Confronting our mistakes: A comprehensive evaluation of radiographic errors in digital chest radiography among adult population in a public sector hospital

Objective: To find out the various types of radiographic errors in digital chest radiography and their effect on image quality leading to image rejection. Material and Methods: This cross-sectional study was carried out in Radiology department of Pakistan Institute of Medical Sciences for a period of One month, September 2019. The study included 1560 digital Chest X-Rays, reaching the Picture Archive and Communication System (PACS), fulfilling the inclusion criteria. All these X-rays were analyzed by two radiology residents for the presence of radiographic errors in them. The various radiographic errors were then classified as: Positioning error, poor collimation, Artifacts, improper exposure, motion blur and mislabeling. The frequency of each radiographic error was measured along with their implication on image quality resulting in three major image categories: ACCEPT, JUST ACCEPTABLE and REJECT. The SPSS was adopted for inferential statistical analysis. Results: The study included 1013 (64.9%) male patients and 547 (35.1%) female patients. The mean age came out to be 36 +/- 15 years. Out of 1560 X-rays, 964 (61.8 %) had radiographic errors in them while 596 (38.2%) were completely devoid of radiographic errors. Positioning error (44.5 percent) was the most frequently encountered error followed by poor collimation (29.8%), artifacts (14.9%), Improper exposure (8%), motion blur (2.2%) and mislabeling (0.5%). The rejection rate came out to be 16.5 %. The major cause of image rejection was anatomy cutoff, especially the cut-off of cardio phrenic (CP) angle. Conclusion: Positioning errors represent the commonest cause of image rejection in chest radiography. The main identified pitfall was lack of radiographer’s education and training in performing an examination and indicates a need to improve their performance. Key words: Digital Radiography, Chest X ray, Radiographic error, Image reject