Mammogram Reject Rate Analysis and Cause in Regional Hospitals in Saudi Arabia

Background: Technical repeats of mammograms cause increased radiation exposure to patients. Therefore, regular quality assurance needs to be established to ensure the standard of performance in any breast center. Reject/repeat (RA) analysis is a subjective evaluation of image quality where images judged to be of poor quality are categorized according to their cause. The aim of this study was to evaluate the total number of rejected mammograms, the most commonly repeated views, and the reasons in a regional hospital in Saudi Arabia. Method: Retrospective data collection was obtained from the Hologic Selenia Dimensions Digital Mammography System from 1. Sept 2021 to 31. August 2024. A ‘Reject Analysis’ report, including reject rates, rejection causes, rejected projections, and the total number of mammographic exposures, was retrieved from the machine itself. Anonymized, rejected images were then exported and analyzed by the researcher. Results: A total of 20792 exposures in the 3-year period were included in this study. There were 2475 repeat rejections, translating into an average reject rate of 11.9%. The most common reasons for repeat rejections were patient positioning, x-ray equipment failure, patient motion, and artifacts. Conclusion: The reported RR rate of 11.9% is well above the <3% acceptable level recommended by most international guidelines, and more research is required to reveal the underlying cause. We believe that regular mammography RA is an effective means for exposure reduction among mammography patients and to continuously improve training programs and maintain the quality and performances of many breast centers.