When an X-ray or a scan is requested to help diagnose a condition, the patient assumes the right kind of imaging test has been chosen. But sometimes medical professionals get it wrong.

“People are sometimes sent for inappropriate imaging,” says Dr Nicola Strickland, President of The Royal College of Radiologists (RCR) and Consultant Radiologist at Imperial College Healthcare NHS Trust in London. “We want patients to have the correct imaging to diagnose their condition, so they receive as little ionising radiation as possible and stand the greatest chance of getting an accurate diagnosis quickly.”

Requesting the wrong kind of imaging test can mean incorrect or delayed diagnoses and waste time and money unnecessarily.

“For instance, requesting a lumbar spine X-ray for a patient with lower back pain is usually pointless unless a fracture is suspected,” says Strickland. “A standard X-ray reveals nothing about soft-tissue problems.

“The majority of back pain is caused by obesity, poor posture, lack of exercise or weak abdominal muscles – all best treated by lifestyle changes. Plain X-rays of the lumbar spine usually show nothing relevant,” says Strickland. “Sometimes an MR (magnetic resonance) scan of the lumbar spine is appropriate, but doctors should understand the specific indications for this test.”

 

Increasing efficiency and lowering risk

 

Poor imaging choice can also mean unnecessary patient risk. Strickland says: “A suspected pulmonary embolism requires a CT (computed tomography) scan. This is equivalent to around 200 chest X-rays – a significant radiation burden – so must be selected only when this is the most likely diagnosis.”

Inconclusive X-rays and scans can lead to further tests, unnecessary radiation doses or other imaging tests.

Unnecessary tests also put more strain on stretched radiological resources: 9% of UK Consultant Radiologist posts are currently unfilled, and 41% of those have been vacant for over a year. In addition, radiographers (who 'take the pictures' for radiologist doctors to diagnose) are in even shorter supply: there is a 15% shortage of radiographers in the UK.

To decrease the risk of the wrong test being requested, the iRefer tool, a set of guidelines drawn up by radiologists to help doctors choose the right imaging test, is now being incorporated into electronic requesting systems in pilot sites in hospitals and GP practices. If the trial succeeds it will be adopted more widely.

Strickland says: “Using iRefer will allow doctors correctly to explain to patients the reason they have requested a particular test, improving patient understanding. It also fits in with 'Choosing Wisely', an initiative to help doctors and patients make better treatment decisions together and helping achieve maximum efficiency in UK healthcare.

“The whole of modern healthcare depends on the right imaging test done at the right time. Appropriate scanning can avoid unnecessary operations, deliver better overall patient care, avoid misusing radiological resources and save time and money.”