National audit of appropriate imaging

Area of Science:

• Radiology and Medical Imaging
• Healthcare Quality Improvement
• Clinical Audit

Background:

• Effective utilization of diagnostic imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), is crucial for patient management.
• General practitioner (GP) referrals are a significant driver of CT and MRI investigations, necessitating adherence to established referral guidelines.
• Auditing referral processes ensures that imaging investigations are appropriate and contribute effectively to clinical decision-making.

Purpose of the Study:

• To audit the availability and awareness of imaging referral guidelines among UK radiology departments.
• To assess the rate of vetting for GP-initiated CT and MRI requests by radiologists.
• To determine the appropriateness of CT and MRI investigations using retrospective assessment against guidelines.

Main Methods:

• A web-based questionnaire was distributed to UK imaging departments.
• Data collected included awareness of guideline availability, vetting rates of GP-requested CT and MRI, and retrospective appropriateness assessment.
• The study involved 88 departments and 1700 consultant radiologists.

Main Results:

• Guideline availability awareness was suboptimal, with only 68% of departments confirming availability to all staff, below the 100% standard.
• Vetting of GP-requested CT and MRI investigations was high, meeting targets at 96% and 95% respectively.
• Appropriateness of CT (93%) and MRI (95%) investigations met or exceeded targets, with 'inability to affect patient management' being the most common reason for inappropriateness.

Conclusions:

• Despite limited awareness of referral guidelines, robust vetting processes for GP-requested CT and MRI lead to high rates of appropriate imaging.
• The study highlights the effectiveness of request vetting in optimizing the use of clinical radiology services.
• Further efforts are needed to improve awareness and adherence to imaging referral guidelines across all departments.