Justification of CT examinations in young adults and children can be improved by education, guideline implementation and increased MRI capacity

Tahvonen, Pirita; Oikarinen, Heljä; Pääkkö, Eija; Karttunen, Ari; Sequeiros, Roberto Blanco; Tervonen, Osmo

doi:10.1259/bjr.20130337

Cited by 29 publications

(20 citation statements)

References 22 publications

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“…However, logistic and financial constraints may prohibit a widespread use of MRI in children in a developing country such as India. We believe that increasing MRI facility and availability of resources can definitely help further reduce the number of CT scans performed in the future [18,19].…”

Section: Discussionmentioning

confidence: 99%

Clinical application of ‘Justification’ and ‘Optimization’ principle of ALARA in pediatric CT imaging: “How many children can be protected from unnecessary radiation?”

Sodhi

Krishna

Saxena

et al. 2015

European Journal of Radiology

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Section: Discussionmentioning

confidence: 99%

Clinical application of ‘Justification’ and ‘Optimization’ principle of ALARA in pediatric CT imaging: “How many children can be protected from unnecessary radiation?”

Sodhi

Krishna

Saxena

et al. 2015

European Journal of Radiology

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“…In such situations, local protocols and consensus should be adopted and followed. 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.…”

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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“…The justification of medical imaging examinations is the first basic radioprotection principle of patients exposed to ionizing radiations [9,12,13]. Radiology request are an essential communication tools used by clinicians referring patients for radiological investigations.…”

Section: Discussionmentioning

confidence: 99%

Relevance and usefulness of head CT-scan requests in the management of adult headaches: A cross-sectional study in two referral hospitals in Cameroon

Mbede

Tegueu

Kengne

et al. 2019

Preprint

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Background: In developing sub-Saharan Africa countries such as Cameroon, the head CT-scan, which is more available and accessible than magnetic resonance imaging, gold standard, exposes to a high irradiation dose level and is still expensive. In those countries, head CT-scan has become a routine exploration in patients with headache. In front of this inflation, it is necessary to assess CT-scan requests and their profitability in the patient management. Objective: To assess the relevance and the usefulness of head computerized tomography scanner (CT-scan) requests in the management of adult headache in two referral teaching hospitals of Cameroon, in order to improve their appropriateness. Methods: This was a prospective cross-sectional study conducted in medical imaging units of the Central Hospital of Yaounde and the Laquintinie Hospital of Douala on five months period. We confronted indication mentioned on head CT-scan requests to the recommendation grades and indication’s mentions of the referral imaging guidelines of the French Society of Radiology in order to assess the relevance on the one hand. We also confronted head CT-scan results to the expectations of the requesting physicians in order to assess the usefulness on the other hand. Data analysis: Non-parametric statistical analysis. Results: During the study period, 169 examinations requests for headaches were collected. Symptom was the main clinical data mentioned on CT-scan requests (60.4%), followed by the suspected clinical diagnosis (40.2%). Requesting physicians were general practitioners (50.3%), followed by neurologists in 14.2%. Overall, 92.3% of requests were judged appropriate while 2.4% were non-indicated. The general practitioner’s requests were non-indicated in 75% of the cases. Inappropriate requests multiplied by two the risk of having no significant abnormality on the head CT-scan. Of all the head CT-scan requests, 73.2% were useful and 100% of relevant CT-scans were also useful. 45.5% of useless head CT-scans were requested by a general practitioner. Conclusion: Physicians need to follow the guidelines and justify the use of head CT-scans in patients suffering from headache in order to improve the relevance and usefulness of head CT-scans requests.

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Justification of CT examinations in young adults and children can be improved by education, guideline implementation and increased MRI capacity

Cited by 29 publications

References 22 publications

Clinical application of ‘Justification’ and ‘Optimization’ principle of ALARA in pediatric CT imaging: “How many children can be protected from unnecessary radiation?”

Clinical application of ‘Justification’ and ‘Optimization’ principle of ALARA in pediatric CT imaging: “How many children can be protected from unnecessary radiation?”

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

Relevance and usefulness of head CT-scan requests in the management of adult headaches: A cross-sectional study in two referral hospitals in Cameroon

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