Clinical assessment before PET/computed tomography: frequency and diagnostic impact

Area of Science:

• Radiology and Nuclear Medicine
• Clinical Practice Assessment

Background:

• Referring physicians often do not perform history taking or physical examinations before ordering PET/CT scans.
• The impact of omitting these clinical assessments on the quality of clinical reasoning and diagnostic yield of PET/CT is not well understood.

Purpose of the Study:

• To determine the frequency of history taking and physical examination omissions before PET/CT referrals.
• To assess whether these omissions affect clinical reasoning quality or PET/CT diagnostic yield.

Main Methods:

• A study involving 288 patients undergoing PET/CT at a tertiary academic hospital.
• Patients reported whether history taking and physical examination were performed by referring physicians.
• Multivariable regression analyzed the association between omitted assessments and clinical reasoning quality or PET/CT positivity.

Main Results:

• History taking was omitted in 18.2% of referrals, and physical examination in 47.7%.
• Omission of history taking or physical examination was not significantly associated with clinical reasoning quality or PET/CT positivity.
• Certain specialties and referral types showed significant associations with the performance of physical examinations.

Conclusions:

• A significant proportion of patients referred for PET/CT do not undergo prior history taking or physical examination.
• While omissions did not affect clinical reasoning or PET/CT yield in this study, they may reduce contextual information for image interpretation.