Abstract
The radiology request/referral is an important part of the communication between the referring physician and the radiology department. It forms the basis for radiologists and radiographers to be able to carry out their work. Through the radiologic request form, the referrer orders an examination for a patient, as part of the patient's medical examination or follow-up. In conjunction with education and practice, we have noticed that reduced quality of the referrals is not uncommon. The aim was to identify the main contributing factors to unjustified referrals for diagnostic imaging procedures. A literature review was undertaken.
 Analyzing the literature, the overall themes emerged, and resulted in five subcategories; 1) insufficient, inaccurate or lack of clinical information or questioning, 2) weaknesses in choosing the desired modality, 3) missing routines and 4) need for further standardization of the referring-practice, and 5) insufficient knowledge of radiological diagnostics on behalf of the referring physicians. Weaknesses in clinical history and questioning were the most frequently presented contributing factors.
Highlights
Justification is one out of three main principles of radiation protection in medical imaging
The results in the scientific articles would describe factors that can contribute to a poor referral to the radiology department
Fourty-four% of the referrals (57 of 129) were written electronically, where the majority (30 of 57) of these were deviant, which was clinically significant in deciding the justification of the referral (Agarwa et al, 2009)
Summary
Justification is one out of three main principles of radiation protection in medical imaging. The principle involves weighing advantages against disadvantages of the requested examination to decide on the best alternative for every patient. The best alternative would be the one with the lowest overall risk, and the exam should serve a purpose in the followup of the patient. Unjustified diagnostic imaging procedures is likely a worldwide problem. With increasing use of radiological imaging, comes overuse. A Swedish national survey concluded that approximately 20% of the reviewed CT-examinations were unjustified (Almén, Leitz & Richter, 2009). The entire scope of the problem may be hard to measure, as well as the solutions
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