European Radiology

, Volume 20, Issue 5, pp 1227–1233 | Cite as

Radiologists’ responses to inadequate referrals

  • Kristin Bakke Lysdahl
  • Bjørn Morten Hofmann
  • Ansgar Espeland



To investigate radiologists’ responses to inadequate imaging referrals.


A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested.


Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer’s judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure.


In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging.


Referral and consultation Decision making Physician’s role Diagnostic imaging Questionnaires 



We wish to thank the respondents for their participation. This work was supported by grants from Oslo University College.


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Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Kristin Bakke Lysdahl
    • 1
    • 2
  • Bjørn Morten Hofmann
    • 2
    • 3
  • Ansgar Espeland
    • 4
    • 5
  1. 1.Faculty of Health SciencesOslo University CollegeOsloNorway
  2. 2.Section for Medical Ethics, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Faculty of Health Care and NursingGjøvik University CollegeGjøvikNorway
  4. 4.Department of RadiologyHaukeland University HospitalBergenNorway
  5. 5.Section for Radiology, Department of Surgical SciencesUniversity of BergenBergenNorway

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