R Akinola, M Akinkunmi, K Wright, O Orogbemi
adequately filled, ct scan, mri, radiology, request forms
R Akinola, M Akinkunmi, K Wright, O Orogbemi. Radiology request forms: are they adequately filled by clinicians?. The Internet Journal of Radiology. 2009 Volume 12 Number 1.
The role of the radiologist in a medical team is to help in making a diagnosis that will aid in an effective and concise management of the patient. This can only be achieved if the clinicians give a detailed clinical history through a properly filled request form. This study was conducted to assess the adequacy of filled request forms in a tertiary health institution.One hundred and forty four request forms with 145 requests for computed tomography scan (CT scan) and Magnetic Resonance Imaging (MRI) received at the diagnostic centre in a teaching hospital were studied for completeness.
Radiology request forms are essential communication tools used by doctors referring patients for radiological investigations (
The standard is that all request forms received should contain the patient’s name, age, address, telephone number, ward, clinical background, the specific question to be answered, the name and signature of referring clinician and the name of the consultant responsible for patient’s care(
Previous studies in literature have shown that up to 20% of radiographic examinations are clinically unhelpful (
The aim of this study is to audit the adequacy of completion of CT scan and MRI request forms received at the diagnostic center of this tertiary institution.
Materials and Methods
A total of 144 consecutive request forms,
A total of 138 (95.2%) CT scan and 7 (4.8%) MRI requests from 144 request forms were received,
Four (3.0%) of the cards had no information on the specific part of the body to be examined requested. For CT scan, the commonest request was for the brain, 58 (42.0%), whilst the least were one (0.7%) each of sinuses, neck and skull. One of the cards requested for a CT of both head and neck,
All cards received were incompletely filled. Almost all of them had the names of the patients filled, except two (1.4%), where the column for the “other names” was not filled. Only 130 (90.3%) of them had their ages filled, though 13 (10%) were filled as “A” (Adult) and 74 (57%) did not indicate the unit of measurement in terms of years, months or days. Out of the 6 (4.2%) addresses filled only 3 (50%) were fully filled, while 138 (95.8%) addresses were not filled at all,
The date was not filled for 2 (1.4%) patients whilst all but one (99.3%) of the sex column was filled. Eleven (7.6%) of the wards / clinic column were not filled,
Although 143 (99.3%) of clinical history were filled, only 26 (18.2%) of these were filled in details. In one particular instance, (0.7%), the clinical history was totally absent. Clinical history with referring doctor asking specific questions occurred in 59 (41.0%) cases and all these received reports that addressed the questions. In Eighty five (59.0%) of the forms, no specific questions, were asked to help the radiologist address the clinicians concern. Less than 2% of forms indicated whether the patient was ambulant or not, (
The part of the body to be examined was filled in the majority (93.1%) of cases and specific examination requested was stated in all cases, (
The referring officers’ signature was seen in 81 (56.3%) cases. The names of the consultant in charge were given in most (97.2%) of the cases, (
Interestingly, the clinical diagnosis was given only in 2 (1.4%) patients, (
In the radiographer’s column for number and sizes of the x-ray film used, only 8 (5.6%) were filled, albeit inappropriately. Furthermore, less than 1% of the radiographers signed at the designated location, (
All the forms had abbreviations especially in the field of the wards/ clinic, the age, sex and clinical diagnosis with relevant details. The request forms were devoid of telephone numbers of both the clinician and patient
The radiology request cards are usually the only means of communication between a clinician and the radiologist; since there is little opportunity to discuss clinical cases and their management by both parties. However, additional information can be obtained by the radiologist or radiographer directly from the patient or by contacting the clinician. The best possible service is provided to the patient only if a multidisciplinary approach is adopted by the various teams involved in the management (
The absence of patient’s demographic data, contact details and incorrect information may cause serious errors even in identifying the patient. This might sometimes warrant a recall of the patient. The same may also apply when the referring clinician cannot be contacted for further discussions about the patient. The Royal College of Radiologists suggests that all radiologists’ reports should address the question posed by the referring doctors
This can only be achieved by increasing the awareness of referring clinicians on the need to ask specific questions and to provide full clinical details to aid radiological diagnosis. Moreover, it tends to serve as a guide for radiologists to decide the appropriate radiological investigations and to limit patient exposure to unnecessary radiation which may be harmful (
Though the individual risks are not large, the increasing exposure to radiation in the population may be a public health issue in future
There is evidence that inadequate clinical information is associated with increased level of inaccurate report; while accurate clinical information is more likely to assist the radiologist in constructing a report which will in turn help the referring doctor with the management of the patient(
Similar to the findings by Depasquale and Crockford,
Unlike Cohen et al, (
All the forms had abbreviations especially in the fields of the wards/clinic, the age and clinical diagnosis with relevant details. Most abbreviations used were often not universally accepted ones, such as SOL(space occupying lesion), CVA (cerebrovascular accident), MVA (we do not know what this means), MCA (middle cerebral artery), CVD (chronic vascular disease), CLD (chronic liver disease), PLCC (Primary liver cell carcinoma), AVM (arteriovenous malformation), NPC (nasopharyngeal carcinoma), TIA (transient ischemic attack), CN (cranial nerve), HT (hypertension), CA (carcinoma), RIF (right iliac fossa), LOC (we do not know what this means), Outpx (outpatient), Dz (disease), A (adult), R (right), L (left), Lt (left) , RE (right eye), R/o (rule out), 20 (secondary), Paed. (pediatrics), Surg. (surgery), ? (query), # (fracture).
There is ample room for a change in the attitude of clinicians in filling a radiology request form. It is essential that a detailed clinical history is provided to enable informed judgment on patient exposure to radiation.
Since the role of a radiologist is to aid other colleagues in reaching their diagnosis and provide appropriate treatment of the various conditions in cases of interventional radiology, it is important that radiologists be furnished with adequate information when the request forms are filled.
There is need
To design and provide a request proforma with a view to obtaining good clinical information, which will include telephone numbers.
For Continuing Medical Education forum targeting all stakeholders
For a review of all radiology request forms by a radiologist to avoid unnecessary radiation