Unnecessary computed tomography and magnetic resonance imaging rates in a tertiary care hospital

Objective. The actual rate of unnecessary imaging is unknown in our country. In this study we aimed to detect unnecessary computed tomography (CT) and magnetic resonance imaging (MRI) rates and the radiological quality of these examinations in our hospital. Methods. CT/MRI request documents of 1,713 patients who had multidetector CT or MRI examination in a 2-month period at a single tertiary care hospital were obtained. We evaluated that whether the disorder that mentioned in request document was present or not in multidetector CT or MR images from the picture and archiving communicating system of our hospital. Scoring was done as follows; score 0 (there is no pathologic finding), score 1 (suspicious findings), and score 2 (presence of mentioned pathology). The radiological quality of the examinations was scored as follows; grade 0 (poor quality), grade 1 (moderate quality), and grade 2 (good quality). Results. There was not any pathologic finding in 35% of the patients included in the study (score 0, unnecessary imaging). There was/were finding(s) regarding to the disorder that mentioned in the request document in 43% of the patients (score 2). Suspicious findings were existed in the remaining patients (score 1). In the assessment of radiologic quality of the examinations that included in the study; 94% of the radiologic examinations had good quality and the remaining had moderate (0.2%) and poor (5.5%) quality. Conclusions. Unnecessary CT or MRI rate was detected as 35% in our hospital. Unnecessary imaging causes increased nephrogenic systemic fibrosis, contrast-induced nephropathy and/or radiation risks, and total cost. It may also cause reduced patient compliance and prolongation of therapy period.

Keywords:

Ionizing radiation, medical education, radiological examinations, health policy, imaging utilization, repeat imaging CT, MRI, health care,

PDF

___

[1] Gimbel RW, Fontelo P, Stephens MB, Olsen CH, Bunt C, Ledford CJ, et al. Radiation exposure and cost influence physician medical image decision making: a randomized controlled trial. Med Care 2013;51:628-32.
[2] Tosun O, Algin O, Yalcin N, Cay N, Ocakoglu G, Karaoglanoglu M. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skeletal Radiology 2012;41:575-87.
[3] Algin O, Ozmen E, Arslan H. Radiologic manifestations of colloid cysts: a pictorial essay. Can Assoc Radiol J 2013;64:56-60.
[4] Algin O, Evrimler S, Ozmen E, Metin M, Ersoy O, Karaoglanoglu M. Desmoid tumor associated with familial adenomatous polyposis: evaluation with 64-detector CT enterography. Iran J Radiol 2012;9:32-6.
[5] Kartal MG, Algin O. Evaluation of hydrocephalus and other cerebrospinal fluid disorders with MRI: an update. Insight imaging 2014;5:531-41.
[6] Algin O, Evrimler S, Ozmen E, Metin MR, Ersoy O, Karaoglanoglu M. A novel biphasic oral contrast solution for enterographic studies. J Comput Assist Tomogr 2013;37:65-74.
[7] Saadat S, Ghodsi SM, Firouznia K, Etminan M, Goudarzi K, Naieni KH. Overuse or underuse of MRI scanners in private radiology centers in Tehran. Int J Technol Assess Health Care 2008;24:277-81.
[8] The Ministry of Health of Turkey, Health statistics yearbook. 2013 http://sbu.saglik.gov.tr/Ekutuphane/kitaplar/health_statistics_yearbook_2013.pdf
[9] Crownover BK, Bepko JL. Appropriate and safe use of diagnostic imaging. Am Fam Physician 2013;87:494-501.
[10] The Ministry of Health of Turkey, Health statistics yearbook. 2013 http://ekutuphane.sagem.gov.tr/kitaplar/health_statistics_yearbook_2014.pdf
[11] Atac GK, Parmaksiz A, Inal T, Bulur E, Bulgurlu F, Oncu T, et al. Patient doses from CT examinations in Turkey. Diagn Interv Radiol 2015;21:428-34.
[12] Technical Report, Radiation sources in Turkey (Turkiye’de Radyasyon Kaynaklari) 2012 Available at: http://www.taek.gov.tr/belgeler-formlar/func-startdown/886/.
[13] Chen RC, Chu D, Lin HC, Chen T, Hung ST, Kuo NW. Association of hospital characteristics and diagnosis with the repeat use of CT and MRI: a nationwide population-based study in an Asian country. AJR Am J Roentgenol 2012;198:858-65.
[14] Ip IK, Mortele KJ, Prevedello LM, Khorasani R. Repeat abdominal imaging examinations in a tertiary care hospital. Am J Med 2012;125:155-61.
[15] Berrington de Gonzalez A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009;169:2071-7.
[16] Sulagaesuan C, Saksobhavivat N, Asavaphatiboon S, Kaewlai R. Reducing emergency CT radiation doses with simple techniques: a quality initiative project. J Med Imaging Radiat Oncol 2016;60:23-34.
[17] IAEA. Radiation protection of patients (RPOP). Referring medical practitioners. https://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/HealthProfessionals/6_OtherClinicalSpecialities/referring-medical-practitioners/index.htm
[18] Arslanoglu A, Bilgin S, Kubal Z, Ceyhan MN, Ilhan MN, Maral I. Doctors' and intern doctors' knowledge about patients' ionizing radiation exposure doses during common radiological examinations. Diagn Interv Radiol 2007;13:53-5.
[19] Bailey ED, Anderson V. Syllabus on radiography radiation protection. 6th revision, Sacramento, CA. https://www.cdph.ca.gov/pubsforms/Guidelines/Documents/RHB-RadiographySyllabus.pdf
[20] RSNA Syllabus for Biological Effects and Radiation Safety Associated with Imaging Modalities Updated 2011-12. https://rsna.org/RadioBiology_Syllabus.aspx
[21] Geenen RW, Kingma HJ, van der Molen AJ. Contrast-induced nephropathy: pharmacology, pathophysiology and prevention. Insights Imaging 2013;4:811-20.
[22] Prince MR, Zhang H, Morris M, MacGregor JL, Grossman ME, Silberzweig J, et al. Incidence of nephrogenic systemic fibrosis at two large medical centers. Radiology 2008;248:807-16.
[23] Algin O. A new contrast media for functional MR urography: Gd-MAG3. Med Hypotheses 2011;77:74-6.