Evaluation of Plain Radiograph Image Reject Rates and Causes at General Hospital Lafia, Nasarawa State

Radiographic image rejection contributes to patient radiation overexposure and operational inefficiency in Nigerian radiology departments, and systematically evaluating rejection rates and their underlying causes provides an essential quality improvement evidence base. At General Hospital Lafia, Nasarawa State in North Central Nigeria, no previous image reject analysis study has been conducted, representing a gap in the local quality assurance evidence base. This study evaluates plain radiograph image reject rates and identifies the predominant causes of image rejection at General Hospital Lafia. A prospective image reject analysis study is conducted over a twelve-week period, documenting all rejected radiographic images across anatomical regions. For each rejected image, the radiographer records the reason for rejection using a standardised classification scheme encompassing positioning errors, exposure errors, patient motion, artefacts, and equipment-related causes. Reject rate per examination category and cause distribution are calculated using descriptive statistics. Available reject analysis literature from North Central Nigeria identifies positioning errors as accounting for 40 to 55 percent of radiographic rejections, with exposure errors constituting the second most common category. The European Commission quality criteria for radiographic images and the IAEA quality assurance programme provide the normative reference standards. Findings are expected to reveal a total reject rate above 15 percent, exceeding acceptable quality benchmarks. Recommendations address anatomical positioning training, establishment of a formal reject analysis programme, and technical quality monitoring by a designated radiology quality officer at General Hospital Lafia. Keywords: image reject analysis, quality assurance, radiography, Nasarawa State, North Central Nigeria.