高于推荐的 8%目标和美国医学物理学家协会（AAPM）设定的 10%阈值。一项旨在确定高 RR 潜在原因的分析表明，放射技师可能拒绝了具有诊断价值的图像。放射技师对具有诊断价值的图像的定义缺乏一致性，这可能是整体 RR 较高的一个潜在原因。本研究旨在调查放射技师在定义诊断射线照相时可能存在的差异。
创建了一个包含图像库和问卷的在线调查，参与者对每张图像进行接受或拒绝的评分。Fleiss Kappa 用于确定放射技师在接受或拒绝图像库中的图像时的一致性水平。
20 名具有不同工作年限的放射技师参加了这项研究。放射技师的判断存在公平的一致性，κ=.277（95%CI，.277 至.278），p<.005。“接受”和“拒绝”类别的个体κ均为 0.277。初级（κ=.278）、中级（κ=.371）和高级（κ=.275）放射技师的一致性水平没有显著差异。
结果表明，放射技师对诊断射线照相的定义存在差异，这种放射技师感知的错位可能是高 RR 的潜在原因之一。
这项研究为研究人员提供了对该科室高 RR 潜在原因的更好了解。通过校准放射技师对诊断射线照相的定义，可以帮助重新调整放射技师对何时应拒绝射线照相的共识。这将降低整体 RR 和患者的整体剂量。较低的 RR 可缩短常规放射服务的整体周转时间，确保在不进一步增加我们有限资源压力的情况下提供优质服务。
