Objectives
In Luxembourg, the frequency of CT and MRI examinations per inhabitant is among the highest in Europe. A national audit was conducted to evaluate the appropriateness of CT and MRI examinations according to the national referral guidelines for medical imaging.
Methods
Three hundred and eighty-eight CT and 330 MRI requests corresponding to already performed examinations were provided by all radiology departments in Luxembourg. Four external radiologists evaluated the clinical elements for justification present in each request. They consensually assessed the appropriateness of each requested examination with regard to the national referral guidelines and their clinical experience.
Results
The appropriateness rate (AR) was higher for MRI requests than for CT requests (79% vs. 61%;
p
< 0.001). AR was higher for requests referred by medical specialists rather than by general practitioners, both for CT requests (70% vs. 37%;
p
< 0.001) and MRI requests (83% vs. 64%;
p
= 0.002). For CT, AR was higher when the requests concerned paediatric rather than adult patients (82% vs. 58%;
p
< 0.001), when the radiology departments were equipped with both CT and MRI units rather than with only CT units (65% vs. 47%,
p
= 0.004) and when the requests concerned head-neck (79%), chest (77%) and chest-abdominal-pelvic (81%) areas rather than spinal (28%), extremity (51%) and abdominal-pelvic (63%) areas (
p
< 0.001).
Conclusions
The appropriateness of CT and MRI in Luxembourg is not satisfactory and collective efforts to improve should be continued. The focus should be on general practitioners and on spinal CT examinations.
Electronic supplementary material
The online version of this article (10.1186/s13244-019-0731-9) contains supplementary material, which is available to authorized users.
This prospective study aims to determine the optimal menstrual phase and uterine location to detect the thickest junctional zone by magnetic resonance imaging (MRI). Healthy nulliparous women were subdivided according to their use of hormonal contraception. Each women was investigated three times during their menstrual cycle. Eighteen nulliparous non-users and 29 nulliparous users of hormonal contraception (mean age 26.4 and 25.8 years, respectively) underwent a pelvic MRI (1.5T) examination during the follicular, ovulatory and luteal phase. The junctional zone thickness was measured at six locations in the uterine wall. A significantly thinner junctional zone was observed at the anterior and posterior wall of the midcorpus (P = 0.01 and P = 0.004 respectively) and fundus (P = 0.009 and P = 0.023 respectively), in the contraception users compared with the non-users. No differences in junctional zone thickness were noticed between the menstrual phases and the uterine wall locations. The ratio of junctional zone versus total myometrial thickness was also different between both groups and between the assessed uterine locations. To conclude, any phase in the menstrual cycle and location within the uterine wall was validated to determine the junctional zone thickness on MRI, although the fundal location is preferred.
This study provides data on normal perfusion parameters of inner and outer myometrium, which may be potentially useful in assisted reproductive therapy.
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