Clinically Unjustified Diagnostic Imaging – a Worrisome Tendency in Today’s Medical Practice

Sobiecka, Aleksandra; Bekiesińska‐Figatowska, Monika; Rutkowska, Magdalena; Latos, Tomasz; Walecki, Jerzy

doi:10.12659/pjr.896847

Cited by 18 publications

(9 citation statements)

References 9 publications

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“… 34 Previous studies assessing the appropriateness of imaging tests relied on expert opinion in those cases where evidence was lacking or equivocal. 35 However, we wanted to examine the frequency and characteristics of such situations in relation to the guidelines consulted. We found 158 imaging tests (7.8%) and 754.1 mSv (16.7% of the collective effective dose) not included in the guidelines, fewer than in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Vilar-Palop¹,

Hernández-Aguado

Pastor‐Valero

et al. 2018

BMJ Open

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ObjectivesTo determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated.DesignCross-sectional retrospective study.SettingTwo Spanish public tertiary hospitals.Participants2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded.Primary and secondary outcome measuresFive outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category.ResultsApproximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays.ConclusionThere was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.

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Section: Discussionmentioning

confidence: 99%

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Vilar-Palop¹,

Hernández-Aguado

Pastor‐Valero

et al. 2018

BMJ Open

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“…In 2001, Brenner et al found that lifetime cancer risk was quantitatively correlated with the number of pediatric CT scans [7]. Internationally, about a third of all magnetic resonance imaging (MRI) and CT imaging examinations are considered unwarranted [8,9]. Previous studies have shown concerning results indicating that both healthcare professionals and trainees are not sufficiently familiar with radiological dosage and relevant hazards [10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

An assessment of medical students’ proficiency regarding the hazards of radiological examinations on the health of workers and patients: a cross-sectional study from Palestine

Awadghanem

Sbaih

Hasoon

et al. 2020

J Occup Med Toxicol

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Background The use of radiological examination is increasing worldwide. Since radiation exposure can result in many health hazards, medical professionals, as well as medical students, should possess adequate knowledge regarding radiation and its related hazards to protect themselves and the patients. Many studies have assessed medical students’ knowledge on this topic, but never in Palestine. In this study, we aimed to examine Palestinian medical students’ awareness and knowledge regarding radiological examination modalities and their risks on themselves and their patients. Methods This was an observational, cross-sectional, population-based study, conducted to assess the awareness of radiation exposure and its risks among Palestinian medical students. An online questionnaire was implemented on medical students at An-Najah National University. A total knowledge score that ranged from 0 to 22 was calculated for each participant, with higher scores indicating better knowledge regarding radiation doses and the related hazards. Results Two hundred eighty and seven students participated in our study, with a response rate of 71%. The average knowledge score of the participants was 10.97 ± 4.31 out of a maximum of 22 points. Male participants and participants in advanced study years achieved better knowledge scores (p-values were 0.034 and < 0.001, respectively). Perceived radiology knowledge was significantly associated with the actual knowledge score among the participants (p-value< 0.001). Receiving radiology lectures in fourth and fifth years significantly affected the participants’ knowledge score (p-values were < 0.001). Conclusions We found a severe lack of knowledge regarding radiation doses and related risks among medical students. Therefore, we recommend that medical schools update and supplement their curriculum regarding knowledge on radiation.

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“…Malone et al and others report that 30–77% of medical imaging examinations with high‐effective dose are considered inappropriate or unnecessary . This is in spite of the introduction of referral guidelines in many countries, which aim to support evidence‐based decisions for appropriate imaging referrals .…”

Section: Introductionmentioning

confidence: 99%

“…Malone et al 1 and others report that 30-77% of medical imaging examinations with high-effective dose are considered inappropriate or unnecessary. 7,8 This is in spite of the introduction of referral guidelines in many countries, which aim to support evidence-based decisions for appropriate imaging referrals. [9][10][11] Use of such evidence-based guidelines can assist to justify examinations that involve ionising radiation and promote the efficient use of healthcare resources.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of unjustified emergency department x‐ray examination referrals performed in a regional Queensland hospital: A pilot study

Rawle

Pighills

2018

J of Medical Radiation Sci

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IntroductionThe underpinning principles of radiation protection are justification, optimisation and limitation. Each medical imaging referral that uses ionising radiation must balance the justification of exposure to radiation against the benefits of the examination. Scrutiny of justification is the role of radiographers, for general radiography, and is usually performed using the clinical details provided on the referral. International studies report up to 77% of medical imaging examinations are unjustified or inappropriate. In regional Queensland, justification seems to involve a subjective assessment and enforcement is ad hoc. This study aimed to determine the number of unjustified emergency department x‐ray examinations performed in a regional Queensland hospital.MethodsAn audit of the clinical details provided on x‐ray referrals and in the medical records was performed on x‐ray examinations undertaken within an 11‐day period. Justification was determined by compliance with the Government of Western Australia's diagnostic imaging pathways.ResultsOf the 186 referrals assessed, 75.3% were categorised as not having complied with the imaging pathway and were considered unjustified. When the clinical details in the patient's medical record were reviewed, in conjunction with the referral, the unjustified rate reduced to 49.2% of examinations.ConclusionResults demonstrate a lack of information transfer by referring clinicians and a lack of compliance with justification requirements for imaging by medical imaging staff. Improved communication regarding the need for imaging, and the refusal of referrals that are not justified, will ensure that patients are only exposed to radiation when clear benefit has been demonstrated.

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Clinically Unjustified Diagnostic Imaging – a Worrisome Tendency in Today’s Medical Practice

Cited by 18 publications

References 9 publications

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

An assessment of medical students’ proficiency regarding the hazards of radiological examinations on the health of workers and patients: a cross-sectional study from Palestine

Prevalence of unjustified emergency department x‐ray examination referrals performed in a regional Queensland hospital: A pilot study

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