Outpatient radiology imaging request quality using the reason for exam imaging reporting and data system (RI-RADS): A...

To examine the prevalence and determinants of outpatient imaging request quality using the Reason for Exam Imaging Reporting and Data System (RI-RADS).

This retrospective, multicentre, cross-sectional quality audit included 1103 consecutive outpatient requests for ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT), and conventional radiography (CR) collected between January and June 2026. All requests were graded by one radiologist, and a stratified subsample was independently reviewed by four additional readers. Interobserver agreement was assessed using Fleiss' kappa. Independent predictors of request quality were identified using multivariable ordinal regression. The proportional-odds assumption was assessed using the Brant test, and a partial proportional-odds model was fitted as a sensitivity analysis for predictors that violated this assumption.

Only 18 requests (1.6 %) achieved RI-RADS grade A, yielding an overall inadequacy rate of 98.4 %. Grade D was the most frequent category (51.9 %), and complete clinical information was documented in only 2.2 % of requests. Hospital was the strongest independent predictor of poor request quality. Orthopedics was associated with poorer request quality (OR = 3.59, p < 0.001), whereas neurosurgery and surgery were associated with better quality (p < 0.01). CT requests had higher odds of poorer quality than MRI requests (OR = 2.99, p < 0.001). Spine, neck, and lower-extremity examinations were associated with poorer request quality. In contrast, infection or inflammation and trauma were associated with better request quality (OR = 0.181 and 0.065, respectively; p < 0.001). The proportional-odds assumption was not universally satisfied (global Brant test,p = 0.008). In the partial proportional-odds analysis, H3 and H4 showed significantly higher odds of poorer RI-RADS grades across all estimable thresholds (OR ranges, 5.39-59.14 and 5.85-38.08, respectively; allp < 0.001). Overall interobserver agreement was fair (Fleiss' κ = 0.376), with substantial agreement for the diagnostic question (κ = 0.655).

Outpatient imaging request quality was critically poor across the participating hospitals. Variation among hospitals and specialities highlights the need for standardised imaging request frameworks and targeted quality improvement initiatives.