Methods and materials
33,000 ESR member radiologists from 53 countries were invited to respond to an anonymized web-based multiple-choice questionnaire.
The survey included countries member of the EU and/or the EEA (Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lichtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, United Kingdom), and non EU/EEA countries (Albania, Andorra, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Gibraltar, Israel, Kazakhstan, Kosovo, Kyrgyzstan, Moldova, Monaco, Montenegro, North Macedonia, Russian Federation, San Marino, Serbia, Turkey, Ukraine, Uzbekistan, Vatican City).
Questions concerned the availability, use, and features of imaging referral guidelines in children.
Results
Question 1) Country of practice.
2072 (6.3%) out of 33,000 contacted radiologists participated to this survey. Of these, 1598 (77.1%) practiced in EU/EEA countries, whereas 474 (22.9%) practiced in non-EU/EEA countries.
Question 2) Main practice.
1716 (82.8%) were general radiologists, 241 (11.6%) paediatric radiologists, 55 (2.8%) residents, and 60 (2.9%) others.
Question 3) "Does your country have a legal requirement for imaging referral guidelines?"
Radiologists practicing in EU/EEA countries answered "yes" in 863 cases (54%), "no" in 336 (21%), and "don't know" in 399 (25%), whereas radiologists practicing in non-EU/EEA countries answered "yes" in 207 cases (44%), "no" in 148 (31.4%), "don't know" in 119 (24.6)% (Fig.1).
Question 4) "Are some referral guidelines available in your place of work?"
Answers from EU/EEA countries were "yes" in 962 of cases (60%), "no" in 615 (38.5%), and "don't know" in 21 (1.3%) whereas answers from non-EU/EEA countries were "yes" in 242 cases (51.1%), "no" in 224 (47.3%), "don't know" in 8 (1.6%) (Fig. 2).
Question 5) "What is the source of the referral guidelines?"
In EU/EEA countries, answers provided were "European guidelines" in 348 cases (37.5%), "national guidelines" in 410 (44.2%), "local (institutional) guidelines" in 64 (6.9%), "non-European guidelines" in 13 (1.4%), "modified from another recognised source" in 16 (1.7%), "adopted without modification from another recognised source" in 7 (0.8%), "none of the above" in 37 (3.7%), "don't know" in 64 (6.9%); in 671 cases the question was skipped.
In non-EU-EEA countries, the answer was "European guidelines" in 99 cases (42.9%), "national guidelines" in 68 (29.4%), "local (institutional) guidelines" in 26 (11.3%), "non-European guidelines" in 5 (2.2%), "modified from another recognised source" in 3 (1.3%), "adopted without modification from another recognised source" in 3 (1.3%), "none of the above" in 7 (3%)%, "don't know" in 26 (11.3 %); the question was skipped in 243 cases (Fig. 3).
Question 6) "Are there dedicated referral guidelines for children and/or pregnant women and unborn children?"
Answers from EU/EEA countries was "yes for both groups" in 622 cases (38.9%), "yes only for children" in 120 (7.5%), "yes only for pregnant women" in 35 (2.2%), "not available for either of these groups" in 85 (5.3%), "don't know/no answer" in 736 (46.1%).
In non-EU/EEA countries answer was "yes for both groups" in 145 cases (30.6%), "yes only for children" in 19 (4%), "yes only for pregnant women" in 13 (2.7%), "not available for either of these groups" in 28 (5.9%), "don't know/no answer" in 269 (56.8%) (Fig. 4).
Question 7) "If available, which of the following items are included within your guidelines? (Indicate all that apply)"
Answers from EU/EEA countries were "strength of evidence" in 270 cases (44.2%), "grading of recommendation" in 304 (49.8%), "radiation dose involved" in 433 (70.9%), "cost-effectiveness" in 91 (14.9%), "availability of equipment/expertise" in 165 (27%), "none of the above" 14 (2.3%), "don't know" in 88 (14.4%); the question was skipped in 987 cases.
Answers from non-EU/EEA countries were "strength of evidence in 52 cases (35.4%), "grading of recommendation" in 62 (42.2%), "radiation dose involved" in 108 (73.5%), "cost-effectiveness" in 32 (21.8%), "availability of equipment/expertise" in 53 (36.1%), "none of the above" 3 (2%), "don't know" in 16 (10.9%); the question was skipped in 327 cases (Fig. 5).
Question 8) "To which of the following groups are the guidelines for paediatric imaging routinely circulated and used by? (Indicate all that apply)"
In EU/EEA countries, the answers were "radiologists" in 475 cases (84%), "general practitioners" in 70 (12.4%), "family paediatricians" in 72 (12.7%), "hospital paediatricians" in 214 (37.8%), "radiographers" in 250 (44.1%), "emergency department clinicians" in 135 (23.9%), and "hospital doctors" in 129 (22.8%); the question was skipped in 1032 cases. In non-EU/EEA countries, the answers were "radiologists" in 117 cases (84.7%), "general practitioners" in 29 (21%), "family paediatricians" in 22 (16%), "hospital paediatricians" in 52 (37.7%), "radiographers" in 51 (37%), "emergency department clinicians" in 40 (29%), and "hospital doctors" in 36 (26.1%); the question was skipped in 336 cases (Fig. 6).
Question 9) “If guidelines for paediatric imaging are available but not routinely used by your team, what are the reasons? (Indicate all that apply)”
In EU/EEA countries, the answers were: “not easily accessible” in 148 cases (28.9%), “outdated” in 35 (6.8%), not trusted by referrers in 67 (13.1%), “not trusted by the radiologists” in 25 (4.9%), “other” in 48 (9.4%), and “don’t know” in 253 (49.3%); the question was skipped in 1085 cases. In non-EU/EEA countries, the answers were: “not easily accessible” in 36 cases (27.7%), “outdated” in 20 (15.4%), not trusted by referrers in 13 (10%), “not trusted by the radiologists” in 13 (10%), “other” in 48 (9.4%), and “don’t know” in 58 (44.6%); the question was skipped in 344 cases (Fig. 7).
Question 10) “Are you aware that the iGuide by the European Society of Radiology includes imaging referral guidelines for the most common paediatric conditions”.
Answers from EU/EEA countries were “yes” in 580 cases (47.6%), “no” in 638 (52.4%); the question was skipped in 380 cases. Answers from non-EU/EEA countries were “yes” in 166 cases (45.7%), “no” in 197 (54.3%); the question was skipped in 111 cases.