Courtney Nance

1
Repeat Analysis and Comparison

Quality Assurance ensures optimum patient care in an imaging department. A way to

improve quality assurance is to have a repeat analysis. Problems are discovered by tracking and
focusing on repeat cause. As a result, a plan of action can be made for improvement from a
repeat analysis.
August 25 through October 24, 2014 my repeats were monitored at Dixie Regional
Medical Center, Health Performance Center and 400 East Campus. Breaks in analysis were taken
due to special rotations on September 12-21 and October 3-19. 366 exposures were made with 25
repeats totaling a 6.8% total repeat rate. In comparison, my repeat rate February 20-March 27,
2014 at Valley View Medical Center totaled to 9.4%, totaling an overall improvement of 2.6%.
Repeat categories were considered for a causal repeat rate to display where improvements can be
made. My repeats tallied in four areas: motion 4%, artifacts 16%, collimation 20%, and
positioning 60%.

Courtney Nance

Total Repeat Rate

10%
9%

9.40%

8%
7%
6.80%

6%
5%
4%
3%
2%
1%
0%

Semester 2

Semester 4

Motion errors do not occur often in my clinical

experience. Motion repeat cause totaled 0% in semester two analysis. Only 1 of 25 repeats was
due to motion this semester. This particular exam was an oblique positioned foot and the patient
moved the exact time the exposure switch was pressed. To prevent future occurrences of
voluntary movement, clear and concise instructions can be used. Also, a positioning sponge is
useful to act as an immobilization device if the patient requires it.
Artifact repeats are due to lack of questioning, informing the patient, or the technologist
not paying close attention. This causal repeat rate had a small improvement from 16.6% to 16%.
I tried paying closer attention to artifacts semester four and was happy to see improvement. I can
improve by paying attention to hospital gown snaps, patients hand placement over anatomy and
changing patients clothing when it is questionable. R.T.s often have good suggestions, but
during an exam with my marker I need to take initiative on intuition, like changing the patient.

Courtney Nance

Causal Repeat Rate

80% 0.72
70%
0.6
60%
50%
40%
30%
0.16
Semester 0.17
2
Total % 20%
10%
0%

0.04

0.2
Semester 4
0.11

Repeat Category

Most Collimation errors were made during portable x-ray exams in semester four. In
semester two, I had the problem of too tightly collimating, not adjusting when angling the tube
for elongation of structures, and needing to pay closer attention to palpation totaling 11.1%
repeat rate. This semester I increased to 20% repeat rate. Because of location in semester four, I
participated in more portable exams requiring small differences in procedures. I encountered
problems like the image receptor not correctly positioned. Also, patients moving an extremity
without notice due to the loose plastic cover surrounding the imaging plate. To fix these
problems I can palpate more carefully which would ensure the image receptor and body part are
in the correct position. Also, immobilization devices can be used to help with patient
cooperation.
Positioning repeat rate compared to semester two has greatly improved from 72% to
60%. Previous analysis I found difficulties in improper CR centering and rotation of structures
which is still the case this semester, but I have improved using better techniques. Most of my

Courtney Nance

positioning repeats encountered in chest exams. Body habitus plays a key role in chest
positioning by finding a centering point and orienting the image receptor correctly. Realizing
asthenic versus hypersthenic body types will determine the shape of lungs, helping position
correctly. Using obvious landmarks for palpation to locate structures can help reduce positioning
repeats. With experience I have learned better methods to aligning body parts correctly.
However, I can still improve by expanding knowledge of better methods and paying close
attention to palpation land marks. Also, knowing other exam components (angles, technique,
distance, centering point, etc.) so I can focus more on positioning.
Repeat Analysis allows a measurable system to improve individuals. A technologist can
always improve more whether it deals with patient care or technical factors to achieve the most
optimum image. With more experience there has been an overall improvement, but it is
important to keep moving in that forward direction. I can improve on paying closer attention to
fine details (artifacts, positioning and movement), and not making a process too complicated.
Awareness to problems is crucial to progression, which I plan to do.