Analysis of the appropriateness of orthopaedic computed tomography scans as exemplified by lower extremity bones and joints

Abstract

Purpose:The objective of this study is to analyse the appropriateness of lower extremity coputed tomography (CT) scans as performed in a large orthopaedic hospital. Material and methods:A total of 1410 CT scans acquired in the years 2014-2018 were analysed for compliance with the "Guidelines for Physicians Issuing Diagnostic Imaging Referrals" (iRefer). These guidelines were published by the Royal Radiologist Society and recommended for use by the Polish Medical Society of Radiology, the National Consultant for Radiology and Diagnostic Imaging, and the Minister of Health. In addition, the study involved the analysis of information provided on CT referrals by referring clinicians.Results: Nearly 21% of CT referrals were found to be unsubstantiated based on the diagnosis made by the referring physician, the body region of interest, and the clinical department. Most referrals identified as non-compliant with the guidelines were related to cancers followed by inflammatory conditions. The lowest number of unjustified exams was reported for endoprostheses and injury-related cases. Conclusions:The study revealed a significant degree of non-compliance with the diagnostic algorithm as defined in the iRefer guidelines, particularly in cases of cancers and inflammatory conditions. Consequently, the patient's exposure to ionizing radiation is increased. Incorrect decisions regarding the appropriate diagnostic imaging technique are founded on the lack of appropriate cooperation between the clinician and the radiologist, insufficiency or lack of information provided on the referral, as well as the defensive attitude of referring physicians. It is therefore necessary to change appropriate in-hospital management and cooperation models.

An economic impact of incorrect referrals for MRI and CT scans: A retrospective analysis

“…The findings imply that about a quarter of CT scans performed on the general population was inappropriate and unnecessary 17 . Our findings are consistent with results of previous studies that demonstrated a yearly rise in the utilization of CT and MRI scans 18 …”

“…In turn, it triggers a rise in the number of unnecessary diagnostic procedures 17 . As a result, it leads to the growth of the number of medical personnel involved and associated costs 18 …”

“…17 As a result, it leads to the growth of the number of medical personnel involved and associated costs. 18 Here, we evaluated the effectiveness of imaging in Kazakhstan for the first time. According to our findings, the number of MRI and CT scans increased every year.…”

“…17 Our findings are consistent with results of previous studies that demonstrated a yearly rise in the utilization of CT and MRI scans. 18 Another factor that can contribute to the rise of non-eligible screening is the patient's request for the radio-graphic test. 19 In fact, a range of factors can impact the frequency of tests, including but not limited to, patient and physician demands, problems with correct diagnostics, financial aspects, etc.…”