George Hospital, George, South Africa.
S Afr Med J. 2020 Dec 14;111(1):46-51. doi: 10.7196/SAMJ.2020.v111i1.14860.
Requests for computed tomography (CT) and magnetic resonance imaging (MRI) scans by doctors with different levels of experience have cost and risk implications globally. Evidence-based appropriateness criteria guide doctors to the suitable use of radiology imaging. There are few studies regarding appropriateness of CT requests in the South African (SA) context. Previous research in the Garden Route district of Western Cape Province, SA, evaluated the appropriateness of scans.
To review the appropriateness of CT and MRI scans done in a 6-year follow-up study at one facility.
This was a retrospective descriptive study. All CT and MRI scans performed during October 2018 at George Hospital were classified according to American College of Radiology guidelines as: usually appropriate (UA), might be appropriate (MBA), or not appropriate (NA). Stratified analysis allowed simple statistics and some comparison with the previous study.
A total of 515 CT and MRI scans were included, of which 81.4% were UA, 7.4% MBA and 11.2% NA. Most scans were requested by medical officers (n=255), followed by consultants (n=126) and junior doctors (n=70). Medical officers made the majority of inappropriate requests. Second-year interns requested the lowest number of inappropriate scans, with registrars not requesting any inappropriate scans. Most of the inappropriate scans were requested after hours. Thirty-seven of the 123 (30.1%) after-hours scans were inappropriately requested compared with 21 of 392 (5.4%) scans during normal working hours, which were inappropriate.
Although the majority of scans were being ordered appropriately, pre-authorisation by experienced physicians and incorporation of guidelines would make requests more complete and possibly more appropriate, especially after hours.
不同经验水平的医生对计算机断层扫描（CT）和磁共振成像（MRI）扫描的请求在全球范围内都涉及成本和风险。基于证据的适宜性标准指导医生合理使用放射影像学检查。在南非（SA）背景下，关于 CT 请求适宜性的研究很少。此前，在西开普省花园路线地区进行的研究评估了扫描的适宜性。
在一个设施的 6 年随访研究中，回顾 CT 和 MRI 扫描的适宜性。
这是一项回顾性描述性研究。2018 年 10 月在乔治医院进行的所有 CT 和 MRI 扫描均根据美国放射学院指南进行分类：通常适宜（UA）、可能适宜（MBA）或不适宜（NA）。分层分析允许进行简单的统计和与之前研究的一些比较。
共纳入 515 例 CT 和 MRI 扫描，其中 81.4%为 UA，7.4%为 MBA，11.2%为 NA。大多数扫描是由医疗官（n=255）请求的，其次是顾问（n=126）和初级医生（n=70）。医疗官提出了大多数不适当的请求。第二年实习医生请求的不适当扫描数量最少，住院医师没有请求任何不适当的扫描。大多数不适当的扫描是在非工作时间请求的。与正常工作时间内请求的 392 次扫描中不合适的 21 次相比，123 次非工作时间扫描中不合适的有 37 次（30.1%）。
尽管大多数扫描都是适当的，但经验丰富的医生进行预授权并纳入指南将使请求更加完整，可能更合适，特别是在非工作时间。
