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

ABSTRACT

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.