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Evidenced-based radiology? A single-institution review of imaging referral appropriateness including monetary and dose estimates for inappropriate scans

  • James W. RyanEmail author
  • Aoife Hollywood
  • Aaron Stirling
  • Martina Glynn
  • Peter J. MacMahon
  • Ferdia Bolster
Original Article

Abstract

Background

There has been a year on year increase in imaging requests at our academic institution. The iRefer guidelines are produced by the Royal College of Radiologists in the UK and are designed to prevent inappropriate imaging and radiation exposure. They have been available to general practitioners and hospital physicians in Ireland since March 2015.

Aims

Our aims were to determine the proportion of inappropriate imaging referrals pre- and post-guideline introduction and to calculate the cost and dose estimates for inappropriate scans.

Methods

A retrospective review of 1124 radiographs was performed with reference to a validated audit template. Emergency department, in-patient, and general practitioner referrals were reviewed. Cost and cumulative dose estimates were calculated for inappropriate referrals taking into account salaries, average time spent performing/reporting radiographs, and median effective dose values.

Results

The introduction of the iRefer guidelines has not significantly affected the proportion of inappropriate radiograph referrals at our institution, 42% pre-introduction and 43% post-introduction. We identified 784 inappropriate referrals across 6 radiograph subtypes, imparting a total median effective dose of 65.1 mSv to patients. The time spent performing inappropriate abdominal and spinal radiographs in 2017 yielded an estimated cost of €8036.40.

Conclusion

A significant amount of inappropriate radiographs continue to be requested and performed, exposing patients to needless ionizing radiation and wasting staff members time at a financial cost. Interventions are needed to decrease inappropriate referrals.

Keywords

Imaging appropriateness iRefer guidelines Patient dose Radiology services 

Abbreviations

ESR

European Society of Radiology

RCR

Royal College of Radiologists

UK

United Kingdom

HSE

Health Service Executive

GP

General practitioner

PNS

Para-nasal sinus

NB

Nasal bone

AR

Abdominal radiographs

ED

Emergency department

IP

In-patient

SR

Spinal radiograph

CDS

Clinical decision support

mSv

Millisieverts

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human or animal participants performed by any of the authors.

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Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Mater Misericordiae University HospitalDublinIreland

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