Royal College Of Radiologists Research Articles

A framework for developing Generic Implant Safety Procedures (GISPs) for scanning patients with medical implants and devices in MRI.

UK guidelines for MR safety recommend that MRI departments refer to the implant manufacturer for advice regarding the MRI safety of scanning patients with an implantable medical device prior to scanning [1]. This process of assuring safety can be time consuming, leading to delays and potential cancellations of a patient's MRI. Furthermore, at times the implant cannot be identified, or the implant manufacturers cannot provide up to date MRI safety information. The purpose of generic implant safety procedures (GISPs) is to define a process for managing patients with certain types of implants where the risk from scanning is low. This process incorporates scope for an evidence-based risk-benefit decision to scan some groups of patients under locally-approved conditions, without seeking to identify the exact make and model of the implant and subsequent assurance of MR safety from the implant manufacturer. This publication provides best practice recommendations from a multi-professional working group for the development of these procedures. It is supported by The Institute of Physics and Engineering in Medicine, The Society of Radiographers, The Royal College of Radiologists, The British institute of Radiology, The British Association of MR Radiographers, The International Society of Magnetic Resonance in Medicine British and Irish Chapter and the NHS Scotland MRI Physics Group.

Use of Uterine Artery Embolization for the Treatment of Uterine Fibroids: A Comparative Review of Major National Guidelines.

Fibroids cause significant morbidity, including anemia, pelvic pain, and infertility. It is imperative that healthcare providers are well-versed on the varying treatments available for fibroids. Specifically, uterine artery embolization (UAE) is a treatment that improves anemia, pelvic pain, and quality of life. The purpose of this article is to compare international guidelines on UAE to offer best practices to healthcare providers. Guidelines from the American College of Obstetrics and Gynecology (ACOG), The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists, National College of French Gynecologists and Obstetricians (CNGOF), The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the National Institute for Health and Care Excellence (NICE) were reviewed alongside peer-reviewed PubMed articles. A comparative review of major international guidelines was conducted to encompass potential geographical, cultural, and societal variances with UAE. Review of data revealed guidelines agree with many constituents surrounding treatment of fibroids with UAE. Guidelines diverge regarding offering UAE for small fibroids, intracavitary/submucosal fibroids, and pedunculated serosal fibroids with variations on suggested imaging. Most agree that an experienced care team including a gynecologist and interventional radiologist should be included. Preoperative antibiotics and IUD removal may be recommended. UAE for patients who desire fertility remains an option after counseling within most guidelines. UAE is a safe, efficacious, and cost-effective alternative to hysterectomy and myomectomy. Including UAE as a treatment option during the patient counseling process is critical. Guidelines vary based on data interpretation and are based on clinical research and expert opinion. Due to mixed data and lack of randomized controlled trials, organizations differ when offering UAE to patients who wish to preserve fertility. It is vital to note emerging studies supporting the safety of UAE for subsequent pregnancy.

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.

EP181 - The role of abdominal X-rays in the acute abdomen: a retrospective audit

Abstract Introduction Abdominal x-rays (AXR) are commonly performed as part of the diagnostic work up for acute abdomen despite wide availability of CT. Several studies dispute the role of AXR in acute abdomen, due to low accuracy, uncertain role in diagnosis & management and superiority of CT (1). There are calls to replace AXRs with CT altogether where possible, as patients often end up having CT scans, thereby receiving larger doses of radiation (2). The Royal College of Radiologists (RCR) have produced guidelines to reduce the use of AXR in the acute setting (3). The aim of this audit was to clarify if we adhere to the RCR Guidelines at our DGH. Methods 62 consecutive adult surgical patients admitted to our surgical admissions unit as emergency, between September and November 2023 were included in this retrospective audit. Data was collected regarding patient demographics, reason for request, AXR report, whether patient underwent CT, CT report and time between AXR and CT. Results 97% of AXR requests were compliant with RCR guidelines. 30/62 patients also had a CT scan following initial AXR. Of these, 13 had normal AXR and CT. 9 had normal AXR but abnormal CT. 8 had abnormal AXR which was confirmed on subsequent CT. Discussion We identified that our surgical unit has good compliance with RCR guidelines. However, nearly half of our patients also had a CT scan, in addition to AXR. Although the AXR has lower radiation dose, it may be prudent to restrict the addition of AXR, if a CT is required to assess acute abdomen. We now aim to discuss and propose change in our practice for the future.

Awareness of radiation risks by medical students & referrers requesting radiological examinations in the North of Scotland: an audit

IntroductionRadiological imaging has played an important role in diagnostic medicine for over a century, though it is known to contribute to dermatological conditions, cataracts, and cancer. The associated risk of harm has led to the introduction of protective regulations around the world. Present-day NHS clinicians are increasingly requesting and relying on diagnostic imaging. Knowledge surrounding the radiation doses of common radiological investigations and the associated risks is imperative, and on a global level has been found to be inadequate. Consequently, there is a need for the formal inclusion of teaching within training programmes.Aims/objectivesThis prospective audit aims to establish the knowledge of radiation doses and risks of common radiological investigations of both medical students and referrers within four NHS Health Boards based in the North of Scotland. It also seeks to establish prior teaching and the preference for further educational interventions.Audit standardReferrers should have adequate knowledge of radiation doses and the risks associated with common radiological investigations.Audit targetThe standard should be achieved by 90% of referrers.MethodsA 19-question online survey was devised to include subjective and objective questions on ionising radiation awareness, education preference, and respondent demographics, based on RCR (Royal College of Radiologists) audit criteria and previous studies. Data collection was conducted between the 22/02/23 to the 22/03/2023 and the questionnaire was distributed to senior medical students and radiological referrers of different grades within NHS Grampian, NHS Highland, NHS Shetland, and NHS Orkney. A descriptive analysis of the data was undertaken using Microsoft Excel Version 16.71.ResultsTwo hundred eight questionnaires were completed. 22.11% (n = 46) of the sample population had received no prior teaching on the topic of ionising radiation. Over half of the respondents (51.92%, n = 108) rated the importance of radiation risks as either important or extremely important, with 69.71% (n = 145) of participants rating their perceived knowledge as limited or average. Most correctly identified that a CT scan (n = 203), PET-CT scan (n = 199) and a chest x-ray (n = 196) exposed patients to ionising radiation. A small proportion of the participants incorrectly thought that an MRI scan (n = 21) and an ultrasound scan (n = 2) involved ionising radiation. The results obtained failed to meet the RCR audit target, which states that 90% of doctors should be aware of common radiological doses. It was observed that only 17.79% (n = 37) of survey respondents scored over 50% in the knowledge assessment, with the median knowledge score of the whole cohort being 2.5 out of 9 (27.78%).Respondents who had prior teaching on the topic performed better those who had no prior teaching, with average scores of 3.19 (35.44%) and 2.04 (22.67%) respectively. Senior clinicians performed better when compared to junior clinicians and medical students.Conclusion & future recommendationsThis audit found that the knowledge of radiation risks within the North of Scotland in the selected sample population was insufficient across all levels of the clinical team. Further, continuous education around the topic and future audit opportunities may help to optimise knowledge and training.

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.

Cultivating Inclusivity and Bridging Gaps Through Reverse Mentoring: A Feasibility Study Within the Royal College of Radiologists

AimThe Royal College of Radiologists (RCR) recognizes the importance of addressing differential attainment, bridging existing disparities, and fostering diversity and equity. Materials and methodsA joint-faculty reverse mentoring (RM) pilot launched from July 2023 to January 2024. Participation was voluntary, mentors (trainees) from ethnic minority backgrounds and mentees (RCR officers) were recruited across the UK. Mentoring pairs engaged in regular meetings focused on sharing lived experiences and informal discussions. Data were collected through prepilot and postpilot surveys, virtual question polls at induction meeting, and written reports. Data were analyzed using descriptive statistics and thematic analysis for quantitative and qualitative data, respectively. ResultsEight matched pairs met predominantly online, on average 4 times over 6 months. Discussions covered a wide range of topics exploring systemic biases and professional development. Expectations expressed were to learn from others' experiences and achieve personal and professional growth. The prepilot survey revealed that 50% of respondents had experienced or witnessed racial discrimination, with only 28.5% feeling capable of supporting colleagues facing challenges. By mid-pilot, meaningful connections were established, allowing mentors to share experiences, and foster safe spaces. The postpilot survey results indicated that 90% of respondents felt better equipped to support colleagues facing challenges related to protected characteristics. Key lessons included understanding cultural differences, resilience, and empowering participants to drive change. ConclusionsThe exchange of perspectives and experiences between individuals from diverse backgrounds and levels of expertise enhanced mutual understanding and inclusivity. This dynamic process has the potential to catalyze positive change across diverse domains, underlining its significance in shaping a more equitable postgraduate training landscape.

E011 Magnetic resonance imaging in axial spondyloarthritis: usage, reporting times and scanning times - a service evaluation in a large tertiary centre

Abstract Background/Aims Rapid access to magnetic resonance imaging (MRI) of the spine and sacroiliac joints is essential for the timely diagnosis of axial spondyloarthritis (axSpA). A recent NASS/BRITSpA national FOI survey highlighted deteriorating waiting times to access MRI for the assessment of inflammatory back pain in the UK, with only 73% of Trusts reporting access within 8 weeks, compared to 90% in 2017. In addition, NHS England and the Royal College of Radiologists have recently published a target of 28 days for turn-around time (TAT) for a verified report to be provided after image acquisition in any circumstance. Aims: To evaluate the usage of MRI performed under the “inflammatory back pain protocol” at a large tertiary centre, including the time from MRI request to scan being performed, TAT for reporting and whether this has changed over time. Methods A service evaluation audit was conducted at Leeds Teaching Hospitals Trust (LTHT). MRIs of the spine and sacroiliac joints requested between December 2021 and May 2023 under the local “inflammatory back pain protocol” were identified by the radiology department. Data extracted from medical records included: indication for MRI request, time elapsed from request to scan, and from scan to verified report. Results A total of 668 MRI requests were identified. The commonest reason for MRI request was to aid the diagnosis of axSpA 75% (n = 501); followed by disease activity monitoring in established axSpA (16.7%, n = 111) and assessment of axial involvement in peripheral psoriatic arthritis, i.e. diagnosis of axPsA (8.5% n = 57 scans). The majority (92%) had a request to scan time of 8 weeks, with a TAT to report of 4 weeks (77%). However, a greater delay in TAT to verified report was seen from December 2022 to May 2023 with <45% of reports issued within 28 days, despite no change in scanning time. Causes identified were related to local workforce issues including delays in appointing new radiographers and radiology consultants. Conclusion The main reason for request of an MRI under the inflammatory back pain protocol at LTHT is to support making a diagnosis of axSpA. A significant number of patients were scanned for treatment monitoring and to diagnose axial psoriatic arthritis, although data on the utility of MRI for these indications are limited. Whilst nearly all patients were scanned within 2 months at all time periods, the TAT to report has significantly deteriorated since December 2022 in our region, due to workforce issues. Further understanding of the impact of workforce factors on service delivery in rheumatology is required. 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.

154 The 2023 Royal College of Radiologists (RCR) National re-audit of radical radiotherapy for Non small cell lung cancer (NSCLC) – changing Standards of Care in UK practice

154 The 2023 Royal College of Radiologists (RCR) National re-audit of radical radiotherapy for Non small cell lung cancer (NSCLC) – changing Standards of Care in UK practice

Service Improvements and Workload Increases: Royal College of Radiologists (RCR) Re-Audit of Curative Intent Radiotherapy for Non-Small Cell Lung Cancer (NSCLC)

AimsThe Royal College of Radiologists (RCR) audit of radical radiotherapy (RR) for patients with non-small cell lung cancer (NSCLC) in 2013 concluded that there was under-treatment compared to international comparators and marked variability between cancer networks. Elderly patients were less likely to receive guideline recommended treatments. Access to technological developments was low. Various national and local interventions have since taken place. This study aims to re-assess national practice. Materials and methodsRadiotherapy departments completed one questionnaire for each patient started on RR for 4 weeks in January 2023. ResultsNinety-three percent of centres returned data on 295 patients. RR has increased 70% since 2013 but patients on average wait 20% longer to start treatment (p = 0.02). Staging investigations were often outside a desirable timeframe (79% of PET/CT scans). Advanced planning techniques are used more frequently: 4-dimensional planning increased from 33% to 90% (P < 0.001), cone beam imaging from 67% to 97% (p < 0.001) and colleague led peer review increased from 41% to 73% (P < 0.001). ConclusionThere have been significant improvements in care. There has been a considerable increase in clinical oncology workload with evidence of stress on the system that requires additional resourcing.

The Adhesive Capsulitis Corticosteroid and Dilation (ACCorD) randomized controlled trial.

Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data. In the UK, the National Institute for Health and Care Excellence (NICE) advises that prompt early management of frozen shoulder is initiated in primary care settings with analgesia, physiotherapy, and joint injections; most people can be managed without an operation. Currently, there is variation in the type of joint injection: 1) CSI, thought to reduce the inflammation of the capsule reducing pain; and 2) HD, where a small volume of fluid is injected into the shoulder joint along with the steroid, aiming to stretch the capsule of the shoulder to improve pain, but also allowing greater movement. The creation of musculoskeletal hubs nationwide provides infrastructure for the early and effective management of frozen shoulder. This potentially reduces costs to individuals and the wider NHS perhaps negating the need for a secondary care referral. We will conduct a multicentre RCT comparing CSI and HD in combination with CSI alone. Patients aged 18 years and over with a clinical diagnosis of frozen shoulder will be randomized and blinded to receive either CSI and HD in combination, or CSI alone. Feasibility outcomes include the rate of randomization as a proportion of eligible patients and the ability to use routinely collected data for outcome evaluation. This study has involved patients and the public in the trial design, dissemination methods, and how to include groups who are underserved by research. We will disseminate findings among musculoskeletal clinicians via the British Orthopaedic Association, the Chartered Society of Physiotherapy, the Royal College of Radiologists, and the Royal College of General Practitioners. To ensure wide reach we will communicate findings through our established network of charities and organizations, in addition to preparing dissemination findings in Bangla and Urdu (commonly spoken languages in northeast London). If a full trial is shown to be feasible, we will seek additional National Institute for Health and Care Research funding for a definitive RCT. This definitive study will inform NICE guidelines for the management of frozen shoulder.

The Royal College of Radiologists National Vulvar Cancer Audit

AimsThis audit examined UK vulvar cancer practice from March 2018 to January 2019 and compared it to standards from national and international recommendations. Follow-up data collection in 2020 examined patient outcomes and toxicity. Materials and methodsAudit standards were based on Royal College of Radiologists (RCR) guidance and published literature. A web-based questionnaire was sent to the audit leads at all cancer centres in the UK. Prospective data collection included patient demographics, tumour characteristics, radiotherapy indications, dosimetry, timelines, and follow-up data. The audit targets were 95% compliance with the RCR dose/fractionation schemes in definitive and adjuvant patients, 40% use of intensity modulated radiotherapy (IMRT), 100% of radical patients treated as category 1, and 95% use of gap compensation for category 1 patients. Results34/54 UK radiotherapy centres (63%) completed data entry for 152 patients. 23 out of 34 (68%) centres submitted follow-up data for 94 patients. One indicator exceeded the audit target: 98% of radical patients received IMRT. The indicators of RCR dose/fractionation compliance for adjuvant/definitive radiotherapy were achieved by 80%/43% for the primary, 80%/86% for elective lymph nodes, and 21%/21% for pathological lymph nodes. The use of concomitant chemotherapy with radical radiotherapy in suitable patients was achieved by 71%. Other indicators demonstrated that 78% were treated as category 1 and 27% used gap compensation. Acute toxicity was mostly related to skin, gastrointestinal, and genitourinary sites. Grade 3 and Grade 4 toxicities were seen at acceptable rates within the radical and adjuvant groups. Late toxicity was mostly grade 0. ConclusionThis audit provides a comprehensive picture of UK practice. IMRT is widely used in the UK, and treatment-related toxicity is moderate. The dose fractionation was very heterogeneous. The designation of vulvar cancer as category 1 was not regularly followed for radical/adjuvant patients, and there was minimal gap compensation during treatment.

National Survey of Current Follow-up Protocols for Patients Treated for Endometrial Cancer in the UK

AimsThe aim of this study was to establish a baseline of national practice for follow-up after treatment for endometrial cancer in the UK. Materials and methodsAn online cross-sectional survey was developed and distributed through the Royal College of Radiologists via an email link to the audit leads of radiotherapy centres in the UK. The survey was conducted from November 2021 to 5 January 2022. The main themes assessed in the survey were the form, frequency and duration of follow-up practices. ResultsThere were a total of 43/61 (70%) complete responses. 93% of centres had a standard follow-up protocol and 7% who did not have a follow-up protocol discharged patients after the post-operative review. Five centres (13%) used molecular profiling to inform follow-up practices.Patient-initiated follow-up was mainly used in the cohort of patients who had surgery alone with no adjuvant treatment (68%, (19/28)). In the cohort who had face-to-face follow-up, the majority had pelvic examinations as part of their review and total follow-up for five years.93% of respondents are interested in a national follow-up protocol. ConclusionOur data shows that there is national variation in practise with regard to follow-up of women treated for endometrial cancer. Many of the follow-up practises are based on conventional follow-up regimens and these may fail to address the more holistic needs of cancer survivors. Recent publication of updated guidance from the British Gynaecological Cancer Society may help standardise practise and provide a more relevant approach to follow-up for women treated for endometrial cancer.

Assessing the impact of structured reporting on learning how to report lung cancer staging CT: A triple cohort study on inexperienced readers

PurposeTo assess the clinical utility of chest computed tomography (CT) reports for non-small-cell lung cancer (NSCLC) staging generated by inexperienced readers using structured reporting (SR) templates from the Royal College of Radiologists (RCR-SR) and the Italian Society of Medical and Interventional Radiology (SIRM-SR), compared to traditional non-systematic reports (NSR). MethodsIn a cohort of 30 NSCLC patients, six third-year radiology residents reported CT examinations in two 2-month-apart separate sessions using NSR in the first and NSR, RCR-SR, or SIRM-SR in the second. Couples of expert radiologists and thoracic oncologists in consensus evaluated completeness, accuracy, and clarity. All the quality indicators were expressed on a 100-point scale. The Wilcoxon signed ranks, and Wilcoxon-Mann Whitney tests were used for statistical analyses. ResultsResults showed significantly higher completeness for RCR-SR (90 %) and SIRM-SR (100 %) compared to NSR (70 %) in the second session (all p < 0.001). SIRM-SR demonstrated superior accuracy (70 % vs. 55 %, p < 0.001) over NSR, while RCR-SR and NSR accuracy did not significantly differ (60 % vs. 62.5 %, p = 0.06). In the second session, RCR-SR and SIRM-SR surpassed NSR in completeness, accuracy, and clarity (all p < 0.001, except p = 0.04 for accuracy between RCR-SR and NSR). SIRM-SR outperformed RCR-SR in completeness (100 % vs. 90 %, p < 0.001) and accuracy (70 % vs. 62.5 %, p = 0.002), with equivalent clarity (90 % for both, p = 0.27). ConclusionsInexperienced readers using RCR-SR and SIRM-SR demonstrated high-quality reporting, indicating their potential in radiology residency programs to enhance reporting skills for NSCLC staging and effective interaction with all the physicians involved in managing NSCLC patients.

Local education measures are insufficient at ensuring timely imaging in acute pancreatitis

Abstract Aims The Royal College of Radiologists (RCR) has outlined specific criteria for imaging in acute pancreatitis. The presence of pancreatic necrosis, free intraperitoneal fluid and extensive perihepatic fat stranding is associated with worse outcome. Timely computed tomography (CT) scanning 72 to 96 hours following onset of symptoms leads to more accurate diagnosis of pancreatic necrosis. Furthermore, ultrasound examination of the gallbladder is also recommended within 24 hours of admission to demarcate cause. Methods Two plan-do-study-act (PDSA) cycles were run between January to October 2022 and January to September 2023 in the surgical emergency unit. 50 patients were randomly selected amongst all pancreatitis admissions for each cycle. Outcome measures were percentage of CT scans adhering to optimal timing and percentage of ultrasound scans that were carried out within the first 24 hours. Cycle 1 findings were presented locally to staff as a teaching intervention. Results CT scans were performed in 60% and 66% of patients in cycle 1 and 2, respectively. Of these, 39% and 70% had optimal CT scan timing during cycle 1 and 2, respectively. Furthermore, only 33% of patients had US scans performed within 24 hours of admission during both cycles. Conclusion The above findings suggest that local teaching interventions are inadequate at meeting the recommended standard of 95% compliance defined by the RCR. This is likely due to rotating staff, lack of knowledge and incomplete prompting when ordering imaging. Further audit with an information technology based intervention is suggested to improve compliance.

Reducing inappropriate plain abdominal film requests from the emergency department in accordance with The Royal College of Radiologists (RCR) iRefer guidelines

Reducing inappropriate plain abdominal film requests from the emergency department in accordance with The Royal College of Radiologists (RCR) iRefer guidelines

Decreasing Lens Irradiation on Brain Imaging: A Multi-CT Scanner Quality Improvement Project.

Cataracts, a leading global cause of blindness, are associated with ionising radiation exposure. This audit aimed to enhance lens exclusion during non-contrast head computed tomography (CT) scans at Newham University Hospital (NUH) using two CT scanners. A retrospective audit of non-contrast head CT scans at NUH excluded scans for trauma and imaging of orbital structures. A one-week audit in April 2023 assessed lens exclusion, compared to the Royal College of Radiologists (RCR) standards. A total of 101 consecutive scans were analysed and 63 (62%) scans were included in the final study. Thirty-eight percent of the scans were excluded according to the exclusion criteria of head, neckand facial traumas, orbital infectionsand papilledema. Results were presented, followed by a three-month radiographer re-education period, emphasizing gantry tilt and patient positioning. A reaudit in August 2023 evaluated outcomes. For the reaudit, 183 consecutive scans were analysed, with 131 (72%) scans included in the final studyand 52 (28%) scans excluded according to the same exclusion criteria as the first audit. Lens exclusion in non-contrast head CT scans improved significantly from 0/63 (0%) compliance to 19/131 (14.50%) (p=0005) compliance with the standards. Variability in radiographer practices, 'near misses' and time constraints were identified as challenges. Staff turnover impacted compliance. This audit has shed light on a critical aspect of patient care in the field of radiology. This research underscores the importance of rigorous and standardised protocols in radiological procedures, particularly when it comes to protecting the lens of the eye. By enhancing lens exclusion during non-contrast head CT scans, we have taken a significant step in mitigating the risk associated with ionising radiation exposure. Although substantial improvements were made, achieving the RCR audit standard remained elusive. Ongoing re-education, reauditsand a multidisciplinary approach are necessary to optimise radiographer adherence and reduce ionising radiation exposure to the lens during head CT scans.This quality improvement project proves thatcontinued emphasis on gantry tilt and patient positioning in radiographer education and training can make a significant difference in patient safety.As we move forward, let us remember that even small improvements can make a big difference in safeguarding the health and well-being of patients.

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.

Radiology reporting of incidental osteoporotic vertebral fragility fractures present on CT studies: results of UK national re-audit

To describe a UK-wide re-audit of the 2019 Royal College of Radiologists (RCR) audit evaluating patient-related data and organisational infrastructure in the radiological reporting of vertebral fragility fractures (VFFs) on computed tomography (CT) studies and to assess the impact of a series of RCR interventions, initiated to raise VFF awareness, on reporting practice and outcomes. Patient specific and organisational questionnaires largely replicated those utilised in 2019. The patient questionnaire involved retrospective analysis of between 50 and 100 consecutive, non-traumatic CT studies which included the thoracolumbar spine. All RCR radiology audit leads were invited to participate. Data collection commenced from 1 April 2022. Data were supplied by 129/194 (67%) departments. One thousand five hundred and eighty-six of 7,316 patients (21.7%) had a VFF on auditor review. Overall improvements were demonstrated in key initial/provisional reporting results; comment on spine/bone (93.2%, 14.4% improvement, p<0.0002); fracture severity assessment (34.7%, 8.5% improvement, p=0.0007); use of recommended terminology (67.8%, 7.5% improvement, p=0.0034); recommendations for further management (11.7%, 9.1% improvement, p<0.0002). The 2022 national re-audit confirms improvements in diagnostic performance and practice in VFF reporting. Continuing work is required to build on this improvement and to further embed best practice.

Preventing post-contrast acute kidney injury and hypersensitivity reactions: UK national audit

To audit UK radiology departmental protocols related to the prevention of Iodine-based contrast media (ICM) adverse drug reactions (ADRs) and to assess their compliance with the Royal College of Radiologists (RCR) endorsed Royal Australian and New Zealand College of Radiologists' 2018 Iodinated Contrast Guidelines. Questionnaires were sent to all UK acute National Health Service (NHS) providers treating adult patients with an audit lead registered with the RCR (162 providers encompassing 211 hospital radiology departments). The questionnaire included three main sections: renal function screening, renal protection regimens, and hypersensitivity reactions prevention and follow-up. Data collection was conducted between April and July 2022. Sixty-one per cent (129/211) of departments responded, representing 67% of eligible providers. An independent imaging services provider supplied one additional set of data (n=130 overall). Of the responding departments, for post-contrast acute kidney injury (PC-AKI), 41% and 56% had the recommended risk assessment for inpatients and outpatients, respectively. Renal function testing was often over-utilised, and their results were applied improperly. Sixty-eight per cent of departments used the advised threshold for considering renal protection. For hypersensitivity reactions, 9% of departments had the correct risk assessment. Thirty-six per cent of departments had the correct risk mitigation protocol for identified high-risk patients. The documentation and follow-up for hypersensitivity reactions were similarly inadequate. Local protocols on preventing ICM ADRs were largely non-compliant with RCR guidelines. Departments need to update their protocols in line with current evidence to avoid iatrogenic morbidity or unnecessary tests and over-precaution.