Learning objectives
To compare clinical diagnosis on admission and Computed Tomography (CT) findings with clinical impression on CT requests cards.
To compare CT findings with definitive operative findings.
To evaluate the grade and specialty of requesting clinicians.
Background
Reliance on cross sectional image is increasing – particularly for investigation of surgical / urology patients.
Computed Tomography (CT) delivers a significant dose of ionising radiation
There is a need to select patients based on the clinical question asked and history given from clinicians
IRMER1,2 guidelines exist to justify exposure to diagnostic ionising radiation (xray,
CT) to patients.
This works on principals of justification and optimisation of ionising radiation investigations
A retrospective review of 73 acute CT abdomen/pelvis scan requests and reports (from a total...
Findings and procedure details
Inadequate clinical information was noted in 1/3 of acute CT abdominal requests.
Examples are shown in figure 2.
Clinical impression in the notes correlated with request information in 63%,
however,
¼ requests were essentially ‘excludograms’.
Suspected clinical diagnosis on request cards did not correlate with CT findings in >50%.
There was an appropriate level of referrer in the majority of case
>60% (45 cases) – the decision to order the CT was made by a surgical consultant or specialist registrar(figure 3)
In those undergoing surgery...
Conclusion
Clinical information is adequate in 2/3 of cases
History does not correlate to CT findings in >50%
Appropriate level of requesters (Consultant & SpR Surgery)
Fair correlation of CT findings with surgery
Operation notes not always present in electronic or paper form.
It is recommended that more clinical information is required from referrers,
including relevant previous history with a suspected clinical diagnosis.
Requestswith “abdominal pain? cause” should be rejected.
Acute CT will remain important in acute decision making,
rather than relying on clinical judgement.
The...
Personal information
Dr Nikhil Rao,
Radiology Registrar,
West Midlands Deanery,
Birmingham UK
email:
[email protected]
Dr Praveen Varra,
Radiology Registrar,
West Midlands Deanery,
Birmingham UK
Dr Ian Barros D'Sa,
Consultant Radiologist,
Sandwell & West BirminghamHospitals NHS Trust,
UK
References
1.
Department of Health.
The Ionising Radiation (Medical Exposure) Regulations 2000 IR(ME)R together with notes on good practice.
London: TSO 2000 http://www.opsi.gov.uk/si/si2000/20001059.htm
2.
(Department of Health.
The Ionising Radiation (Medical Exposure) (Amendment)Regulations2006http://www.opsi.gov.uk/si/si2006/20062523.htm