How many medical requests for US, body CT, and musculoskeletal MR exams in outpatients are inadequate?

PURPOSE

Our aim was to evaluate how many medical requests for US, CT and MR outpatients exams are inadequate.

MATERIALS AND METHODS

We evaluated three series of consecutive requests for outpatients exams, distinguishing firstly the adequate from the inadequate requests. The inadequate requests were classified as: (A) absence of real indication; (B) lacking or vague clinical query; (C) absence of important information on patient's status. US requests concerned 282 patients for 300 body segments, as follows: neck (n=50); upper abdomen (n=95); lower abdomen (n=12); upper and lower abdomen (n=84); musculoskeletal (n=32); other body segments (n=27). CT requests concerned 280 patients for 300 body segments, as follows: chest (n=67); abdomen (n=77); musculoskeletal (n=94); other body segments (n=62). MR musculoskeletal requests concerned 138 patients for 150 body segments, as follows: knee (n=87); ankle (n=13); shoulder (n=28) , other body segments (n=22).

RESULTS

A total of 228/300 US requests (76%) were inadequate, ranging from 66% (musculoskeletal) to 86% (neck), classified as: A, 21/228 (9%); B, 130/228 (57%); C, 77/228 (34%). A total of 231/300 (77%) body CT requests were inadequate, ranging from 72% (chest) to 86% (musculoskeletal), classified as: A, 22/231(10%); B, 88/231(38%); C, 121/231(52%). A total of 124/150 (83%) MR musculoskeletal requests were inadequate, ranging from 69% (ankle) to 89% (knee), classified as: A, 12/124(10%); B, 50/124(40%); C, 62/124 (50%). No significant difference was found among the levels of inadequacy for the three techniques and among the body segments for each of the three techniques.

CONCLUSIONS

The majority of the medical requests for outpatient exams turned out to be inadequate. A large communication gap between referring physicians and radiologists needs to be filled.