Radiology Request Research Articles

Assessment of Reason for Exam Imaging Reporting and Data System (RI-RADS) in inpatient diagnostic imaging referrals

ObjectivesTo test the Reason for Exam Imaging Reporting and Data System (RI-RADS) in assessing the quality of radiology requests in an Italian cohort of inpatients; to evaluate the interobserver reliability of RI-RADS.MethodsA single-center quality care study was designed to retrospectively identify consecutive radiology request forms for computed tomography, magnetic resonance imaging, and conventional radiography examinations. One radiologist scored the requests using the RI-RADS. The association between RI-RADS and clinical request variables (urgent request, on-call requests, indication for imaging, requesting specialty, imaging modality, and body region) was evaluated. We calculated interobserver agreement between four readers in a subset of 450 requests.ResultsWe included 762 imaging requests. RI-RADS grades A (adequate request), B (barely adequate request), C (considerably limited request), D (deficient request), and X were assigned to 8 (1%), 49 (7%), 237 (31%), 404 (53%), and 64 (8%) of cases, respectively. In the multivariate analysis, the indication for imaging, body region, and requesting specialty significantly influenced the RI-RADS. Indications for imaging with a high risk of poor RI-RADS grade were routine preoperative imaging and device check requests. The upper extremity was the body region with the highest risk of poor RI-RADS grade. Requesting specialties with a high risk of poor RI-RADS grade were cardiovascular surgery, intensive care medicine, and orthopedics. The analysis of the interobserver agreement revealed substantial agreement for the RI-RADS grade.ConclusionThe majority of radiology exam requests were inadequate according to RI-RADS, especially those for routine imaging. RI-RADS demonstrated substantial reliability, suggesting that it can be satisfactorily employed in clinical settings.Critical relevant statementThe implementation of RI-RADS can provide a framework for standardizing radiology requests, thereby enabling quality assurance and promoting a culture of quality improvement.Key PointsRI-RADS aims to grade the completeness of radiology requests.Over half of the imaging requests were RI-RADS D grade; RI-RADS demonstrated substantial reliability.Most radiology requests were inadequate and RI-RADS could classify them in clinical practice.Graphical

Adequate Completion of Radiology Request Forms: A Clinical Audit at Managil Teaching Hospital in Sudan

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.

X-ray imaging of multiple adjacent regions in paediatric patients: Potential utility for diagnosis and patient management

BackgroundIn emergency presentations, it is not uncommon for patients to present with imaging requests of multiple body regions to detect concurrent injury. While current literature explores diagnostic efficacy of adjacent imaging for forearm fractures, there is limited research on its effectiveness across all extremities. This paper explores the diagnostic yield of X-ray adjacent imaging of the upper and lower limb in paediatric patients. MethodsA retrospective audit was performed using information available on radiology request forms from paediatric patients (age <18 years) that had multiple X-rays of adjacent body regions over six months at two hospitals. The main or first X-ray was referred to as initial imaging, while all subsequent X-rays of adjacent regions was considered secondary imaging. Clinical history and radiologists’ findings were collected, categorised, and analysed using Chi square. ResultsThere were 661 X-rays performed across 277 patients. Initial imaging was significantly more likely to detect injuries or abnormalities (35 %) than X-rays of adjacent regions (1.6 %), with 94 % of all abnormalities detected on initial imaging overall (χ2(3) = 241.247, p < 0.001). X-ray request forms with no clinical symptoms were significantly more likely to have no findings detected (χ2(3) = 53.493, p < 0.001). ConclusionX-ray imaging of a body region adjacent to an injury has low diagnostic yield, suggesting the need for interventions to reduce unnecessary adjacent X-ray imaging. Clinical history information was often limited and concurrent injuries were low.

A review of completeness and appropriateness of radiology request and adequacy of clinical information on radiology request at BDF Hospital in Bahrain

A retrospective cohort study of the completeness and appropriateness of the radiological have been performed at the Royal Medical Services - Bahrain Defence Force Hospital (RMS-BDF) between 12-March-2023 and 25-March-2023. In this framework, only two imaging modalities were selected: general X-rays and CT scan. Referrals from within RMS-BDF have been selected due to easy access and availability of all data needed for this audit. The electronic radiological request for these modalities were manually assessed for the following criteria: essential clinical information and other relevant clinical information. All evaluation criteria were listed in a data sheet and the assigned radiologists were asked to evaluate the radiological requests and tick correspondent notices in the data sheets. All data sheets were then sent to a statistician to analyze the data using Microsoft Office excel to generate graphs and figures. The data analysis showed that the accepted CT scan requests were 298 (69%) out of total 421 radiological requests. For the general X-rays, the accepted requests were 855 (40%) requests while the invalid requests were 1269 (60%) requests. According to Bahrain Defence Force Hospital standards, the referrer must provide enough medical information in order to justify the use of the radiation and to provide quality service to the patients. The outcome of this audit can be used to evaluate the compliance and completeness of the radiological request after intervention. Instructing the physicians and training them to fill all required and necessary clinical information.

Collaborating with non-radiological clinical colleagues.

Paediatric radiology is a challenging and intriguing subspecialty, dealing with children, guardians and non-radiological clinical colleagues. Paediatric radiologists are routinely in contact with numerous paediatric and surgical subspecialties, all having different needs, perceptions, prioritisations and expectations. Moreover, the radiologist is part of the team of radiographers, sonographers, nurses and secretaries, assisted by appropriate equipment and electronic tools. The framework of good collaboration to ensure safety and effectiveness for the imaged child is a shared responsibility among all medical practitioners involved. Communication in routine practice has many forms and includes appropriately filled radiology requests in accordance to the patient's medical records, routine and timely production of structured, problem-solving radiology reports, face-to-face or electronic-assisted communications and discussions on a pre-defined framework, mutually-agreed and evidence-based protocols adjusted to local availability, skills and national and international guidelines. Mutual understanding of advantages and limitations of imaging is paramount. Well-meant discussions, professionalism and empathy should promote soft skills, bidirectional communication and good collaboration for the benefit of added-value paediatric radiology. International societies, health authorities, medical directors and senior consultants have the responsibility to suggest and safeguard frameworks and recommendations. Regular multidisciplinary meetings and multidisciplinary research projects under openness, honesty and transparency are pathways favouring good collaboration.

Assessing, Advising, and Advancing the Filling Practices of the Radiology Request Form in Africa: A Systematic Review.

Despite the increased use of diagnostic imaging in Africa, the completion of the Radiology Request Form (RRF) remains suboptimal, often relying on paper-based communication. To examine the practices surrounding RRF completion in the African continent, on 25 March 2024, we conducted a systematic review of peer-reviewed articles describing the practice in African settings. Non-African studies, studies involving non-human subjects, and articles examining the practice of the RRF for interventional usage were excluded. Our search involves PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, Google Scholar, and African Journals Online. The included studies were 3004, of which 30 met the inclusion criteria. These studies span eight countries and highlighted several shortcomings, including the usage of informal forms, unconventional abbreviations, illegibility, inaccuracy, and the lack of important fields from institutional forms, commonly the last menstrual period and the referrer's contact details. We also found widespread non-compliance in all RRF fields; half of the studies did not have an adequately filled form. Incomplete RRFs lead to delayed imaging, increased workloads for radiographers and radiologists, and potential misdiagnoses due to insufficient information. It will also impede the application of radiation protection principles. To address these challenges, empowering radiographers and radiologists and encouraging best practices is essential. Regular audits and educational initiatives aimed at clinicians are recommended. While transitioning to a paperless communication system might help, implementing nationwide quality improvement projects to standardise radiology request forms is currently more feasible.

Assessing and Enhancing the Adequacy of Radiology Request Forms at a Tertiary Care Hospital in Sudan: A Clinical Audit.

Clinical auditing is one method of improving the quality of patient care. Radiology request forms (RRFs) are crucial for the purpose of facilitating communication between the radiologist or radiographer and the referring clinician. A two-cycle clinical audit was conducted at the Radiology Department of Atbara Police Hospital in Khartoum, Sudan. A total of 100 forms were collected, with 50 forms from each cycle. As an intervention, the existing blank paper format for radiology requests was replaced with a structured form based on the standards of the Royal College of Radiologists (RCR). This new form was distributed hospital-wide, and doctors were educated on its use through presentations and briefings. The collected forms were then compared against the RCR standards for completeness and accuracy. Data were entered into Microsoft Excel 2016 for analysis. The interventions led to notable improvements in several areas. Accuracy in recording the patient's address, phone number, and location increased from 0 (0%) in the first cycle to 50 (100%) in the second cycle, marking a 100% improvement. In addition, referencing the patient's age improved from 15 (30%) in the first cycle to 50 (100%) in the second cycle, indicating a 70% increase. The mean score for RRF documentation was 25.33% in the first cycle and significantly increased to 97.77% in the second cycle. The audit shows significant improvement in RRFs post-intervention, highlighting the importance of standardization. However, deficiencies point to the need for orientation and follow-up training for physicians to ensure accurate form completion. Integrating quality assurance, including periodic audits and real-time feedback, can help sustain these gains. Collaboration between radiologists and referring physicians is also essential for ongoing improvement.

E073 The use of magnetic resonance imaging to assess disease activity in axial spondyloarthritis- data from a tertiary rheumatology centre

Abstract Background/Aims The role of MRI of the spine and sacroiliac joints to aid the diagnosis of axial spondyloarthritis (axSpA) is now well established. However, its utility in disease monitoring, in particular assessment of treatment non-response is unclear with limited and conflicting data on the relationship between inflammatory changes suggestive of disease activity on MRI and outcome measures such as ASDAS-CRP and BASDAI. Although the most recent ASAS/EULAR guidelines recommend against routine use of MRI in the assessment of treatment response in axSpA, this is a pragmatic approach often undertaken in NHS clinics with substantial cost implications. We aimed to explore the current use of MRI to assess disease activity in axSpA in a large tertiary centre, in particular its utility in exploring treatment non-response and its impact on treatment switching decision. Methods As part of a service evaluation audit, MRIs performed under the “inflammatory back pain protocol” at Leeds Teaching Hospitals Trust between December 2021 and May 2023 were identified from radiology request data. Patients with axial spondyloarthritis (nr-axSpA, r-axSpA or axial psoriatic spondyloarthritis [axPsA]), were identified. Demographic data, baseline MRI findings, current medications, repeat MRI findings for ongoing axial symptoms, outcome measures and inflammatory markers were extracted from the clinical notes. Data on MRI findings consistent with inflammatory or structural changes related to axSpA or alternative findings, were extracted from the radiologist’s report. Results Overall, 111 patients had an MRI to assess disease activity, 93 had axSpA (49 r-axSpA, 44 nr-axSpA) and 18 axPsA. Patients were predominantly male (58.5%) and HLA-B27 positive (65.8%), 25.2% and 27.9% current smokers and ex-smokers respectively. A history of psoriasis was documented in 25.2% and peripheral arthritis in 42.3%. Baseline MRI was available on 76 patients (68.9%), of which 61 (80.3%) had spinal or sacroiliac inflammation as per the radiologist report. In total, 79 patients were on bDMARD therapy, with TNFi the commonest class (n = 59, 52.7%). Repeat MRI demonstrated active inflammation in the spine or sacroiliac joints in 58.6% (n = 65) as per the radiologist report. Patients with active inflammation in the repeat scan were more likely to have their bDMARD switched or treatment escalated (54% vs 36%). Other important findings included spinal stenosis (n = 4), disc disease (n = 15), vertebral fractures (n = 2) and potential malignancy (n = 1). Conclusion In our practice, MRI is of utility in the monitoring and assessment of non-response in axSpA in two-thirds of cases, aiding treatment decision making by leading to a switch of bDMARD in half of patients and excluding alternative pathologies, such as vertebral fractures and disc disease which may also affect components of disease activity scores. Further research exploring association of MR findings with clinical outcomes, including economic evaluation of routine MRI to assess disease activity in axSpA is warranted. Disclosure J. Weddell: None. R. Shah: None. P. Robinson: None. A. Barr: None. C. Vandevelde: None. J. Freeston: None. D. McGonagle: None. H. Marzo-Ortega: None.

Structured request form in musculoskeletal radiology examinations (CONCERTO): results of an expert Delphi consensus-structured radiology request form for correct classification of patients to undergo radiological examinations of the Italian Society of Medical and Interventional Radiology (SIRM), the Italian Society of Rheumatology (SIR) and the Italian Society of Orthopedics and Traumatology (SIOT).

To describe a Delphi consensus for the realization of a structured radiology request form for patients undergoing musculoskeletal imaging. A steering committee (four radiologists, a rheumatologist and an orthopedic surgeon) proposed a form to an expert panel (30 members, ten radiologists, ten rheumatologists and ten orthopedic surgeons). Through an online survey, the panelists voted on their level of agreement with the statements of the form using a 10-point Likert scale (1: no agreement; 10: total agreement) in a three-round process. A combination of two distinct criteria, a mean agreement level ≥ 8 and a percentage of at least 75% of responses with a value ≥ 8, was deemed as acceptable. The form achieved high median ratings in all the assessed key features. During the first round, all items met the threshold to be advanced as unmodified in the next round. Additional proposed items were considered and introduced in the next round (six items in Section 1, five items in Section 2, ten items in Section 3, 11 items in Section 4, six items in Section 5, eight items in Section 6, ten items in Section 7 and eight items in Section 8). Of these items, in round 3, only six reached the threshold to be integrated into the final form. Implementation of a structured radiology request form can improve appropriateness and collaboration between clinicians and radiologists in musculoskeletal imaging.

Adherence of Radiological Investigation Requests from Medical Wards, to Royal College of Radiologists’ Guidelines

Background: Radiological investigation requests get rejected by vetting radiologists, if they do not adhere to Royal College of Radiologists (RCR) guidelines and Ionizing Radiation (Medical Exposure) Regulations - IR(ME)R 2017 guidelines. This leads to significant delays for all three parties involved: the requesting clinician, the radiologist who vets the investigation, and the patient whose management is affected. Hence radiological investigation requests, which are the main means of communication between the referring clinician and the radiologist, should be appropriately filled in to facilitate the justification process and to optimize patient management. Aims/purpose: To evaluate the adherence of radiological investigation requests of inpatients from medical wards at University Hospitals of Leicester, to RCR guidelines and identify improvement areas, thereby reducing preventable patient delays. Methods: Data from 500 investigation requests of adult inpatients for common modalities of imaging (CT, X-Ray, and MRI) from medical wards at University Hospitals of Leicester were collected across two audit cycles, omitting any patient-identifiable information, and were analyzed for their completeness and adherence to RCR protocols. Results: Based on the analysis, inadequacies of imaging requests were identified, both in completion and adherence to RCR guidelines. In the initial audit cycle, even though more than 90% of the 250 investigation requests analysed contained clinical history, the name of requesting clinician and the question to be answered, only 64% of the investigation requests contained clinical examination or relevant investigation findings. In comparison to more than 94% of MRI and X-Ray requests, only 68.6% of CT requests adhered to RCR and IR(ME)R 2017 guidelines. In order to raise awareness and educate, the audit findings and recommendations were presented in a local medical teaching session within the hospital, and the same was propagated among medical doctors, through an online flyer. During the re-audit, another 250 radiological investigation requests were evaluated, where 73.3% of the requests included relevant clinical examination and/or investigation results and 76% of the CT requests adhered to iRefer guidelines for indication. Conclusion: Radiological investigation requests get rejected if it does not adhere to RCR guidelines for completeness (1) or indication (in compliance with IR(ME)R 2017)(3). This in turn results in delays in patient management. This could be minimized by increasing awareness about the above guidelines and the need for adhering to the same, thereby making sure all the necessary details are filled in and the investigation being requested is appropriate for the clinical indication. Keywords: Radiology, Audit, Medicine.

Factors Causing Inadequate Implementation of the HIMS Electronic Medical Records Outpatient at Level II Hospital, dr. Soepraoen Malang

The use of HIMS operationally is useful for improving performance and service, facilitating coordination between units, and increasing HR capabilities. The formation of HIMS not only automates old procedures, but organizes and updates and even creates new and more efficient data flows, this is very important, especially the implementation of HIMS in the field of radiology. The purpose of this Community Services residency is to analyze the factors that cause inadequate implementation of HIMS Electronic Medical Record Outpatient Level II Hospital dr. Soepraoen Malang. Therefore, this residency discusses existing problems using fishbone diagrams, USG (Urgency, Seriousness, Growth), and SWOT Analysis (Strengh, Weakness, Opportunity, Treats). The results of the residency show that after analyzing the problem with fishbone, USG, and SWOT, the implementation of a strategy that can be applied to community service residency activities is to make regulations in the form of SOPs regarding data input for medical, non-medical, radiology requests and conducting training activities for Outpatient Polyclinic operators. Evaluation of the strategy that has been made is by coordinating between management and sections/fields according to their respective duties, principals and functions in an attempt to optimize the implementation of electronic medical record HIMS in outpatient services at polyclinics.

1069 Radiological Diagnosis of Groin Hernia - The New Norm?

Abstract Aim Ultrasound is an effective means for diagnosis of groin hernia however, RCS England and The British Hernia Society recommend that herniae should be diagnosed clinically and ultrasound should not be arranged at a primary care level. Following an increase in radiologically-diagnosed herniae referred to the general surgery department, we sought to determine whether ultrasound was used as a primary diagnostic tool. Method Ultrasound requests received from primary care between January and December 2021 were identified using radiology department records. Exclusion of incomplete, follow up and paediatric scans (&amp;lt;16 years old) was ensured. Electronic records were reviewed for clinical history, examination, radiology request and imaging report. Results 342 patients were included. 193 patients had the right groin scanned and 149, the left. The predominant symptoms for which scans were requested were “lump/swelling” (46%) and “pain” (36%). 13% were for suspected recurrence. 27% had a hernia on examination and 45% had no documented examination findings. The most common clinical question on imaging requests was “?hernia” (63%). 143 (42%) of ultrasound scans positively identified a hernia. Of these, 52% had a documented hernia on examination. Conclusions Ultrasound imaging is commonly used to diagnose or confirm diagnosis of groin hernia in the primary care setting. This study was conducted during the COVID-19 pandemic; reduced access to face-to-face consultations may have resulted in increased use of imaging and absence of clinical examination in the assessment of these patients. Patients with suspected hernia should be reviewed by a secondary care specialist prior to diagnostic imaging.

Adequacy of completion of radiology request forms at St. Francis' Hospital of Katete District: A clinical audit in Zambia.

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.

Equipment downtime in the radiology departments of three teaching hospitals in Ghana

IntroductionRadiology equipment requires routine maintenance to prevent equipment breakdown. Equipment breakdown can lead to adverse patient outcomes and lost revenue to hospitals. In Ghana, there is a mismatch between the available radiology equipment and requests which may result in frequent breakdown. Several studies have been conducted to investigate equipment downtime across radiology departments. However, there is none for Ghana. This study therefore investigated the downtimes of radiology equipment across three hospitals in Ghana. MethodThe study covered the period January–December 2020. An inventory sheet was used to collect data on equipment specifications, frequency of breakdown, downtimes, average daily patient throughput, the average cost of common examinations, the availability of post-installation training and maintenance contracts/agreements. ResultsThe study reviewed 32 items of radiology equipment. Radiology equipment across the hospitals broke down frequently and downtimes were very high. Radiographers/radiologists across the hospitals were provided with poor/inadequate post-installation training, and maintenance contracts/agreements were unavailable. The radiology equipment downtimes resulted in significant lost revenue of GH₵ 16,279,803 (US$ 1,968,537). ConclusionRadiology equipment across the hospitals broke down frequently and downtimes were lengthy leading to significant lost revenue for the hospitals. Post-installation trainings were poor/inadequate, spanning a few hours. Also, maintenance contracts/agreements were non-existent across the three hospitals. A nationwide study is needed to determine equipment downtimes and lost revenue across all radiology departments in Ghanaian hospitals, to better inform policy-making. Implications for practiceThis study may help hospital managers and other stakeholders involved in policy formulation and strategic planning, put measures in place to minimise radiology equipment breakdown in Ghana. The study may also help optimise radiology services and enable radiology departments to render uninterrupted clinical services to patients in Ghana.

The incidence of acute lower limb thrombosis, in symptomatic patients detected with ultrasound, with consideration of recent COVID‐19 vaccination or infection

AbstractIntroductionAfter the COVID‐19 vaccination roll out began in March 2021 patients began presenting to a Victorian Emergency Department with lower limb pain following their vaccination. As a result, radiology requests for ultrasound examinations, to exclude post vaccination deep vein thrombosis (DVT) began appearing.MethodA retrospective search of lower limb venous ultrasound examinations was undertaken for a 1‐year period from March 2021 to February 2022. Patients were included in the study if they had a clinical indication of having been referred following COVID‐19 vaccination. Bivariate analysis was conducted, using logistic regression, to determine the strength of association between independent variables (i.e., age, gender, vaccination status, and COVID‐19 diagnosis) and dependent variables (i.e., a diagnosis of DVT and superficial vein thrombosis [SVT]).ResultsThe study found 1627 examinations had a lower limb venous ultrasound examination over the study period. Ultrasound was positive for acute DVT in 218/1627 examinations (13.4%). 104/1627 (6.4%) presented for ultrasound following COVID‐19 vaccination. Six of these were found to have acute lower limb DVT detected. The association between post vaccination and DVT was an odds ratio (OR) of 0.379 (95% CI 0.164–0.874, p = .023). All examinations that were diagnosed with acute thrombus had recently received AstraZeneca (AZ) (Vaxzevria, ChAdOx1‐S/nCoV‐19) vaccine. Four examinations were diagnosed with superficial vein thrombosis (SVT) post recent COVID‐19 vaccination. One patient was diagnosed with Vaccine Induced Thrombosis with Thrombocytopenia after their first dose of AZ.ConclusionThis study found 6/1627 (0.37%) lower limb venous ultrasound examinations, over a 1‐year period, were positive for acute DVT after COVID‐19 vaccination. The results showed post vaccination examinations were less likely to be diagnosed with a DVT than the population referred who had not had recent vaccination.

GPT-4 for Automated Determination of Radiologic Study and Protocol Based on Radiology Request Forms: A Feasibility Study

Published under a CC BY 4.0 license.

ASSESSMENT OF REFERRING CLINICIAN'S ADHERENCE TO ROYAL COLLEGE OF RADIOLOGISTS GUIDELINES FOR ABDOMINAL RADIOGRAPHY

Introduction: One of the commonest complaints encountered in the emergency department is acute abdominal pain and the most common investigation ordered to evaluate it is an abdominal X-ray (AXR). However many studies have shown that AXR has a low diagnostic yield and this investigation may be overused. So in order to optimize the sensitivity of AXR, the Royal College of Radiologists (RCR) introduced the iRefer guidelines. Aims: This study aims to assess referring clinicians' adherence to iRefer guidelines for abdominal radiography. And to determine whether the professional status of the referring clinician inuences their adherence to the guideline. Methodology: This is a retrospective study of consecutive adult patients, who presented to a rural tertiary care center between October 2020 and March 2021. Indications for AXR and clinician seniority were determined from the radiology request slips. The appropriateness of imaging was determined by comparing the indication for abdominal radiographs to iRefer guidelines by the Royal College of Radiology. Data was then analyzed accordingly. Results: Our study included 100 patients. 22% of abdominal radiographs were requested according to the iRefer guidelines while 78% were against the guidelines (p-Value = 0.0001). Out of 22 radiographs adhering to iRefer Guidelines, 7 radiographs were normal and 15 were abnormal (14 correct and 1 incorrect in comparison to gold standard). Also, out of 78 radiographs not adhering to the guidelines, 59 radiographs were normal and 19 were abnormal (5 correct and 14 incorrect). Conclusion: The accuracy of detected abnormalities, if we adhere to iRefer guidelines, is 93%. Therefore, we need to follow the iRefer guidelines for every abdominal X-ray. Non-adherence to iRefer guidelines leads to unnecessary exposure of a patient to radiation and increased cost of treatment. To improve the patient's management we need to educate and inform the doctors of different levels about the guidelines.

Are Clinicians Communicating Adequately with Radiologists Through Radiological Requisition? A Clinical Audit Assessing Current Local Practice

Background: To prevent controversy, the request forms were selected to use a method of convenience sampling and also included forms from both inpatient and outpatient different department. The aim of this study whether the different request forms that were submitted to the radiological department and notice that the patients having complete information in each form of different department of radiology. Study design: This was retrospective and descriptive study. The study was carried out at the department of Radiology, MTI Mardan Medical Complex, Mardan for six months duration from May 2022 to October 2022. Methods: The total participants request form were 300 which distribute, 85 forms in CT (computated tomography), 105 forms in MRI (magnetic resonance imaging) and 110 forms in US (ultrasound image). The completeness of the data entered by the doctors was examined on the forms to avoid bias. Results: Our audit information indicate that to analysed 300 request forms were filled out just the name of patients as well as part of examination. The different category of request form included name, age, diagnosis diseases, relevant history and Dr. Name or contact number. Conclusion: The referring doctors managed to fail to fully and precisely fill out all of the disciplines. To recognize this system and communicate about how it may be done better, we suggest having discussions with radiologists and doctors from different departments. Keywords: Radiologists, Radiology request form, Adequate.

Smpte in Radiology: The Forgotten Quality Control Test − A Pictorial Essay

One of the most unused quality control tests in radiology is SMPTE. Even thought, it is a simple test, but it is rarely done in radiology departments around the world. The American College of Radiology request a SMPTE test as a part of the evaluation and accreditation of radiology departments. This paper will explain the historical background of this test and undocumented literature in radiology about SMPTE. As well, how this test is done in order to increase awareness about the usefulness of such quality control tests in a simple way.

Missed Radiological Diagnosis of Otosclerosis in High-Resolution Computed Tomography of the Temporal Bone-Retrospective Analysis of Imaging, Radiological Reports, and Request Forms.

Several studies reported low detection rates of otosclerosis in high-resolution computed tomography (HRCT), especially when the scans were reviewed by non-specialized general radiologists. In the present study, we conducted a retrospective review of the detection of otosclerosis in HRCT by general radiologists and the impact of inadequately filled radiological request forms on the detection rate. Retrospective analysis of hospital records, HRCT reports, and radiological referral notes of 40 patients who underwent stapedotomy surgery for otosclerosis. HRCT imaging data sets were retrospectively reviewed by a blinded experienced neuroradiologist, whose reading served as the gold standard. General radiologists reading HRCT scans had an overall detection rate of otosclerosis of 36.1% in this cohort (13 of 36 available HRCT reports). The neuroradiologist had a much higher detection rate of 82.5% (33 of 40 cases). Interobserver agreement between the general radiologists and the subspecialist neuroradiologist was poor (Cohen's kappa κ = 0.26). General radiologists missed the diagnosis in 15 of the 33 CT-positive scans, corresponding to a missed diagnosis rate of 45.4%. There was a highly significant association between a missed diagnosis and the lack of an explicitly mentioned clinical suspicion of otosclerosis in the request forms (Pearson's chi-squared test, p &lt; 0.005). The diagnosis of otosclerosis is frequently missed by radiologists on HRCT scans of the temporal bone in a clinical setting. Possible reasons include a relative lack of experience of general radiologists with temporal bone imaging as well as the failure of clinicians to unambiguously communicate their suspicion of otosclerosis.