Necessity of Technologist-Directed Repeat Chest, Musculoskeletal X-Rays

Most repeat chest radiographs do not add significant clinical information or alter diagnosis, according to a study published in the American Journal of Roentgenology.

Researchers from NYU Langone Medical Center in New York, NY, sought to assess the frequency and utility of repeat radiographs directed by radiologic technologists who perceived the earlier images were of suboptimal image quality.

The researchers assessed 95 musculoskeletal and 87 chest radiographic examinations that had been repeated one or more times because of perceived image quality issues, rejecting original images from PACS submission. Musculoskeletal and chest radiologists reviewed rejected and repeat images in their timed sequence, in addition to the studies' remaining images, and then answered questions regarding the added value of repeat images.

The results showed the reviewing radiologist frequently agreed with the reason for rejection for musculoskeletal (64.2%) and chest radiographs (60.9%), but for 77.9% of the rejected musculoskeletal radiographs and 93.1% of rejected chest radiographs, the clinical inquiry could have been satisfied without repeating the image. For 75.8% and 64.4%, the repeated images showed improved image quality. Only 28.4% and 3.4% of repeated images were considered to provide additional information that was helpful in addressing the clinical question.

The researchers concluded that most repeated radiographs (particularly of the chest) did not add significant clinical information or alter diagnosis, although they did increase radiation exposure to the patient. The decision to repeat images should be made after viewing the questionable image in context with all images in a study and might best be made by a radiologist rather than the performing technologist.