Knowledge on Irradiation, Medical Imaging Prescriptions, and Clinical Imaging Referral Guidelines among Physicians in a Sub-Saharan African Country (Cameroon)

Abstract

Background Clinical imaging guidelines (CIGs) are suitable tools to enhance justification of imaging procedures. Objective To assess physicians' knowledge on irradiation, their self-perception of imaging prescriptions, and the use of CIGs. Materials and Methods A questionnaire of 21 items was self-administered between July and August 2016 to 155 referring physicians working in seven university-affiliated hospitals in Yaoundé and Douala (Cameroon). This pretested questionnaire based on imaging referral practices, the use and the need of CIGs, knowledge on radiation doses of 11 specific radiologic procedures, and knowledge of injurious effects of radiation was completed in the presence of the investigator. Scores were allocated for each question. Results 155 questionnaires were completed out of 180 administered (86.1%). Participants were 90 (58%) females, 63 (40.64%) specialists, 53 (34.20%) residents/interns, and 39 (25.16%) general practitioners. The average professional experience was 7.4 years (1–25 years). The mean knowledge score was 11.5/59 with no influence of sex, years of experience, and professional category. CIGs users' score was better than nonusers (means 14.2 versus 10.6; p < 0.01). 80% of physicians (124/155) underrated radiation doses of routine imaging exams. Seventy-eight (50.3%) participants have knowledge on CIGs and half of them made use of them. “Impact on diagnosis” was the highest justification criteria follow by “impact on treatment decision.” Unjustified requests were mainly for “patient expectation or will” or for “research motivations.” 96% of interviewees believed that making available national CIGs will improve justification. Conclusion Most physicians did not have appropriate awareness about radiation doses for routine imaging procedures. A small number of physicians have knowledge on CIGs but they believe that making available CIGs will improve justification of imaging procedures. Continuous trainings on radiation protection and implementation of national CIGs are therefore recommended.

What is the impact of clinical guidelines on imaging costs?

“…[ 2 ] Prior to recognizing solutions for managing applications of diagnostic imaging, it is essential to determine what reasons drive the inappropriate use of such technologies and further impose unnecessary costs so as to propose proper solutions by investigating fundamental causes. [ 25 ] In a study investigating the utilization of imaging services accompanied by magnetic resonance in patients covered by medical insurance at Esfahan, Iran, it is stated that application of magnetic resonance imaging (MRI) services is following an increasing trend which itself is due to the increase in new MRI centers and contracts with physicians for referring patients at Esfahan. On the other hand, certain professional groups prescribe these services more than others which is a result of Esfahan's special epidemiological status.…”

“…Physician referrals also play a key role in how diagnostic services are used, and many factors influence physicians “behavior in prescribing tests, including professional uncertainty, stress caused by uncertainty and time constraints, and physicians” self-references. [ 25 ] This means that the ownership of advanced imaging equipment by physicians creates economic incentives to increase the use of imaging. In addition, radiologists can be one of the main reasons for the increase in inappropriate use of imaging because unnecessary extra imaging is recommended by doctors.…”

Exposure Levels of Adult Patients during Radiographic Examinations: Sinuses and Coastal Grill Cases at the Ngaoundere Regional Hospital, Cameroon

“…Therefore, some clinicians would ignore the importance of these parameters for imaging, coupled with the fact that some patients in our environment are not always able to accurately age [12]. Much more according to [13], the level of awareness of clinicians in Cameroon is very low and superficial, which affects the quality of their imaging demands. Despite the compliance of certain test reports, it should be noted that contact with the patient during imaging examinations should allow us to complete the missing parameters.…”

Connaissances en radioprotection des travailleurs exposés aux rayonnements ionisants en milieu médical en Afrique francophone sub-saharienne

“…Le faible niveau de connaissance globale de la radioprotection des travailleurs exposés avait déjà été observé de façon isolée dans les différents pays membres de la SRANF notamment au Cameroun (Moifo et al, 2017), au Burkina Faso (Nikiema et al, 2017), et en Centrafrique (Kouandongui Bangué Songrou et al, 2019). Cette mauvaise connaissance globale de la radioprotection par les travailleurs exposés n'était pas spécifique aux pays francophones sub-sahariens.…”