Film Reject Analysis and Radiation Doses Received by Patients in Selected Hospitals in Southwestern Nigeria

Document Type : Original Paper



2 University of Ibadan

3 Ajayi Crowther University


Introduction: A reject rate is the percentage of diagnostic images repeated due to errors during radiological examinations. The present study aimed to evaluate the patient radiation doses and analyze the film reject rate as part of quality assurance program in three diagnostic centers in Nigeria.
Materials and Methods: This study was conducted in three hospitals, namely Federal Medical Center (FMC), General Hospital (GH), and Sacred Heart Hospital (SHH), located in Abeokuta, Ogun State, Southwestern Nigeria. For the purpose of the study, the accepted and rejected radiographs during different X-ray examinations were recorded. A total of 376 rejected and accepted radiographs were evaluated in the three hospitals, and the economic losses due to rejected films were determined. The quality control (QC) tests, which involve kilo voltage (kV), milliampere seconds (mAs), etc, were carried out on the facilities of two out of three hospitals using Victoreen 6000m QC kits. The results of the QC tests and exposure parameters were used to estimate the patient doses for different examinations carried out during the study.
Results: Based on the results of the study, the SHH  had the highest estimated annual loss of $225, followed by the FMC and GH with annual monetary losses of $208 and $166, respectively. In addition, the anteroposterior projection of the lumbosacral spine had the highest mean dose (15±1.64 mGy) in this study, which was observed in the SHH. Additionally, at FMC, all the estimated doses were low.
Conclusion: Regarding the monetary loss and increase in patient dose burden involved in repeated examinations, it is essential to train personnel on the factors leading to repeated exposures.


Main Subjects

  1. References


    1. Carmichael JH. European guidelines on quality criteria for diagnostic radiographic images. Office for Official Publications of the European Communities; 1996.
    2. Schandorf, C, Tetteh G.K. Analysis of the status of x-ray diagnosis in Ghana. British Journal of Radiology. 1998;71(850):1040–8. DOI: 10.1259/bjr.71.850.10211064.
    3. Shalemaei RR. Films reject analysis for conventional radiography in Iranian main hospitals. RadiatProtDosimetry. 2011; 147 (1 - 2): 220 – 2. DOI: 10.1093/rpd/ncr306.
    4. World Health Organization (WHO). Quality assurances in diagnostic radiology. A guide prepared following workshop held in Neuherberg; 1982.
    5. British Institute of Radiology (BIR). Assurance of quality in diagnostic x-ray department. London, British Institute of Radiology;1988.
    6. West M. The principle of quality control applied to both equipment and technique in postgraduate medical sciences, radiation protection of patient. In; Wooten, R. editor. Cambridge University Press. 1993:49-57.
    7. Oluwafisoye PA, Olowookere CJ, Oluwagbemi MA, Adeola OF. Monitoring and quality control tests of Nigerian National Petroleum Corporation (NNPC) diagnostic facilities: parts of quality assurance programme of radiology in Nigeria. Journal of Theoretical and Applied Information Technology (JATIT). 2009; 5(3): 286-94.
    8. Ogundare FO, Uche CZ, Balogun F A. Radiological parameters and radiation doses of patients undergoing abdomen, pelvis and lumbar spine X-ray examinations in three Nigerian hospitals. British Journal of Radiology. 2004; 77: 934-40. DOI: 10.1259/bjr/55841517.
    9. Mallam SP, Akpan MD, Oladipupo MD. A reappraisal of existing expression for estimating radiation output from diagnostic x-ray machine. Nigerian Journal of Physics. 2004; 16 (2): 30-4. DOI: 10.4314/njphy.v16i2.38009.
    10.  Suliman II, Abbas HI and Habbani FI. Entrance surface doses to patient undergoing selected diagnostic X-ray examinations in Sudan. Radiat Prot Dosim. 2006; 123 (2): 209-14. DOI: 10.1093/rpd/ncl137.
    11. Davies M, McCallum H, White G, Brown J. & Hlem M. Patient dose audit in diagnostic radiography using custom designed software. Radiography. 1997; 3: 17 – 25. DOI: 10.1016/S1078-8174(97)80021-1.
    12. Conference of Radiation Control Programme Directors(CRCPD). Nationwide evaluation of X-ray trends: computed tomography (Conference of radiation control programme directors, department of health and human services); 2006.
    13. AEOI. Quality Control Procedure of Diagnostic Medical Imaging Devices. 2012(INRA-RP-RE-121-00/25-0-Esf.1387):103.
    14. Olowookere CJ, Obed RI, Oluwafisoye, P.A., Vincent, U.I. Medical/Health Physicist: Missing component of Nigeria Radiological Crew. Journal of Advancement in Medical and Pharmaceutical Sciences. 2008. Volume 2(4).
    15. Boone JM, Seibert JA. An accurate method for computer-generated Tungsten anode X-ray spectra from 30 to 140 kV. Medical Physics.1997; 24: 1661-70.  DOI: 10.1118/1.597953.