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. 2022 Feb 7:87:e69-e78.
doi: 10.5114/pjr.2022.113330. eCollection 2022.

Analysis of the appropriateness of orthopaedic computed tomography scans as exemplified by lower extremity bones and joints

Tomasz Latos  1 , Paweł Sztwiertnia  1 , Wojciech Wierzchołowski  2 , Jerzy Michał Walecki  1
Affiliations

Analysis of the appropriateness of orthopaedic computed tomography scans as exemplified by lower extremity bones and joints

Tomasz Latos et al. Pol J Radiol. .

Abstract

Purpose: The objective of this study is to analyse the appropriateness of lower extremity coputed tomography (CT) scans as performed in a large orthopaedic hospital.

Material and methods: A total of 1410 CT scans acquired in the years 2014-2018 were analysed for compliance with the "Guidelines for Physicians Issuing Diagnostic Imaging Referrals" (iRefer). These guidelines were published by the Royal Radiologist Society and recommended for use by the Polish Medical Society of Radiology, the National Consultant for Radiology and Diagnostic Imaging, and the Minister of Health. In addition, the study involved the analysis of information provided on CT referrals by referring clinicians.

Results: Nearly 21% of CT referrals were found to be unsubstantiated based on the diagnosis made by the referring physician, the body region of interest, and the clinical department. Most referrals identified as non-compliant with the guidelines were related to cancers followed by inflammatory conditions. The lowest number of unjustified exams was reported for endoprostheses and injury-related cases.

Conclusions: The study revealed a significant degree of non-compliance with the diagnostic algorithm as defined in the iRefer guidelines, particularly in cases of cancers and inflammatory conditions. Consequently, the patient's exposure to ionizing radiation is increased. Incorrect decisions regarding the appropriate diagnostic imaging technique are founded on the lack of appropriate cooperation between the clinician and the radiologist, insufficiency or lack of information provided on the referral, as well as the defensive attitude of referring physicians. It is therefore necessary to change appropriate in-hospital management and cooperation models.

Keywords: computed tomography; defensive medicine; iRefer; ionizing radiation; orthopaedics.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Graphical distribution of initial diagnoses as provided in computed tomography referrals
Figure 2
Figure 2
Percentage of computed tomography referrals from individual Departments
Figure 3
Figure 3
The appropriateness of computed tomography exams by initial diagnosis as provided in the referral. Columns are headed with percentages of appropriate and inappropriate exams being ordered for a particular indication
Figure 4
Figure 4
Appropriateness of computed tomography studies by the referring unit. Columns are headed with percentages of appropriate and inappropriate exams being ordered by a particular referring department
Figure 5
Figure 5
The appropriateness of computed tomography exams by the length of experience of the referring physician. Columns are headed with percentages of appropriate and inappropriate exams being ordered by physicians with particular length of experience
See this image and copyright information in PMC

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