Diagnostic radiography requests in Zimbabwe’s public hospital complex: completeness, accuracy and justtification

Abstract

Complete, accurate and justified radiological examination requests are prerequisite to radiological exposures. However, global research shows evidence of high numbers of incomplete and inaccurate requests as well as that up to 77% radiological exposures are unjustified. Plain lumbar spine and plain skull radiology examinations are reported as being procedures that generate high dose and a low diagnostic yield. This study was designed to objectively measure the completeness, accuracy and justification of these two examinations in an effort to make inferences that will contribute to an improved radiology service. This research could therefore have positive effects on optimisation of radiation protection in Zimbabwe. Methodology A non participatory prospective descriptive analytical document review of quota sampled radiological request forms for 200 plain skull and 200 plain lumbar spine examinations was employed. Data was captured using structured data collection instruments designed and tested by the researcher for this study. The instrument was designed using the IAEA-HHS4 (2010) minimum prescribed request data as a framework and adding additional form fields found to be relevant through a review of all identified radiological request template forms in use at the research site. Data analysis involved central tendency measures and inferential statistics. Results: The central tendency demonstrated for the two examinations was that generally referrers for plain lumbar spine and for plain skull radiology would respectively provide 38.9 +/- 0.6% and 40.2+/-0.5% overall examination request information. This information was significantly below expectation. There was however no significant difference between the samples’ means for the two examinations. The tendency demonstrated in patient information for lumbar spine and skull requests was that generally referrers would respectively provide 48.4 +/- 0.8% and 49.5+/- 0.8% patient information. These values were inclusive of each other and they were significantly (p=0.00 Sig.) below expectation. There was however no significant difference between the two examinations’ data. The tendency demonstrated for examination information was that referrers for the research site would generally provide 29.8+/-0.8% (lumbar) and 32.6+/-0.8% (Skull) examination information. These values were significantly (p=0.000 Sig.) below expectation and demonstrated a significant difference between the sample means for the two examinations. With respect to referrer information, the tendency demonstrated was that generally referrers for plain lumbar spine and for plain skull examinations would respectively provide 38+/- 1% and 38.5 +/- 0.8% referrer identification information. These were significantly below expectation (p= 0.000 Sig.) but there was no significant difference between the samples’ means with respect to referrer information. With respect to accuracy of request data, it was observed that 5% plain lumbar spine and 3% plain skull requests were specific in so far as information documented on request forms could unambiguously identify the area to be imaged. It was also observed that 22.5% (lumbar spine) and 12% (skull) examination requests were indicated and therefore justified. All requests forms were found to be legible. Conclusions: Generally, referrers to this research site tend to provide incomplete, inaccurate and unjustified radiological request data. The observed levels of completeness, accuracy and justification of requests were generally consistent between the two examinations relative to expectation. These levels had medico-legal implications and negative effects on optimisation of radiation protection to patients. Further research to establish causes of this variance in referral behaviour is recommended. The researcher also recommends further research to establish whether there is an association between requested examination and completeness, accuracy and justification of diagnostic radiology examination requests. Keywords: Radiation protection, radiological request, complete request, accurate request, justified request, plain skull imaging, plain lumbar spine imaging.