National audit of appropriate imaging

Aims To audit the availability of imaging referral guidelines; vetting by radiologists of GP-initiated CT and MRI requests; and the achievement of appropriate imaging using retrospective assessment as a surrogate. Materials and methods A web-based questionnaire was distributed to imaging departments in the UK seeking awareness of guideline availability; the percentage of consecutive general practitioner (GP)-requested computed tomography (CT) and magnetic resonance imaging (MRI) investigations that showed evidence of vetting; and the percentage of procedures where retrospective assessment showed the investigation to be appropriate according to imaging referral guidelines. Results Replies were received from 88 departments covering 1700 of 2700 (63%) consultant radiologists practising in the UK. Regarding the availability of guidelines, approximately a third of respondents were not aware of guidelines being available to all radiologists and radiographers. The 68% level of availability (58/88 departments) is well below the standard of 100%. In keeping with the target of 95%, vetting of CT requests was shown in 1815/1890 (96%) and MRI in 1181/1250 (95%). Appropriateness of CT examinations was shown in 1746/1870 (93%) and MRI in 1154/1215 (95%), well above the target of 90%. The most common reason for an inappropriate investigation for both MRI and CT was the inability to affect patient management. Conclusions Although awareness of referral guidelines availability was limited at 68%, well below the 100% standard, the meticulous vetting of requests (shown in 95–96%) with the amendment or return of inappropriate requests (9–12%) enables a high level of appropriate imaging (93–95%) for GP-requested CT and MRI, thus making the best use of clinical radiology.