Evidenced-based radiology? A single-institution review of imaging referral appropriateness including monetary and dose estimates for inappropriate scans

There has been a year on year increase in imaging requests at our academic institution. The iRefer guidelines are produced by the Royal College of Radiologists in the UK and are designed to prevent inappropriate imaging and radiation exposure. They have been available to general practitioners and hospital physicians in Ireland since March 2015. Our aims were to determine the proportion of inappropriate imaging referrals pre- and post-guideline introduction and to calculate the cost and dose estimates for inappropriate scans. A retrospective review of 1124 radiographs was performed with reference to a validated audit template. Emergency department, in-patient, and general practitioner referrals were reviewed. Cost and cumulative dose estimates were calculated for inappropriate referrals taking into account salaries, average time spent performing/reporting radiographs, and median effective dose values. The introduction of the iRefer guidelines has not significantly affected the proportion of inappropriate radiograph referrals at our institution, 42% pre-introduction and 43% post-introduction. We identified 784 inappropriate referrals across 6 radiograph subtypes, imparting a total median effective dose of 65.1 mSv to patients. The time spent performing inappropriate abdominal and spinal radiographs in 2017 yielded an estimated cost of €8036.40. A significant amount of inappropriate radiographs continue to be requested and performed, exposing patients to needless ionizing radiation and wasting staff members time at a financial cost. Interventions are needed to decrease inappropriate referrals.