Appropriate imaging ensures not only mandatory justification of the request for radiation safety [1] but utilisation of the most effective investigation to answer the clinical question, and in so doing avoids wasteful and unhelpful imaging investigations. The UK has a chronic shortage of Radiologists providing a growing need for effective imaging [2]. Audit of the justification, authorisation and appropriateness of higher value CT and MRI exams in line with the Royal College of Radiologists (RCR) iRefer imaging referral guidelines demonstrates efficient use of imaging, good...

The UK Ionising Radiation (Medical Exposure) Regulations 2017 based on the Council Directive, Euratom 2013/59 states that imaging must only be carried out if ‘it has been justified by the practitioner as showing a sufficient net benefit’ [1,4]. Vetting or justification of scans comprises 5-10% of a Radiologists’ time [3]. This is particularly important with current radiology workforce shortage issues and an increasing demand for CT and MRI imaging [2]. Standards used in the 2014 UK RCR National Audit [3] includes: 1. 95% of exams...

In January 2020, 8,392 CT and MRI scans were requested, of which 7796 were performed and 595 (7%) rejected. Of the rejected requests, 28% were not justified, 27% had advice for clinic referral instead of imaging, 16% were duplicate requests, 14% required more clinical information, and 15% did not state a reason, see table 1 and figure 1.[Fig 1] In terms of the breakdown of returns per requestor, inpatient requests comprised the highest number of returns (35%), followed by outpatients (31%), General Practitioner (23%) and...

The RCR standards have been exceeded for evidence of justification (100%) and appropriateness in line with retrospective justification (98%), both values exceed the 2014 RCR National Audit figures of 95-96% and 93-95% respectively [3]. Improvement in evidence of justification is largely due to upgrades in the Radiology Information Systems which record decisions verbatim. In the 2014 national audit on appropriate imaging, there was a 9-12% return rate for inappropriate requests [3]. This study demonstrates a lower return rate (7%) for inappropriate requests. This one third...

1. UK Department of Health. Ionising Radiation (Medical Exposure) Regulations. Her Majesty’s Stationery Office, London. 2017. http://www.legislation.gov.uk/uksi/2017/1322/pdfs/uksi_20171322_en.pdf(Accessed 1.2.21) 2.Workforce Review: Radiology. Aligning demand and capacity in a changing healthcare environment. GE Healthcare Partners. July 2018.https://emea.gehealthcarepartners.com/images/pdfs/Rapid-Review--Radiology-Workforce-Review-FINAL.pdf(Accessed 1.2.21) 3.Remedios D, Drinkwater K, Warwick R. On behalf of the Clinical Radiology Audit Committee (CRAC), The Royal College of Radiologists, London. National Audit of appropriate Imaging, 2014; 69: 1039 - 1044. https://www.rcr.ac.uk/sites/default/files/docs/radiology/pdf/appropriate_imaging_audit.pdf(Accessed 1.2.21) 4. Council Directive 2013/59/Euratom (2013)https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2014:013:0001:0073:EN:PDF(Accessed 1.2.21) 5. Department of Radiology, Northwick Park Hospital, London North West...

S. Siddiqi: Nothing to disclose Z. Ahmed: Nothing to disclose D. J. D'Almada Remedios: Nothing to disclose