For midterm
Topics to be covered
 Repeat Analysis
 Analysis
Of Reject Versus
Repeated Films
 Determination Of Rejection
Rate
 Distribution Of Rejected Film
 Guide To Good Practice
The desired outcome of a
diagnostic x-ray study is the
creation of an acceptable
diagnostic image, a correct
diagnosis, and the
satisfaction of all internal
and external customer.
 Quality
control testing can only
minimize the risk of obtaining subquality images but cannot prevent
them entirely.
 Quality management program must
also include looking at the final
outcome of a diagnostic x-ray
procedure and determining the
quality of outcome to see if further
improvement can be achieved.
Outcome assessment
Repeat
analysis of images
Artifact analysis of images
Accuracy, sensitivity and
specificity analysis of
diagnosis.
Repeat analysis
It is a systematic process of
cataloging rejected films
and determining the nature
of the repeat so that repeat
images can be minimized
or eliminated in the future
Importance of repeat analysis
 It
provides knowledge of data about:
 Equipment and accessory performance
 Departmental procedures
 Skill level of the technical staff
 With
this knowledge, solutions can be
found to minimize repeats and also
document the effectiveness of quality
control and quality assurance
protocols
Advantages
Repeat analysis can show how many
repeats in the depart w/c in turns
address the party concerns of what are
the problems.
 With lower department repeat rates:

 Improved department efficiency
 Lower department cost
 Lower patient doses
Improved department efficiency
With number of repeats are kept low, the
amount of time that patient must spend
undergoing diagnostic procedures
decreases.
 This in turns increases patient
satisfaction and allows the department
to service more patients in the same
period.

Lower department costs
 When
the number of repeats
are reduced, the costs
associated with film,
processing, labor and
depreciation of the equipment
decrease significantly.
Lower patient doses
Images
that are
unacceptable results in the
repeat of the particular
view, which means that the
patient must be re-exposed
to ionizing radiation.
Causal Repeat rate
In repeat analysis studies performed on
departments without quality control
procedures for the darkroom, processor
and equipment, 75% of all repeats were
caused by improper optical density of
film.
 With quality control protocol in place,
studies shows that most repeats are
results of positioning errors.

National average of repeat causes for
departments with quality control
procedures
Category
% Repeat
Positioning
Light films
Misc. (artifacts)
Darkrooms
30
14
14
11
Black films
Tomography scouts
Fog
9
8
5
Patient motion
Mechanical problems
5
4
Repeat analysis
For
a study to be done, a
worksheet for radiographic
imaging departments
should be used, so that the
proper statistical
information is obtained and
recorded.
Worksheet
 A worksheet
should include the
radiographic procedures
performed in the department,
along with the possible causes
of rejection, such as positioning,
overexposure, under exposure,
motion, artifacts, and
miscellaneous causes
Causal repeat rate

The causal repeat rate is the percentage
of repeats from a specific cause and is
calculated with the following equation:
Causal
repeat =
rate
Number of repeats for a specific cause
X 100
Total Number of repeats
Example
A total repeat of a department has 200
films in a month, and 90 out of 200 films
are the result of positioning errors.
 So the percent of repeats caused by
positioning error is 45% of the total
repeat films.

Total repeat rate

The total department repeat rate is
determined with the following equation:
Total repeat Number of repeat films
X 100
rate =
Total number of views taken
Example
If a department has a total of 2300 views
during a month and has incurred a 300
rejected film.
 A 13% percent the department has
incurred in a month

Department repeat rates should not
exceed 4% to 6% and should be less
that 2% for mammographic procedures.
 Any department exceeding 10% to 12%
should be examined seriously, because
of inefficiency and contribute to high
patient dose.

 For
a department to evaluate its
efficiency a worksheet should be
used for any repeat film.
 As a QA/QC officers a worksheet
can aide in identifying problems
if it is mechanical/technical or by
human errors.
Laboratory Exercise

Instruction
 Each group are assigned with a number of
films.
 Analyze the films.
 After analyzing the films, the film should be
rotated to other groups for analysis.
Survey period
repeat
category
examinati
on
to
location
Position
Overexposed
Underexpose
Motion
Artifacts
Other
Total
%
UGI
12
4
3
1
5
8
33
23%
Ba.
Enema
15
1
1
20
3
1
41
28%
IVP
5
2
3
1
7
1
19
13%
OTHER
10
1
3
11
25
1
51
35%
TOTAL
42
8
10
33
40
11
144
%
29%
6%
7%
23%
28%
8%
Total
films
viewed
1320
Total
repeat
144
Total
Repeat
Rate
11%