Background Clinical imaging guidelines (CIGs) have been demonstrated to reduce inappropriate diagnostic imaging. There is insufficient evidence for CIG effectiveness to reduce inappropriate imaging in Africa. We assessed the effectiveness of CIGs training and implementation to reduce inappropriate diagnostic imaging at Mengo Hospital, Uganda. Methods A clinical audit of head CT examinations was conducted at Mengo Hospital. A baseline review of 262 requisitions was done to determine the level of appropriateness for imaging requisitions. We also determined the baseline knowledge level on radiation protection (RP) and CIG use among 15 referrers. We trained these referrers on RP, awareness and use of CIGs and uploaded the iGUIDE onto their smart phones and computer work stations for use. This was followed by a post-intervention assessment where we reviewed 154 requisitions to determine the level of appropriateness. We also assessed the post-intervention knowledge level on radiation protection (RP) and CIG use among the referring clinicians. Results We found 53% and 47% levels of inappropriate head CT requisitions for pre- and post-intervention, respectively. At pre-intervention, we found a 73% level of knowledge on radiation protection and CIGs use while we found a 93% at post-intervention assessment among referrers. Conclusions Implementation and training referring clinicians on CIGs are effective in reducing inappropriateness of head CT requisitions.

Background The advances in diagnostic technology such as the Helical Multi-Detector Computed Tomography (MDCT) have improved the outcome of several diseases, especially in emergencies and children. However, the upsurge in utilization is associated with global unjustified CT procedures, 10-30% of which are performed among children. MDCT imparts relatively high radiation doses with increased risk of radiation induced cancers and wastage of imaging resources. This is a radiation and public health concern in low resource setting especially sub-Saharan Africa, which has a youthful population. Quality improvement in medical imaging requires measuring compliance of imaging-referrers’ ordering practice behavior against an evidence-based tool such as clinical imaging guidelines. To the best of our knowledge, there is paucity of such studies in the sub-Saharan Africa. This study therefore aimed at determining the frequency and proportion of inappropriate requisitions for commonly performed CT examinations among children and young adults. Methods This was a retrospective review for CT requisition forms (CTRFs) for patients aged 35 years and below from 6 hospital-based CT units performed from 1st July 2018 to 31st December 2018. The level of appropriateness for each request was determined using the online Appropriate Use Criteria (AUC)” ESR iGuide Results A total of 931 CTRFs were assessed, 80% of which were head CT scans. Overall, 34.5% CTRFS were inappropriate. Inappropriate Ct requisition was significant associated with the category of hospital, age, non-trauma indication, the anatomical scan region, and the non- use of contrast media agent. A total of 40(4.3%) CTRFs were not categorized because of insufficient clinical information Conclusions The findings show significant levels of performed CT procedures, especially for head region, non-traumatic and non-contrasted among adult patients could be avoided or replaced by procedures that use less or non-ionizing radiation. What is now needed is a pilot study (ies) to investigate causes of inappropriate use of diagnostic imaging and evaluate the effects of some strategies such as education, training and the use of CIGs on such clinical practices in low resource setting