Keywords:
Abdomen, Radioprotection / Radiation dose, CT, Audit and standards, Quality assurance, Patterns of Care
Authors:
P. Clarke, S. Boxall, M. Shanmuganathan; QLD/AU
DOI:
10.26044/ranzcr2019/R-0057
Conclusion
CT imaging has become a favourable investigation in an acute care setting as it reduces the reliance on a clinicians ability to make prompt and safe decisions based on clinical assessment alone. Consequently there has been a shift to a reliance on CT imaging over clinical based judgement leading to unnecessary scanning and increasing risks of radiation exposure to patients5.
Performing CT scans that report no acute pathology is unavoidable, but the high number of normal reported CT A/P scans performed at MBH ED in June 2018 is generally higher compared to similar studies found during a literature review and certainly a target to reduce in future practice. As examples, a published audit conducted out of Royal Adelaide hospital in 2014 had a normal CT rate of 23% and an audit of after-hours CT A/P conducted from a London hospital in 2017 had a normal CT rate of 38%2,1.
Interestingly nearly half of CTs requested by a specialist team after their review had no acute pathology, however the data still suggests a specialist team review prior to ED requesting CT and a push to admit patients for observation without CT would reduce the unfavourable numbers given the high admission rate of 71% post CT anyway. Also the data suggests that by reducing the number of after-hours CT scans perhaps by more prompt decisions for CT made in collaboration with the medical imaging service is needed. The interesting data set will be used by ED in collaboration with sub-specialties to develop an acute abdominal pain management guideline with the aim to reduce the high number of normal and unnecessary CT A/P scans thereby reducing radiation risks, inappropriate follow-up tests and cost to the department. A follow-up audit will need to be conducted to assess its effectiveness in practice.