Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Abstract

ObjectivesTo determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated.DesignCross-sectional retrospective study.SettingTwo Spanish public tertiary hospitals.Participants2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded.Primary and secondary outcome measuresFive outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category.ResultsApproximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays.ConclusionThere was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

“…For instance, communication with patients regarding associated risk is essential to get a rational use of diagnostic imaging test, but there is a lack of knowledge in the general population regarding radiation exposure and the associated risks related to these tests 29 30. In addition, recent studies showed that most clinicians were unaware of radiation exposure associated with imaging tests31–33 and that less than 50% of the imaging tests carried out in clinical practice were considered appropriate according to the available recommendations and 29.1% of the total collective effective dose was associated with inappropriate imaging tests 34…”

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“…Khan et al [10] and others [24] state that in order to select imaging tests judiciously, the clinician must understand what each test can do and be fully knowledgeable about the limitations, also with regard to the available techniques. Malone et al [6] and others [25] also refer to the use of referral guidelines or appropriateness criteria as a good practice in the process of justification. In the absence of written formal system, protocols related to the way in which diagnostic imaging investigation referrals intertwined with clinical pathways often result in what Croft et al [21] like Croskerry [26] refers to the "gradient" of decision-making that parallels the degree of uncertainty associated with the wide variety of patient conditions, as well as to the challenge of the uncertainty about the diagnosis and the inability to stage the disease and make a choice on treatment and management.…”

Time to embrace POCUS as part of the bedside diagnosis of respiratory diseases

“…However, rather than the radiation risk itself, the problem with ionizing radiation imaging techniques is their overuse. For example, in one study of 2022 ionizing imaging tests, about 55% of chest radiographs and 25% of chest CT scans were considered unnecessary, according to selected guidelines . In an era of increased imaging utilization, why not replace tests involving ionizing radiation with non‐ionizing ones of comparable accuracy?…”