Film reject analysis is a quality assurance tool in radiology department which is used to control standard and quality of diagnostic radiograph as the production of adequate diagnostic radiographs with optimum quality involves well defined procedure. A comparative prospective film reject analysis carried over a period of four (4) weeks from 1st to 30th June,2012 at the National Orthopaedic Hospital Enugu and Enugu State University Teaching Hospital, Park-Lane aimed at comparing the reject rate of the two hospitals. It also compares and assesses the possible causes of film reject in the two hospitals. An agreed-upon list of possible causes of film reject was prepared with photocopies made and used to record any reject noticed during the film sorting. An empty carton was also dropped in each department of the hospitals to collect the rejected films. It was found that at Enugu State University Teaching Hospital, film reject rate recorded 9.3%, while at National Orthopaedic Hospital Enugu; the reject rate was 1.7%. Overexposure (exposure factor) was recorded as the highest causes of film reject at Enugu State University Teaching Hospital, Park-Lane with 25%, while at National Orthopaedic Hospital Enugu equipment fault recorded the highest cause of film reject with 63.6%. Chest examination recorded highest reject with 11.6% at Enugu State University Teaching Hospital, Park-Lane while extremities examination recorded highest reject with 2.9% at National Orthopaedic Hospital Enugu. With the introduction of digital radiography (digitizer) into x-ray department, there is a reduction in film reject rate than that of conventional manual processing unit.
TABLE OF CONTENTS
Title Page ---------i
Table of Contents--------vi - viii
List of Tables--------ix - x
List of Figures --------xi
1.2 Statement of Problems------4
1.3 Objective of Study------4
1.4 Significance of Study------5
1.5 Scope of Study-------5
1.6 Review of Related Literature-----5
1.7 Definition of Terms------19
2.1 Reject Film Analysis------20
2.3 Evaluation of Result ------24
2.4 Film Reject Analysis and Computerized Radiography-25
2.5 Film Reject Rates-------25
2.6 Repeat Exposures-------26
2.7 Patient Throughput------28
3.1 Research Design-------29
3.2 Research Methods and Materials----29
3.2.1 Research Population and Sampling----29
3.2.2 Inclusion criteria-------29
3.2.3 Sample Size--------30
3.2.4 Method of Data Collection-----30
4.1 Presentation of Data------32
5.1 Film Reject Rate -------50
5.2 The Number of Film Used-----51
5.3 Rate of Reject by Examination Type ----52
5.4 Causes of Reject -------52
5.5 Financial Cost of Four Weeks Film Reject Analysis-53
5.6 Summary of Findings ------54
5.7 Conclusion --------55
5.8 Recommendations -------56
5.10 Area of Further Research------57
LIST OF TABLES
Table I: The Weekly Distribution of the Number of Film Used for Each Examination in Park-Lane---32
Table II: The Weekly Distributions of Film Reject for Each Examination in Park-Lane----33
Table III: The Percentage Reject Rate for Each Examination in ESUT Teaching Hospital (Park-Lane) --35
Table IV: The Distribution of the Causes of Film Reject for Each Examination in Park-Lane----37
Table V: Estimation of the Financial Cost of 4 Weeks Film Rejects in Park-Lane Hospital----39
Table VI: The Weekly Distribution of Number of Film Used for Each Examination in National Orthopaedics Hospital Enugu (NOHE) 40
Table VII: The Weekly Distribution of Film Reject for Each Examination in National Orthopaedics Hospital Enugu. -41
Table VIII: Percentage Reject Rate for Each Examination in National Orthopaedics Hospital Enugu--43
Table IX: The Distribution of the Causes of Film Reject for Each Examination in National Orthopaedic Hospital Enugu-45
Table X: Estimation of the Financial Cost of 4 Weeks Film Rejects in National Orthopaedics Hospital Enugu--47
Table XI: Comparison in Percentage Reject Rate between National Orthopaedic Hospital and University Teaching Hospital-48
Table XII: Comparison of Causes of Film Reject between Enugu State University Teaching Hospital, Park-lane and National Orthopaedic Hospital Enugu 49
LIST OF FIGURES
Fig.1: A Component Bar Chart of the Total Film Reject and Films Used For the Individual Examination in Park-Lane Hospital-34
Fig.2: A Pie Chart Showing the Percentage Reject Rate for Each Examination Type of ESUT Teaching Hospital (Park-Lane) -36
Fig.3: Frequency Distribution of the Cause of Film Reject -38
Fig 4: Component Bar Chart of the Total Film Reject and Film Used for the Individual Examination in National Orthopaedics Hospital Enugu 42
Fig 5: A Pie Chart of the Percentage Film Reject for Each Examination in National Orthopaedics Hospital Enugu--44
Fig 6: The Frequency Distributions of Cause of Film Reject - 46
Berry and Oliver1 stated categorically that the Production of adequate diagnostic radiographs with optimum quality involves well defined procedures. However, one or more of the radiographs produced during an examination may be of insufficient quality to demonstrate the required anatomical features. Patient may need to be re-examined to obtain the desired image quality and thus receive higher doses than would normally be required for that particular examination. It is not uncommon to encounter patient undergo repeat x-ray examination after their initial x-rays were rejected for poor image quality thereby subjecting also the hospital to an avoidable extra cost. This creates a situation which necessitates the need to explore causes of reject and repeat of x-ray examination.
Watkinson et al2 defined film reject analysis as an exercise that is carried out in the radiology department to make detailed analysis of the rejected films, to understand reason for rejection, in order to reduce the rate at which poor quality radiographs occur. Radiographic films are recording medium for the transmitted radiation through the human body giving a visual display of the anatomical and sometimes physiological structures.
Initially, the image exists as a latent one within the film material but is finally made visible and permanent by processing in some appropriate chemical solution. The processed radiographic film which has an image structure on it is known as a radiograph. When the quality of radiation used to produce image is proportional to the body tissues traversed, in terms of thickness, density, and atomic number, to enable a high diagnostic quality image to be recorded, then the radiograph is accepted, but if not, it is rejected.
A rejected film is a radiograph deemed useless and discarded into a reject bin. It is unsuitable for diagnosis. It is quite different from a repeat radiograph which is one retaken in order to provide improved information and is included with the original radiograph for reporting.
Radiographic films are also rejected when there is an inability of the area of interest in the body to be well demonstrated on the radiograph due to poor patient positioning techniques, processing and x-ray equipment fault as well as the careless exposure of an already exposed film amongst other factors.
Gerald1 observed that the employment of film reject analysis as part of overall Quality Assurance (QA) programmes in clinical and radiology services in the evaluation of image quality is a well established practice.
In a work by Schandorf and Tetteh2, on analysis of the status of x-ray diagnosis in Ghana, noted that two main factors to affect quality assurance programme are human and equipment factors. When the quality control of the facility equipment is adequate, most of the problems associated with images of diagnostic value are as result of human errors such as improper choice of technique, underexposure and overexposure and positioning error. These factors account for 6.1%, 1.5% and 11.7% of film reject in a Teaching, Regional and Private hospital respectively, which they studied.
Different hospitals have different film reject rates probably due to the kind of imaging equipment such as x-ray tube, generator, etc and recording system like cassettes, screens and films used by the hospitals. Most hospitals also use different method of film processor such as manual, automatic and digital processor which also tends to have effect on the quality of radiograph produced.
The aim of this study is to conduct a comparative analysis of film reject in National Orthopaedic Hospital Enugu and Enugu State University Teaching Hospital, Enugu State Nigeria. To the best of the researcher’s knowledge, there has not been a documented study on the comparative analysis of film reject rate in the two hospitals.
COMPARATIVE ASSESSMENT OF FILM REJECT ANALYSIS IN NATIONAL ORTHOPAEDIC HOSPITAL ENUGU AND ENUGU STATE UNIVERSITY TEACHING HOSPITALS
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