Clinical governance in radiologic practice: Evaluating the appropriateness of radiologic investigation considering patient clinical information using the radiology request form

Privacy-preserving large language models (PP-LLMs) hold potential for assisting clinicians with documentation. We evaluated a PP-LLM to improve the clinical information on radiology request forms for musculoskeletal magnetic resonance imaging (MRI) and to automate protocoling, which ensures that the most appropriate imaging is performed. The present retrospective study included musculoskeletal MRI radiology request forms that had been randomly collected from June to December 2023. Studies without electronic medical record (EMR) entries were excluded. An institutional PP-LLM (Claude Sonnet 3.5) augmented the original radiology request forms by mining EMRs, and, in combination with rule-based processing of the LLM outputs, suggested appropriate protocols using institutional guidelines. Clinical information on the original and PP-LLM radiology request forms were compared with use of the RI-RADS (Reason for exam Imaging Reporting and Data System) grading by 2 musculoskeletal (MSK) radiologists independently (MSK1, with 13 years of experience, and MSK2, with 11 years of experience). These radiologists established a consensus reference standard for protocoling, against which the PP-LLM and of 2 second-year board-certified radiologists (RAD1 and RAD2) were compared. Inter-rater reliability was assessed with use of the Gwet AC1, and the percentage agreement with the reference standard was calculated. Overall, 500 musculoskeletal MRI radiology request forms were analyzed for 407 patients (202 women and 205 men with a mean age [and standard deviation] of 50.3 ± 19.5 years) across a range of anatomical regions, including the spine/pelvis (143 MRI scans; 28.6%), upper extremity (169 scans; 33.8%) and lower extremity (188 scans; 37.6%). Two hundred and twenty-two (44.4%) of the 500 MRI scans required contrast. The clinical information provided in the PP-LLM-augmented radiology request forms was rated as superior to that in the original requests. Only 0.4% to 0.6% of PP-LLM radiology request forms were rated as limited/deficient, compared with 12.4% to 22.6% of the original requests (p < 0.001). Almost-perfect inter-rater reliability was observed for LLM-enhanced requests (AC1 = 0.99; 95% confidence interval [CI], 0.99 to 1.0), compared with substantial agreement for the original forms (AC1 = 0.62; 95% CI, 0.56 to 0.67). For protocoling, MSK1 and MSK2 showed almost-perfect agreement on the region/coverage (AC1 = 0.96; 95% CI, 0.95 to 0.98) and contrast requirement (AC1 = 0.98; 95% CI, 0.97 to 0.99). Compared with the consensus reference standard, protocoling accuracy for the PP-LLM was 95.8% (95% CI, 94.0% to 97.6%), which was significantly higher than that for both RAD1 (88.6%; 95% CI, 85.8% to 91.4%) and RAD2 (88.2%; 95% CI, 85.4% to 91.0%) (p < 0.001 for both). Musculoskeletal MRI request form augmentation with an institutional LLM provided superior clinical information and improved protocoling accuracy compared with clinician requests and non-MSK-trained radiologists. Institutional adoption of such LLMs could enhance the appropriateness of MRI utilization and patient care. Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Introduction: Radiology request form (RRF) is a medical referral to a radiologist requesting input concerning the diagnosis, treatment, follow-up of patients, and intervention where necessary. The RRF usually provides information on the patient(s) and the investigation(s) being requested. Methodology: This was a cross-sectional descriptive study, in which request forms were retrospectively reviewed over a period of 6 months in the Radiology Department of the Rivers State University Teaching Hospital. A total of 1131 request forms filled by medical doctors were analyzed to ascertain the degree of completeness of filling the forms. The data were collated and analyzed using the IBM Statistical Package for the Social Sciences version 23. The results were expressed in simple percentages, frequencies, and presented in tables, charts, and graphs. Results: Ultrasonography was the most requested radiologic investigation (55.4%), while X-ray and computed tomography scan account for 41.4% and 1.1%, respectively. Majority of the forms had adequately entered date of request (97.7%) and required investigation and patient's names (99.6%). Patient's age was appropriately entered in 51.9% of cases, while 34.1% kept the space blank. Clinical information was indicated in 50.8% of the forms, while 97.2% did not include history of patient's allergy as regards the use of radiopharmaceutical agents. The patient's consultant and resident's doctor names were appropriately entered in 72.1% and 81.7% of the request forms, respectively. Signature authentication by the resident doctor is available in 13.2% of the request forms. Conclusion: It was observed that majority of the RRFs were not completely and appropriately filled; thus, complete information regarding the patient is not provided to the radiologist to enhance report accuracy. Clinical information if adequately provided can improve the quality of patient management, follow-up, training, and research.

An important element in the multidisciplinary approach to patient management is communications among clinicians. As most of the patients attending any hospital have to go through the department of radiology, the pattern and attitude of clinicians to the completion of radiology request forms was assessed in three teaching hospitals in the South –West of Nigeria. Availability of clinical information and demographic data were assessed in 600 radiological request forms. Name of patients (and surname) was provided in almost all the request forms except one, a victim of road traffic accident who was unconscious at presentation. The result showed that clinical information, age, hospital number, physician identity was not provided in 18.5%, 20.8%, 39.9%, and 8.7% respectively. Information on Consultant- in -charge was not included in 11.3%, while 84.2% showed no information on previous radiological examinations.Only 4.8% of the forms were completely filled leaving 95.2% uncompleted. Generally, there were substantial lapses in the way request forms for radiological investigations were filled. The observed patterns were seen in all the centers and were found to be statistically significant and could not be attributed to chance variation. It is recommended that more attention be paid to completion of radiology request forms to assist radiologist in resolving the diagnosis faster. This will also reduce the waiting time of patients as well as their turnaround time in the hospital. Radiology departments should be involved in the orientation programs for newhouse officers and resident doctors to let them know the importance of various items on the request forms.Key words: Request forms completion, Radiology, Clinical information, Demographic data

ObjectiveTo determine whether the clinical and demographic data recorded on head CT scan request forms for patients with non-trauma neurological issues at the Baghdad Teaching Hospital emergency department are adequate, and to explore if the process of completing radiology request forms can be improved through specific interventions.MethodologyA clinical audit was conducted in two cycles. Data were collected from head CT request forms for patients presenting with suspected non-traumatic neurological issues to the emergency room. In the first cycle, data were gathered retrospectively over one month in January 2025. The data were reviewed and analyzed, and then interventions were implemented to enhance quality. The second cycle took place over one month (April 2025) to objectively evaluate the success of these interventions by comparing the adequacy of relevant information before and after their implementation.ResultsFour hundred one patients were included in the first cycle, with 65.58% of their requests having inadequate clinical information. After implementing the interventions, 30.28% of the 383 patients in the second cycle had insufficient clinical information. The patient demographics were mainly complete, except for age and the time and date of the CT scan request, which showed significant improvement.ConclusionThe audit study reveals that the implemented interventions significantly improved the radiology request forms by ensuring they contain adequate demographic and clinical information. Ongoing efforts are essential to sustain good practices in completing the radiology request forms.

The easiest and best way of communication between the Clinician and Radiologist is the radiograph request form. The physician seeking answers from the radiologist should give his requisites and relevant clinical data on the request form. Such a dialogue helps in diagnosis and patient management effectively. The present communication is an attempt to outline the adequacy of information on the request forms in different modalities in a multispecialty hospital. One hundered each of request forms from outpatient and inpatient services were selected at random. These requests were addressed to the Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) divisions of Department of Radiology, Krishna Institute of Medical Sciences, Hyderabad. The aim of the study was to audit the completeness and usefulness of these request forms. Clinical diagnosis was not given in 84 of the 200 forms (42 %) and clinical details were not mentioned in 124 forms (62 %). Patients’ age and sex were not given in a third of the forms (35 %). Interestingly 91 of the 200 forms (46 %) were signed by the nursing staff and not by the referring physician. In 20 % of the forms, the hand writing was not legible. Unacceptable abbreviations were used in majority of the forms. It became evident that the radiological investigation request forms are inadequately filled thus increasing the limitation of the radiologist to give an appropriate report. Keywords: Radiology request forms; Radiation; CT Scan; MRI

Most imaging examinations use ionising radiation which causes biological effects on the body. For this reason, only justified examinations should be requested by adequately completing the radiology request form (RRF) by clinicians. The RRF allows radiographers and radiologists to assess if the benefit outweighs the risk associated with medical radiation exposure. Inadequately or incorrectly filled RRFs leads to unnecessary radiation exposures, imaging errors, and delays in performing the examination. Therefore, this study aimed at auditing the adequacy of completion of general RRFs at St. Francis' Hospital of Katete District in Zambia. This was a quantitative study in which RRFs for general radiography from January to December 2020 were audited. Data were collected retrospectively using a checklist from a total of 974 RRFs. The filled-in forms were assessed for completeness of information related to the patient, examination, and referring clinician. Data were analysed using descriptive statistics. The standard of completeness was based on the Royal College of Radiologists (RCR) guidelines requiring all the designated variables completed on the RRF. Most N=881(90.5%), RRFs were incompletely filled. With regards to patient's identification, the findings revealed N=4(0.5%), N=597(61.3%), N=3(0.4%), and N=2(0.3%) RRFs devoid of patient's name, hospital number, age, and gender, respectively. Regarding the examination, the findings revealed N=3(0.4%), N=68(7%), N=449(46.2%), and N=336 (37%) RRFs devoid of requested examination, indication, clinical history, and level of urgency, respectively. Regarding the referrer, the findings revealed N=135(13.9%), N=173(17.8 %), N=472(48.5%), and N=31(3.2%) RRFs were devoid of information relating to the ward, clinicians' name, referring department, and signature, respectively. This audit reports that most of the RRFs were incompletely filled-in at St. Francis' Hospital. Furthermore, the hospital number, clinical history and level of urgency were the frequently unfilled variables. Overall, there were gaps in completion of RRFs requiring remedying.

ADEQUATE COMPLETION OF RADIOLOGY REQUEST FORMS AT NEWCASTLE DENTAL HOSPITAL: A TWO-CYCLE AUDIT

Background:Clinical audit is one approach to improve the quality ofpatient care, completion of request form inclusive. Radiology requestforms are essential communication tools between the clinician and theradiologist. The aim of this study is to audit the adequacy of completionof X-ray request forms.Methodology:A review of all consecutive request form received at theX-ray unit of the over a period of six weeks to assess the completenessof filling of the forms, details of biodata/clinical information, previousexposure and information about the requesting officer. The data wasentered into a SPSS statistical software and analysed descriptively andresults presented in tables/figures.Result:Two hundred and two request forms were analysed. All therequest had names on it however 89.1% had complete and adequateinformation while 10.9% have incomplete and inadequate informationon names, one hundred and ninety-six (97%) had dates while, 6(3%)did not have information regarding date of request, space for theaddresses were filled in 80 (39.6%) out of which only 24 (11.9%) hadadequate and complete information. Clinical information were adequateand complete in 34.4%, only 6(8.3%) of those with previous x-rayssubmitted their previous film with the new request.Conclusion:We concluded that radiological investigation forms are stillincompletely and inadequately filled. This will have effect on the qualityand the overall service provided by both the radiographer and theradiologist and may have effect sometimes on the clinical decision andoutcome.

Introduction: Clinical auditing is one method for improving the quality of patient care, including the completion of a request form. Radiology request forms are critical tools for communicating between the referring clinician and the radiologist/radiographer. Objectives: To evaluate the radiology request form and improve the request form content and design at Managil Teaching Hospital, Sudan. Methods: A two-cycle clinical audit methodology at radiology department - Managil Teaching Hospital. A total of 100 request forms were collected, with 50 forms acquired for each cycle. These forms were then compared to the standard structured form provided by the Royal College of Radiologists (RCR). In a second cycle, a pre-made request form was used. The data were inputted into Microsoft Excel 2016 and subsequently analysed. The obtained results were then compared to the RCR Standard. Results: A notable enhancement was noted in various aspects, such as the inclusion of the patient's age in the request forms. In the first cycle, the age was only recorded in 13% of the forms, however in the second cycle, it was recorded in 92% of the forms. Conclusion: A significant proportion of radiology request forms are incomplete but after the 2nd cycle of the audit there was massive improvement regarding adequate filling of the radiology request forms. which will aid in effectively diagnosing patients.

Background: Incomplete radiology request forms (RRFs) hinder diagnostic accuracy, delay patient management, and increase the risk of unnecessary imaging. This issue is particularly relevant in resource-limited healthcare settings where RRFs represent the primary communication tool between clinicians and radiology departments.Objectives: To evaluate the completeness of RRF documentation at Bashair University Hospital and assess the impact of implementing a standardized form supported by targeted clinician education.Methods: A prospective closed-loop clinical audit was conducted over two cycles, with 50 RRFs reviewed in each phase. Cycle 1 was performed over two weeks in May 2025, followed by a one-month intervention that introduced a structured Royal College of Radiologists (RCR)-compliant request form and delivered educational sessions. Cycle 2 was conducted over a subsequent three-month period. Data were extracted using a predefined checklist and analyzed using descriptive statistics and chi-square testing.Results: Baseline documentation was markedly deficient across several critical parameters, including patient address 0 (0.0%), urgency 0 (0.0%), clinical background 8 (16.0%), and the stated clinical question 3 (6.0%). Following the intervention, statistically significant improvements were observed in address documentation 47 (94.0%), p < 0.0001; urgency 47 (94.0%), p < 0.0001; clinical background 42 (84.0%), p < 0.0001; and diagnostic question 41 (82.0%), p < 0.0001. Recording the referring clinician’s name also improved substantially from 9 (18.0%) to 47 (94.0%) (p < 0.0001). The patient's name was consistently documented at 50 (100.0%) in both cycles. Conversely, telephone contact information remained poorly documented (1, 2.0%, p = 1.000), and documentation of the requested imaging modality showed no statistically significant improvement (p = 0.5579).Conclusion: The implementation of a standardized RRF and focused educational intervention substantially improved documentation quality and compliance with RCR standards. These findings demonstrate the feasibility and effectiveness of low-cost interventions in optimizing communication, enhancing diagnostic safety, and reducing unnecessary imaging. Continued monitoring, reinforcement of contact information fields, and periodic re-audits are recommended to sustain improvements.

Background/Aims Ultrasound (US) is sometimes used by rheumatologists to investigate subclinical synovitis for patients with suspected inflammatory arthralgia. The National Early Inflammatory Arthritis Audit sets key metrics to encourage earlier treatment of inflammatory arthritis (IA) within 6 weeks of referral to improve patient outcomes. We aimed to understand the use of US by a rheumatology department in a tertiary care centre, by evaluating the effect of US on patient management, and measure how US affected time taken to start DMARD therapy in eligible patients, in order to optimise its use. Methods We included patients who had US scans of hands/wrist/feet/ankles performed by radiology and requested by rheumatology, completed between January-March 2023. We collected data on demographics, symptoms, clinical examination, clinical impression, differential diagnosis, US results, and whether patient management changed following imaging, by medical record review. We also collected information on the nature of the radiology request, including clinical question, priority and average (median) waiting time, which we compared to national waiting times reported on non-obstetric US. Results The sample included 137 adults (mean age 52 years, 82% female) of which 64% were new patients with inflammatory arthralgia. The majority of patients attended with arthralgia +/- swelling (91%). Clinical examination was documented in 88%, of which clinical synovitis was present on 14%. US synovitis was observed in 80% of patients with clinical synovitis. Subclinical synovitis (synovitis on US but not on clinical examination) was present in 13% of patients, of which none were started within 6 weeks of referral. More than half (54%) of patients were discharged after a negative US scan (no subclinical synovitis). Of the remainder, 26% were started on DMARDs and 9% had a steroid injection. The clinical impression pre-imaging with US scan changed in almost a quarter (23%) and remained the same in nearly half (48%) of the sample. The most common clinical question on the radiology request form was subclinical synovitis/IA (72%). 26% of US requests were routine and 24% were urgent. 72% of patients waited six weeks or more from referral for an US test. Comparatively, 24% of patients waited 6+ weeks for a non-obstetric US in April 2023 and 35.1% in the Midlands. Conclusion Over half of patients were discharged after a negative US scan, assuming US has high sensitivity. US confirmed synovitis in patients with clinical synovitis, however this practice may contribute to long waiting times. US helped to identify subclinical synovitis, which resulted in change in management (assuming high specificity). To optimise the use of ultrasound, consider limiting requests to patients with no clinical synovitis or an inconclusive examination. The evidence supporting use of US for subclinical synovitis in people with inflammatory arthralgia must be considered prior to request. Disclosure A. Gupta: None. P. De Pablo Lastra: None.

Radiology request forms are the basis of communication between referring physicians and radiologists. These are the sole documents on the basis of which a justification to carry out a radiological procedure is carried out. However, across the globe, there is a problem of inadequately filled radiology request forms. Several interventions like standardization and the use of technology have been proposed worldwide to overcome the shortcomings of inadequately filled radiology request forms. We carried out a two-phase audit assessing the impact of a technological intervention on the quality of radiology requests with the results showing marked improvement in key parameters. A subset analysis was also done to highlight the importance of radiology request forms by following the patients' treatment course. The remaining shortcomings highlight the importance of training sessions and refresher courses for junior doctors in order to familiarize them with the importance of adequately filled radiology request forms.

An analysis of a nationwide survey of current trend in breast reconstruction

Objective:To assess the degree of utilization of the radiology request form (RRF), the extent of completion each form, the frequency of filling the fields in all the forms, and its effectiveness as a communication tool between the referring clinicians and radiologists.Materials and Methods:All the RRFs for conventional radiographic examinations were audited over a 3-month period. A database containing all the fields in the form, type of request paper used, and legibility of the physician's handwriting was created. A few resident radiologists in the plain film reporting unit were recruited to join in collecting the data daily. We used simple statistical methods to analyze the extent of completion of each form, frequency of completion of the fields in all the request forms, frequency of use of the appropriate form, and frequency of legibility of the physician's handwriting. The results are expressed in percentages.Results:Five hundred eighty (580) requests were analyzed, consisting of 180 for males and 400 for females. The most-completed request form was 86.67% filled, while the least-completed was 26.67%. The most frequently filled field was the requested examination (99.66%). Of the clinicians, 28% did not use the RRF for their referrals, while 7.37% had illegible handwriting.Conclusion:A significant number of the referring clinicians did not make the best use of the radiology department by not using the institution's approved RRF as an effective means of communication with the radiologists, mainly due to the inadequate completion of the forms.

Background: Adequate and accurate clinical history on a properly filled request form is indispensable if a clinically relevant radiological diagnosis is to be made. Moreover, clinicians need to clearly justify their requests for radiological procedures on a request form to prevent unnecessary radiation exposures and examinations with attendant prolonged waiting time. Objective: The study audited inadequately filled radiology request forms to determine their impacts on diagnosis, patient radiation exposure, and waiting time. Materials and Methods: Following an institutional review board approval, a total of 158 inadequately filled request forms for conventional X-ray examinations were sequentially enlisted and evaluated. Scorings as filled, inadequately filled, and unfilled were used to score each item based on the following: patient biodata/demographic information and patient referral details and referring physician details. Request forms for repeat examinations were further analyzed for remote factors tied to inadequate filling or lack of filling of the details on the repeat forms. Data were analyzed based on descriptive statistics using SPSS statistical software. Results: Patient names including first and surname were adequately filled on all the request cards (100%). Information related to patient referral details such as previous X-ray examination, blood pressure, and last menstrual period were inadequately filled with 4.4%, 2.5%, and 19.7% completion, respectively. Of the 158 request forms assessed, 33 (20.9%) examinations were repeated due to partial or complete cutoff of anatomic region of interest analysis showing inadequate clinical history and requested examination accounting for 45.5% and 24.2% of the remote factors tied to the repeats. Conclusion: The practice of adequate, correct, and consistent filling of radiology request forms was suboptimal with resultant prolonged waiting time and possibly increased exposure among repeat cases. A continued reminder of all referring clinicians needs to be improved to protect patients from prolonged waiting times and unnecessary radiation exposure, for the overall improvement of quality of services. Implications for Practice: Adequate information on the request forms improves diagnostic acuracy, reduced waiting time, and increased overall quality of service delivery.