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CT and MRI imaging in Sweden: retrospective appropriateness analysis of large referral samples

Ståhlbrandt, Henriettæ ; Björnfot, Ida ; Cederlund, Torsten and Almén, Anja LU (2023) In Insights into Imaging 14. p.1-9
Abstract
Objectives
The numbers of computed tomography (CT) and magnetic resonance imaging (MRI) examinations per capita continue to increase in Sweden and in other parts of Europe. The appropriateness of CT and MRI examinations was audited using established European appropriateness criteria. Alternative modalities were also explored. The results were compared with those of a previous study performed in Sweden.

Methods
A semi-automatic retrospective evaluation of referrals from examinations performed in four healthcare regions using the European appropriateness criteria in ESR iGuide was undertaken. The clinical indications from a total of 13,075 referrals were assessed against these criteria. The ESR iGuide was used to identify... (More)
Objectives
The numbers of computed tomography (CT) and magnetic resonance imaging (MRI) examinations per capita continue to increase in Sweden and in other parts of Europe. The appropriateness of CT and MRI examinations was audited using established European appropriateness criteria. Alternative modalities were also explored. The results were compared with those of a previous study performed in Sweden.

Methods
A semi-automatic retrospective evaluation of referrals from examinations performed in four healthcare regions using the European appropriateness criteria in ESR iGuide was undertaken. The clinical indications from a total of 13,075 referrals were assessed against these criteria. The ESR iGuide was used to identify alternative modalities resulting in a higher degree of appropriateness. A qualitative comparison with re-evaluated results from the previous study was made.

Results
The appropriateness was higher for MRI examinations than for CT examinations with procedures classed as usually appropriate for 76% and 63% of the examinations, respectively. The degree of appropriateness for CT was higher for referrals from hospitals compared to those from primary care centres. The opposite was found for MRI examinations. The alternative modalities that would result in higher appropriateness included all main imaging modalities. The result for CT did not show improvement compared with the former study.

Conclusions
A high proportion of both CT and MRI examinations were inappropriate. The study indicates that 37% of CT examinations and 24% of MRI examinations were inappropriate and that the appropriateness for CT has not improved in the last 15 years.

Critical relevance statement
A high proportion of CT and MRI examinations in this retrospective study using evidence-based referral guidelines were inappropriate.

Key points
∙ A high proportion of CT and MRI examinations were inappropriate.

∙ The CT referrals from general practitioners were less appropriate that those from hospital specialists.

∙ The MRI referrals from hospital specialists were less appropriate that those from general practitioners.

∙ Adherence to radiological appropriateness guidelines may improve the appropriateness of conducted examinations. (Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Insights into Imaging
volume
14
article number
134
pages
1 - 9
publisher
Springer
external identifiers
  • pmid:37530862
  • scopus:85167415122
ISSN
1869-4101
DOI
10.1186/s13244-023-01483-w
language
English
LU publication?
yes
id
cbe16c6f-4ee3-424d-b800-08d7f30e612d
date added to LUP
2023-08-13 16:21:35
date last changed
2023-09-01 04:00:10
@article{cbe16c6f-4ee3-424d-b800-08d7f30e612d,
  abstract     = {{Objectives<br/>The numbers of computed tomography (CT) and magnetic resonance imaging (MRI) examinations per capita continue to increase in Sweden and in other parts of Europe. The appropriateness of CT and MRI examinations was audited using established European appropriateness criteria. Alternative modalities were also explored. The results were compared with those of a previous study performed in Sweden.<br/><br/>Methods<br/>A semi-automatic retrospective evaluation of referrals from examinations performed in four healthcare regions using the European appropriateness criteria in ESR iGuide was undertaken. The clinical indications from a total of 13,075 referrals were assessed against these criteria. The ESR iGuide was used to identify alternative modalities resulting in a higher degree of appropriateness. A qualitative comparison with re-evaluated results from the previous study was made.<br/><br/>Results<br/>The appropriateness was higher for MRI examinations than for CT examinations with procedures classed as usually appropriate for 76% and 63% of the examinations, respectively. The degree of appropriateness for CT was higher for referrals from hospitals compared to those from primary care centres. The opposite was found for MRI examinations. The alternative modalities that would result in higher appropriateness included all main imaging modalities. The result for CT did not show improvement compared with the former study.<br/><br/>Conclusions<br/>A high proportion of both CT and MRI examinations were inappropriate. The study indicates that 37% of CT examinations and 24% of MRI examinations were inappropriate and that the appropriateness for CT has not improved in the last 15 years.<br/><br/>Critical relevance statement<br/>A high proportion of CT and MRI examinations in this retrospective study using evidence-based referral guidelines were inappropriate.<br/><br/>Key points<br/>∙ A high proportion of CT and MRI examinations were inappropriate.<br/><br/>∙ The CT referrals from general practitioners were less appropriate that those from hospital specialists.<br/><br/>∙ The MRI referrals from hospital specialists were less appropriate that those from general practitioners.<br/><br/>∙ Adherence to radiological appropriateness guidelines may improve the appropriateness of conducted examinations.}},
  author       = {{Ståhlbrandt, Henriettæ and Björnfot, Ida and Cederlund, Torsten and Almén, Anja}},
  issn         = {{1869-4101}},
  language     = {{eng}},
  month        = {{08}},
  pages        = {{1--9}},
  publisher    = {{Springer}},
  series       = {{Insights into Imaging}},
  title        = {{CT and MRI imaging in Sweden: retrospective appropriateness analysis of large referral samples}},
  url          = {{http://dx.doi.org/10.1186/s13244-023-01483-w}},
  doi          = {{10.1186/s13244-023-01483-w}},
  volume       = {{14}},
  year         = {{2023}},
}