Novel reject and effective dose analysis in digital radiography—a Finnish imaging department study

Reject rate analysis focuses traditionally on frequency rather than radiation impact, thus limiting its alignment with radiation protection goals. This study examined reject rates by body part in digital radiography at a Finnish imaging department and introduced an evaluation of their relative contribution to patients' additional radiation exposure by calculating a median effective dose-weighted reject rate. The resulting metric may serve as a practical tool to support optimization of radiation burden. The pelvic region and lumbar spine rejected radiographs contributed the highest additional radiation dose, followed by the chest, where the high examination volume outweighed the low relative rejection rate in population-wide dose impact. Extremities contributed negligibly to additional effective dose irrespective of their reject rates, primarily due to a substantially lower radiation sensitivity. These findings emphasize the value of integrating effective dose metrics into reject analysis to better reflect patient risk and enhance quality assurance.