Evaluation of the use of the X-ray department with regard to plain chest radiography on acute general medical admissions in the context of recently introduced UK guidelines.

ABSTRACT

All requests for radiographs in the United Kingdom should comply with Royal College of Radiologists (RCR) guidelines, which aim to encourage more appropriate use of diagnostic radiology and so reduce the number of clinically unhelpful radiographic examinations. The aim of this study was to evaluate the use of the X-ray department during the normal working day and out of hours with regard to plain chest radiography on acute general medical admissions. A prospective study was performed using a questionnaire filled in by the requesting clinician, radiographer, and ward staff. Of 265 forms were used in a 1-month period, 221 were completed satisfactorily, and the data from these were used in the study. The median time taken for the chest X-ray to be performed was 80 min; once performed it took a median of 9 min to be returned to the ward. The requesting clinician took a median of 25 min to review the chest X-ray. However, the most striking statistic is that only 22% of the chest X-ray taken were reviewed by the junior doctors; the other 78% were looked at for the first time on the "post-take" ward rounds. The questionnaire form allowed requests to be graded as urgent, "soon," and nonurgent. There was very little difference in how long it took X-rays in these categories to be performed. This study shows that requests for the chest X-rays on acute medical admissions are more or less routine. Even though many are requested and performed as urgent examinations, 78% of all chest X-rays on these patients are not reviewed until the following morning. While many of these examinations may be deemed necessary, it is unlikely that all will comply with the RCR guidelines.