System finds ways to limit image rejects

Since vendors do not incorporate repeat analysis in their PACS products, imaging departments must devise their own mechanisms to record and analyze rejected images. This routine is necessary to provide objective data for training and process improvement.

Texas Children's Hospital (TCH) in Houston recently incorporated repeat/reject analysis into its PACS to improve the quality of diagnostic services, according to a report in a recent paper (J Digit Imag 2003;16:22-25).

The hospital hopes to achieve a better reject rate for 2003 than the department's 2002 average of 4.46%, which represented an increase over the 2001 rate of 4.07%.

"Although the magnitude of our reject rate is comparable with reports from other imaging departments, we believe we have opportunities to reduce it," said Melissa Blado, TCH PACS analyst team leader.

TCH uncovered several potential reasons that it suspects were the cause of the increase in repeat rates.

"Secondary to a staffing shortage, the department has been relying on temporary contract technologists," Blado said.

These contract technologists are less experienced with pediatric patients and with computed radiography equipment, and they have a higher turnover rate. New FTE technologists are also usually unfamiliar with CR technology and consequently generate more rejects, she said.

While repeat rates may never be reduced to zero, since technical errors will always occur with uncooperative patients and human operators, TCH is developing new training strategies to address areas of concern.

"Potential training venues include classes, in-service sessions, and open forums with technologists, our physicist, vendors, and PACS analysts," Blado said.

Areas of discussion will include shielding, how to identify artifacts on the processing station, positioning, and other topics as indicated by monthly repeat analysis reports developed by PACS analysts. Training or coaching will be used primarily to increase the awareness of the reports to the technologists as well as to open dialogue with the department, she said.

"With monthly meetings, training, and consistency of the imaging process, the number of repeats should be minimized," Blado said.