Belgian multicentre study on lumbar spine imaging: Radiation dose and cost analysis; Evaluation of compliance with recommendations for efficient use of medical imaging.

PURPOSE: To assess compliance of lumbar spine imaging referrals with national imaging recommendations and to evaluate the impact of inappropriate imaging on the collective radiation dose and health insurance costs. METHOD: In 2011 and 2015, 633 lumbar spine imaging referrals were evaluated across 9 Belgian hospitals. For each patient, a new clinical anamnesis and physical examination were performed. Together with the referral, this data were confronted with the national imaging recommendations. Collective radiation dose was estimated for the radiography and CT procedures. Cost analysis was based on national reimbursement fees. Statistical analysis was performed using multilevel linear and logistic regression models. RESULTS: The fraction of unjustified imaging referrals decreased from 50 % in 2011 to 41 % in 2015 (p = 0.255). The odds of a justified examination are 3.1 times higher when the referral is done by a specialist instead of a general practitioner. The highest percentage of unjustified examinations was found for CT (85 % in 2011, 81 % in 2015; p = 0.044). Seventy-five percent of the collective dose of both the 2011 and the 2015 study population was not justified. Adherence to the recommendations could result in an estimated 16 % and 5 % cost reduction for the 2011 and 2015 study samples, respectively. CONCLUSIONS: Between 2011 and 2015, no significant improvement was found in requesting justified lumbar spine imaging procedures, although a positive trend was observed for CT. A shift from CT to MRI is necessary to improve the appropriateness of lumbar spine imaging referrals and to reduce the collective radiation dose.

The effective and collective dose to patients undergoing abdominopelvic and trunk computed tomography examinations: A Belgian multicentre study.

OBJECTIVES: This study aims to evaluate the radiation exposure to patients undergoing an abdominopelvic or a chest and abdominopelvic (trunk) CT examination and to assess compliance to imaging referral guidelines. METHODS: To this end, 357 standard abdominopelvic and trunk CT scans were collected from 8 Belgian institutions in 2011 and 2015. Effective dose (E) and collective dose were calculated using CT dose descriptors (CTDIvol and DLP), which were obtained from dose reports generated by the CT scanner. Subsequently, these CT requests were compared against the national referral guidelines to assess compliance. Population estimates for dose and compliance were obtained using multilevel linear regression and generalized estimating equation models. RESULTS: Between 2011 and 2015, a significant decrease of 28% in CTDIvol and DLP was found for abdominopelvic CT. The corresponding E decreased by 27%, and the collective dose by 23%. For trunk CT, a non-significant decrease of 6% was found in CTDIvol and a significant decrease of 14% in both DLP and E. However, the collective dose of trunk examinations increased by 39%. In 2011, 24% of the abdominopelvic examinations were not compliant with the guidelines, whereas this percentage dropped to 17% in 2015. Non-justified examinations accounted for 8% and 12% of all trunk CT scans in 2011 and 2015, respectively. CONCLUSION: Between 2011 and 2015, there was a decrease in dose for patients undergoing abdominopelvic or trunk CT in Belgium. However, a fraction of the estimated doses are linked to unnecessary CT examinations, which should be avoided.