The cost of perfection: An investigation into the unnecessary rejection of clinically acceptable lateral wrist imaging

Introduction: This study illustrates image rejection rates of the lateral wrist x-ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images that needed to be repeated based on the clinical indication. This study highlights the difference in subjective image-repeat decision-making skills existing between radiologists, experienced radiographers and junior radiographers. Methods: A retrospective review was conducted of all rejected lateral wrist x-ray images by a panel of three radiologists, three experienced radiographers and six junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A complement of images that had not been rejected were included in the review to create a blinded study. Results: The review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers. Conclusions: This review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists; however, the difference in decision-making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services and indicates an unnecessary burden to clinical practice. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs.