Appropriate diagnostic imaging - Assessment of the quality of referrals from general practice: Rationel billeddiagnostik i almen praksis

Background and aim Diagnostic imaging is the second most used paraclinical examination in Denmark and 15% of all referrals from general practice concerns radiology. The fast development in diagnostic imaging constitutes a challenge for general practitioners’ when determining the right type of radiological examination for the right patient. Therefore, the study aimed to assess the quality and radiological relevance of referrals from general practice.

Method Over an 8-week period radiologists reviewed randomly sampled referrals from general practice to different modalities; X-ray, ultrasound, CT and MRI regarding musculoskeletal issues. The reviews were conducted according to a preformed registration schema. Themes for the survey were: Relevance of referral, relevance of chosen modality, exhaustiveness of referral information, relevance of information and eventual suggestions for a more relevant modality.

Results Four regional radiological departments participated in the study. A total of 785 referrals were reviewed. Most reviews were conducted on x-ray referrals (35%). Diagnostic imaging was considered relevant or very relevant in 73.5% of the reviewed referrals, of which referrals to CT-scanning was the most relevant (87%). Overall, referral information was relevant in 80% of the cases, and most relevant in referrals to x-ray (87%). In 9.5% of referrals the chosen modality was not the optimal, which was most pronounced for ultrasound referrals (13%). Referral information was most insufficient regarding MRI, where 56.4% of information was described as less insufficient/insufficient. It was a frequent notation, that there was too much irrelevant information, which was ascribed to copy-paste from the general practitioners’ records.

Conclusion A majority of referrals from general practice to diagnostic imaging were considered relevant from a radiologic perspective. However, there seems to be a potential for development regarding the exhaustiveness of information and modality relevance, particularly for referrals to MRI and ultrasound.