Appropriateness of radiological examinations exposing to ionizing radiation: the effect of active referral guideline implementation.

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital, Auditorium 7. Remote access: https://oulu.zoom.us/j/62533584114?pwd=TTVqYUc3eHE4b2RvQTM5eWs5WStTdz09

Topic of the dissertation

Appropriateness of radiological examinations exposing to ionizing radiation: the effect of active referral guideline implementation.

Doctoral candidate

MD Pirita Tahvonen

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Research Unit of Medical Imaging, Physics and Technology

Subject of study

Radiology

Opponent

Professor Ritva Vanninen, Kuopio University Hospital

Custos

Professor Osmo Tervonen, Oulu University Hospital

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Appropriateness of radiological examinations exposing to ionizing radiation: the effect of active referral guideline implementation.

When using ionizing radiation, justification must always be considered due to the possibility of radiation-promoted carcinogenesis. The radiation-induced lifetime risk of cancer mortality is higher in young age. A radiological examination is justified when the benefit to the patient is greater than the expected harm. Although the risk to an individual is small, the concern is attributed to the rapid increase in collective radiation doses, especially related to increased use of CT. Imaging referral guidelines have been developed to support referrers in selecting and justifying radiological procedures.

The purpose of this study was to follow up the effects of active guideline implementation, including education, on the volume and appropriateness of CTs and lumbar spine radiographs on young people in Oulu University Hospital and of spine radiographs in adults in primary care. Furthermore, the aim was to evaluate whether inappropriate lumbar spine radiographs in Oulu University Hospital had relevant findings.

A significant reduction in the number of CTs in young people was seen in lumbar spine (-80%) and cervical spine (-48%) and head (-21%). The number of all spine radiographs decreased significantly; that of lumbar spine radiographs in university hospital by 37% and spine radiographs in primary care by 51%. A significant change was seen in overall appropriateness of CTs, from 71% to 87%. The appropriateness of lumbar spine examinations in Oulu University Hospital and of lumbar spine radiographs in primary care improved significantly. However, the level of appropriateness of different spine radiographs in primary care remained low even after the interventions. The proportion of notable findings in lumbar spine was significantly higher in radiographs that were in accordance with the guidelines than in radiographs that were not.

In conclusion, guideline implementation and education can significantly decrease the number of radiological examinations and result in more appropriate examinations.
Last updated: 6.9.2021