Top

Insights into Imaging

Published in:

Open Access 01-12-2023 | Computed Tomography | Original Article

CT and MRI imaging in Sweden: retrospective appropriateness analysis of large referral samples

Authors: Henriettæ Ståhlbrandt, Ida Björnfot, Torsten Cederlund, Anja Almén

Published in: Insights into Imaging | Issue 1/2023

Abstract

Objectives

The numbers of computed tomography (CT) and magnetic resonance imaging (MRI) examinations per capita continue to increase in Sweden and in other parts of Europe. The appropriateness of CT and MRI examinations was audited using established European appropriateness criteria. Alternative modalities were also explored. The results were compared with those of a previous study performed in Sweden.

Methods

A semi-automatic retrospective evaluation of referrals from examinations performed in four healthcare regions using the European appropriateness criteria in ESR iGuide was undertaken. The clinical indications from a total of 13,075 referrals were assessed against these criteria. The ESR iGuide was used to identify alternative modalities resulting in a higher degree of appropriateness. A qualitative comparison with re-evaluated results from the previous study was made.

Results

The appropriateness was higher for MRI examinations than for CT examinations with procedures classed as usually appropriate for 76% and 63% of the examinations, respectively. The degree of appropriateness for CT was higher for referrals from hospitals compared to those from primary care centres. The opposite was found for MRI examinations. The alternative modalities that would result in higher appropriateness included all main imaging modalities. The result for CT did not show improvement compared with the former study.

Conclusions

A high proportion of both CT and MRI examinations were inappropriate. The study indicates that 37% of CT examinations and 24% of MRI examinations were inappropriate and that the appropriateness for CT has not improved in the last 15 years.

Critical relevance statement

A high proportion of CT and MRI examinations in this retrospective study using evidence-based referral guidelines were inappropriate.

Key points

∙ A high proportion of CT and MRI examinations were inappropriate.

∙ The CT referrals from general practitioners were less appropriate that those from hospital specialists.

∙ The MRI referrals from hospital specialists were less appropriate that those from general practitioners.

∙ Adherence to radiological appropriateness guidelines may improve the appropriateness of conducted examinations.

Graphical abstract

United Nations (2022) Sources and effects of ionizing radiation: United Nations scientific committee on the effects of atomic radiation. UNSCEAR 2002/2021 Report to the General Assembly, with Scientific Annexes Volume I Scientific Annex A Evaluation of medical exposure to ionizing radiation (United States: United Nations Publication). ISBN 978-92-1-139206-7.

Almén A, Jangland L, Radiologiska undersökningar i Sverige under 2018 (2020) Swedish Radiation (in Swedish) Safety Authority Report number 2020:14 ISSN 2000–0456 https://www.stralsakerhetsmyndigheten.se/contentassets/ae6f69b03fab4139a4a1513f047f1123/202014-radiologiska-undersokningar-i-sverige-under-2018.pdf. Accessed 25 Mar 2023.

Viry A, Bize J, Trueb PR et al (2021) Annual exposure of the Swiss population from medical imaging in 2018. Radiat Prot Dosim 195(3–4):289–295CrossRef

Bly R, Järvinen H, Kaijaluoto S, Ruonala V (2020) Contemporary collective effective dose to the population from X-ray and nuclear medicine examinations—changes over last 10 years in Finland. Radiat Protect Dosim 189(3):318–322CrossRef

National Council on Radiation Protection and Measurements (2019) Medical radiation exposure of patients in the United States, NCRP Report 184, National Council on Radiation Protection and Measurements, Bethesda, MD

Oikarinen H, Meriläinen S, Pääkkö E, Karttunen A, Nieminen MT, Tervonen O (2009) Unjustified CT examinations in young patients. Eur Radiol 19:1161–1165. https://doi.org/10.1007/s00330-008-1256-7CrossRefPubMed

Oikarinen H, Karttunen A, Pääkkö E, Tervonen O (2013) Survey of inappropriate use of magnetic resonance imaging. Insights Imaging 4(5):729–733. https://doi.org/10.1007/s13244-013-0276-219CrossRefPubMedPubMedCentral

Almén A, Leitz W, Richter S (2009) National survey on justification of CT examinations in Sweden. Swedish Radiation Safety Authority Report number: 2009:03 ISSN: 2000–0456 https://www.stralsakerhetsmyndigheten.se/contentassets/7690aba4a71d4fd098afc223783f63a6/200903-national-survey-on-justification-of-ct-examinations-in-sweden. Accessed 25 Mar 2023.

Vilar-Palop J, Hernandez-Aguado I, Pastor-Valero M et al (2018) Appropriate use of medical imaging in two Spanish public hospitals: a crosssectional analysis. BMJ Open 8:019535. https://doi.org/10.1136/bmjopen-2017-019535CrossRef

10.

Bianco A, Zucco R, Lotito F et al (2018) To what extent do hospitalised patients receive appropriate CT and MRI scans? Results of a cross-sectional study in Southern Italy. BMJ Open 8:018125. https://doi.org/10.1136/bmjopen-2017-018125CrossRef

11.

Bouëtté A, Karoussou-Schreiner A, Ducou Le Pointe H et al (2019) National audit on the appropriateness of CT and MRI examinations in Luxembourg. Insights Imaging 10(1):54. https://doi.org/10.1186/s13244-019-0731-9CrossRefPubMedPubMedCentral

12.

Ryan JW, Hollywood A, Stirling A, Glynn M, MacMahon PJ, Bolster F (2019) Evidenced-based radiology? A single-institution review of imaging referral appropriateness including monetary and dose estimates for inappropriate scans. Ir J Med Sci 188(4):1385–1389. https://doi.org/10.1007/s11845-019-02005-8CrossRefPubMed

13.

ICRP (2007) 2007 Recommendations of the international commission on radiological protection. ICRP Publication 103 (Users Edition). Ann. ICRP 37(2–4).

14.

European Society of Radiology (ESR) (2019) Methodology for ESR iGuide content. Insights Imaging 10:32. https://doi.org/10.1186/s13244-019-0720-zCrossRef

15.

Ståhlbrandt H, Björnfot I (2023) A novel method for retrospective analysis regarding appropriateness of radiological examinations. Swedish Radiation Safety Authority Report number 2023:03 ISSN: 2000-0456. https://www.stralsakerhetsmyndigheten.se/contentassets/9ec00dd4cf514f2f93748649ff846661/2023-03-a-novel-method-for-retrospective-analysis-regarding-appropriateness-of-radiological-examinations.pdf. Accessed 25 Mar 2023.

16.

Friberg GE (2017) HERCA European action week—results of a coordinated inspection initiative assessing justification in radiology. In: International conference radiation protection in medicine. Achieving change in practise. Vienna, IAEA-CN-255/106

17.

Moriarity AK, Green A, Klochko C, O’Brien M, Halabi S (2017) Evaluating the effect of unstructured clinical information on clinical decision support appropriateness ratings. J Am Coll Radiol 14:737–743. https://doi.org/10.1016/j.jacr.2017.02.003CrossRefPubMed

18.

Venturelli F, Ottone M, Pignatti F et al (2021) Using text analysis software to identify determinants of inappropriate clinical question reporting and diagnostic procedure referrals in Reggio Emilia, Italy. BMC Health Serv Res 21:103. https://doi.org/10.1186/s12913-021-06093-0CrossRefPubMedPubMedCentral

19.

Potočnik J, Thomas E, Killeen R, Foley S, Lawlor A, Stowe J (2022) Automated vetting of radiology referrals: exploring natural language processing and traditional machine learning approaches. Insights Imaging 13:127. https://doi.org/10.1186/s13244-022-01267-8CrossRefPubMedPubMedCentral

20.

Luo JW, Chong JJR (2020) Review of natural language processing in radiology. Neuroimaging Clin N Am 30(4):447–458. https://doi.org/10.1016/j.nic.2020.08.001. (PMID: 33038995)CrossRefPubMed

21.

Hugh Z, Alabousi A, Mironov O (2023) Classification of musculoskeletal radiograph requisition appropriateness using machine learning. Can Assoc Radiol J 74(1):93–99. https://doi.org/10.1177/08465371221121074CrossRefPubMed

22.

Rawle M, Pighills AJ (2018) Prevalence of unjustified emergency department X-ray examination referrals performed in a regional Queensland hospital: a pilot study. Med Radiat Sci 65:184–191. https://doi.org/10.1002/jmrs.287CrossRef

Title: CT and MRI imaging in Sweden: retrospective appropriateness analysis of large referral samples
Authors: Henriettæ Ståhlbrandt
Ida Björnfot
Torsten Cederlund
Anja Almén
Publication date: 01-12-2023
Publisher: Springer Vienna
Keywords: Computed Tomography
Computed Tomography
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01483-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

CT and MRI imaging in Sweden: retrospective appropriateness analysis of large referral samples

Abstract

Objectives

Methods

Results

Conclusions

Critical relevance statement

Key points

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Critical relevance statement

Key points

Graphical abstract

Please log in to get access to this content

Other articles of this Issue 1/2023

Generalizable transfer learning of automated tumor segmentation from cervical cancers toward a universal model for uterine malignancies in diffusion-weighted MRI

Evaluation of optimal monoenergetic images acquired by dual-energy CT in the diagnosis of T staging of thoracic esophageal cancer

Correlation analysis of MR elastography and Ki-67 expression in intrahepatic cholangiocarcinoma

European Society of Breast Imaging (EUSOBI) guidelines on the management of axillary lymphadenopathy after COVID-19 vaccination: 2023 revision

Clinical audit in European radiology: current status and recommendations for improvement endorsed by the European Society of Radiology (ESR)

Correction: Subspecialisation in radiology in Europe, a survey of the accreditation council of imaging