title: Mammographic image reject rate analysis and cause - A National Maltese Study.
abstract: Mammography is used as a first-line investigation in the detection of breast cancer and imaging is required to be of optimal quality and achieved without adverse effects on the health of individuals. Repeated images come at a cost in terms of radiation dose, discomfort to clients and unnecessary financial burdens. No studies investigating mammography quality in Malta had been previously undertaken. Hence, this research aimed to investigate whether mammography is being performed at an acceptable level, through the investigation of reject rates. Quantitative methodology was used to collect data from eight participating mammography units, which were utilising screen film (SFM), computed radiography (CR) and direct digital mammography (DDM). Data relating to the total number of images performed, rejects and causes was prospectively collected over two weeks, resulting in a sample of 2291 images. All units were also asked to answer a questionnaire which provided other data that could be used for analysis. The national mammography reject rate was found to be 2.62%; within the 3% acceptable range. Individual rates' analysis revealed unacceptably high or low reject rates in some units. Positioning was the main reject cause. No significant difference in rejection was found between different types of mammography units or radiographers' experience. Alternatively, radiographers' qualifications, employment conditions and use of rejection criteria were proven to affect reject rates. Whilst on a national level, images are being rejected at an acceptable rate, individual units revealed suboptimal rates; at the cost of extra radiation, added discomfort and financial burden.
authors.affiliation: Medical Imaging Department, Mater Dei Hospital, Msida, MSD 2090, Malta. Electronic address: nicole.mercieca@gov.mt.
authors.forename: N
authors.initials: N
authors.lastname: Mercieca
authors.affiliation: Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, MSD 2090, Malta. Electronic address: jonathan.portelli@um.edu.mt.
authors.forename: J L
authors.initials: JL
authors.lastname: Portelli
authors.affiliation: Kingston and St George's Joint Faculty, Health, Social Care and Education, School of Radiography, Tower Block 4th Floor, Penrhyn Road, Kingston Upon Thames, Surrey, KT1 2EE, UK. Electronic address: H.Jadva-patel@sgul.kingston.ac.uk.
authors.forename: H
authors.initials: H
authors.lastname: Jadva-Patel
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008319:Malta; D008327:Mammography / Q000592:standards*; D056888:Patient Positioning; D011785:Quality Assurance, Health Care; D011786:Quality Control; D012307:Risk Factors
keywords: Mammography; Quality assurance; Quality control; Reject analysis; Reject rates