To what extent do hospitalised patients receive appropriate CT and MRI scans? Results of a cross-sectional study in Southern Italy

Abstract

ObjectivesThe aim of this study was to assess the frequency of appropriateness of inpatient CT and MRI scans performed in Southern Italy.MethodsThe study was carried out by retrospectively reviewing medical records of adult patients admitted between 1 January and 31 December 2012 in two hospitals. The evaluation of appropriateness was performed according to the American College of Radiology Appropriateness Criteria, which assigns a score between 1 and 9.ResultsEight hundred and fifty-three medical records were reviewed. Six hundred and thirty-nine patients received CT examinations and 256 received MRI examinations. Four hundred and ninety-six (77.6%) of the patient population had appropriate CT and 202 (78.9%) received appropriate MRI examinations. The appropriateness was associated with: a confirmation of the diagnostic hypothesis, only one examination performed during hospital stay, the anatomical scan region, with musculoskeletal system being the least appropriate anatomical scan region. Moreover, for CT examinations, appropriateness was also associated with no use of contrast agent.ConclusionsOur findings highlight the need to reduce inappropriate use of CT and MRI. The study showed that the tool used is reliable to measure the extent of appropriateness of diagnostic imaging for inpatient examinations.

National audit on the appropriateness of CT and MRI examinations in Luxembourg

“…The results according to the anatomical area in the first audit showed dramatically more inappropriate examinations for the lumbar spine area (77%) than for other anatomical areas, a great proportion of which should have been performed by an MRI instead. A recent cross-sectional study in Southern Italy [21] revealed that overall 79.4% of CT examinations (596/751) and 83.6% of MRI examinations (310/371) were appropriate, but that only 66.7% of MRI examinations (38/57) concerning spine and extremities were appropriate.…”

Appropriateness of computed tomography and magnetic resonance imaging scans in a rural regional hospital in South Africa: A 6-year follow-up study

“…This compares favourably with international studies. [6] Comparing the findings with the 2012 study results in the same facility, these indicate a favourable trend, with an increase of 17.0%. [10] In both studies, scans were ordered on a digital system, with a clinical history, level of requesting physician and existing laboratory results.…”

“…Revisiting the results of the 2012 study, [6] in 2018 consultants requested significantly more appropriate scans (p<0.05), while medical officers requested significantly more inappropriate scans (p<0.05) ( Table 1).…”

“…[5] An Italian study assessing the appropriateness of CT and MRI found that 77.6% of CT scans and 78.9% of MRI scans were appropriate. [6] Appropriateness was associated with a confirmation of the diagnostic hypothesis, only one examination performed during hospital stay, and the anatomical scan region, with the musculoskeletal system being the least appropriate. For CT scans, appropriateness was also associated with not using contrast agent.…”

“…For CT scans, appropriateness was also associated with not using contrast agent. [6] While some studies have been done in South Africa (SA), there remains a scarcity of literature specific to the appropriateness of requests for CT and MRI scans. [7] Work in Western Cape Province, SA, demonstrated the need for regular review: 22% of referrals from a community health centre to secondary hospitals, of which 70% were for radiological imaging, were found to be unnecessary.…”