Analysis of radiological examination request forms in conjunction with justification of X-ray exposures

Abstract

Objectives: To evaluate the adequacy of patient data and clinical information transmitted to the radiological departments by the referring clinicians in view of the justification demands concerning the radiological examinations, as those are described in the Radiation Protection Regulations of the European Union Nations. Materials and methods: Request forms for 1708 patients referred to radiology department and 410 referred to the CT department were evaluated concerning the proper completion of the form fields. Furthermore, for CT examinations a more detailed evaluation was carried out, to assess the rationalistic use of CT within the diagnostic algorithm. Results: Not properly completed request forms to both departments were observed, however, the omissions were more prominent for the referrals to the radiology department, where the age and the probable clinical diagnosis was not given in 81.5 and 46% of the forms, respectively. Furthermore, the emergency indication was less cautiously used compared to the CT requests. For the CT department 33.3% of requests were justified and the final diagnosis was included in the referring doctor’s probable clinical diagnosis. U/S was the examination of choice in 51% of the cases where an examination should have been performed before CT and in 70.6% of the cases where an alternative examination was proposed. Conclusions: The inadequate transmission of clinical information and the large number of not fully justified CT requests observed in this study are typical examples of the various problems that radiologists have to face in order to apply the justification directives.

Introduction

The medical acts involving ionising radiation should obey two basic principles: justification and optimisation. According to the relevant articles of the Radiation Protection Regulations of European Union Nations [1], [2], the referring doctor has the responsibility for the collection of all diagnostic information that justifies the requested radiological examinations as well as information about previous exposures. This information has to be communicated to the practitioner who after evaluating the transmitted information has the final responsibility for the justification of the requested examination and for decisions concerning the practical aspects of the patient exposure. In the hospital environment clinical radiologists will have the dominant role as practitioners.

Thus a radiologist, before accepting an examination request, should be aware of the clinical condition of the patient and the preceding examinations, in order to be able to make any decisions. This in turn presupposes that the radiological examination request forms are properly filled in and that communication between the radiologist and the clinician or other referring doctor is possible.

In this study, an attempt is made to approach this issue, by evaluating the communication problems in our hospital between the referring clinicians and the two radiology departments (a general radiology and a CT department), as it is perceived from the analysis of the radiological examination request forms. Specifically for the CT department a more detailed investigation was conducted concerning justification of requested examinations.