Radiography: Reject Film Analysis

• Radiographs can be rejected due to incorrect exposure, poor positioning, or issues during processing.
• Identifying the causes of rejected films is key to correcting errors and minimizing unacceptable radiographs.
• A reject analysis should not be based on impressions alone, and should be part of a quality assurance program.
• Reject film analysis might be seen as a threat from the radiographer's view, so it should be explained why, how, when it will be carried out, and the benefit for all involved.
• Sensitometry and radiation consistency tests should be performed alongside reject film analysis to identify processing or radiation output irregularities.

Benefits of Reject Film Analysis

• Pinpoints the primary sources of errors, enabling the implementation of targeted corrective actions.
• Reduces expenses by minimizing film wastage.
• Minimizes patient radiation exposure by decreasing the necessity for repeat imaging.
• Conserves time and resources through the reduction of retakes.
• Establishes a baseline for continuous data assessment.
• Offers statistical evidence that can support requests for additional funding for equipment upgrades, repairs, or replacements.

Potential Problems of Reject Film Analysis

• Lack of staff cooperation.
• Retention of substandard films by radiologists and clinicians if they provide some information.
• Inconsistent updating of reject film records.

Frequency of Reject Film Analysis

• Analyses done on a monthly basis.

Setting up a Reject Film Analysis Program

• Design the program to determine the period over which the program will run.
• Inform staff why the program is necessary, how it will operate, when it will take place, and who is responsible for the program.
• Decide what data is needed and design data recording sheets and place reject film boxes in appropriate areas.
• Gather reject films from specific X-ray rooms and relate the collections to individual radiographers.
• Immediately before program starts you must count all films in store by sizes. Add to this count all unexposed films in cassettes, film hoppers and partially emptyboxes. record this information and dispose of all current reject films.

Method of Reject Film Analysis

• Collect all reject films daily and record numbers of reject films on data sheets daily.
• Immediately, once the program has finished, recount the films in the store, cassettes and half empty boxes to determine number of films used.

Analysis of Reject Film Analysis

• Obtain and calculate number of reject films overall, by size, and by faults.
• Determine number of reject films by rooms or radiographers.
• Determine cost of rejected films overall, and identify common faults.
• Calculate reject films as a percentage of films used.
• Compare current data with that of previous programs.
• A reject rate of 10% or more should be considered unacceptable.
• A reject rate of 5%to 10% justifies continued monitoring.

Action of Reject Film Analysis

• Rank the faults in order of frequency and identify the most common faults.
• Set up remedial programs to correct errors and inform staff of findings and planned remedial action.
• Start remedial action program and nominate dates for another analysis if felt necessary.
• File data for future reference.

Viewing Box Overview

• It provides an even light source with enough intensity for optimal radiograph viewing.
• Regular maintenance and cleaning should be carried out.

Viewing Box Requirements

• Conveniently placed; safely fixed to a wall or stable mobile structure.
• In good working order with a satisfactory design and an even light all over.
• Must be clean inside and out, electrically safe, and have adequate light output.

Design Features of Viewing Box

• Two parallel fluorescent tubes of equal light output, with starters
• Built-in or attached spotlight, a film anchor, a good quality switch and safe electrical wiring.

Viewing Box Cleaning

• Dust on the window or tube reduces light output.
• Marks on the window can be misleading.
• The outside must be cleaned daily.
• The inside must be cleaned 6 monthly.

Needed Equipment For Cleaning Viewing Box

• Viewing box, clean cloth, screw driver

Cleaning Method For Viewing Box

• Remove plug from power socket. Remove the front window.
• Clean window on both sides (intensifying screen cleaner is a useful cleaning agent as it has antistatic properties).
• Clean the back plate and fluorescent tubes.
• Inspect window for damage.
• Make sure that tubes and starters are firmly in place.
• Replace window. Test.

Evaluation of Cleaning

• Check for dust inside and outside.
• Check for marks on viewing window.

Action Post Evaluation

• Wipe over with a cloth.
• Use spirit to clean window of hard-to remove marks.

Electrical Check Overview

• This check should be carried out by or under the supervision of an electrician.
• Switches, fluorescent tubes, starters, and electrical connections should be checked.
• The Electrical Check for Viewing Box should take place 6 monthly.

Needed Equipment For Electrical Check

• Viewing box, screw driver

Method For Electrical Check

• Remove plug from socket. Remove front window.
• Check condition of wiring and electrical connections.
• Check stability of switch.
• Check installation of fluorescent tubes and starters.
• Replace front window. Replace plug in socket.
• Test.

Evaluation of Electrical Check

• Electrical connections firm? Electrical wiring in good condition?
• Tubes and starters located properly and working?
• Light source even and comparable to other viewing boxes?

Action After Electrical Check

• Tighten electrical connections and refit fluorescent tubes or starters.
• Replace tubes or starters if necessary.
• If, after replacing only one tube, it is found to be brighter than the remaining one, replace both.
• The working tube that has been removed can be matched with another one at a later date.
• Replace any faulty parts and File a report.

Viewing Conditions

• Room light levels in the film viewing area should not be too high.
• A bright spotlight should be available for viewing dark areas of the film.
• The viewing box should be mounted at the correct height for easy viewing.
• Light source should be even and the same as other boxes.