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Do the reports address the questions?

I performed an audit in my hospital entitled "Do the reports address the questions?", with an aim to finding out whether radiology request forms contain an identifiable question, explicit or implicit, and whether this is explicitly addressed in the radiology reports in all cases [1]. Requests for radiological examination should present precise but important clinical information and should pose a specific question seeking an answer that is effective towards patient management. The subsequent report should answer the question or suggest an investigation that may help to give an answer. Moreover, question and answer based reporting improves communication and solves clinical problems more effectively.

The Department of Health, in the IR(ME)R act, has clearly outlined this in [8.6.1.] Regulation 5(5), which requires the referrer to supply the practitioner with sufficient medical data, relevant to the medical exposure requested, to enable the practitioner to decide whether the exposure can be justified [2, 3]. This data may need to include previous diagnostic information or medical records.

I studied a random sample of 350 radiology requests and reports, subcategorized into 200 hospital-based, 97 A&E-based and 53 GP-based requests and reports. My study revealed only 62% of hospital requests, 51.5% of A&E requests and 26.4% of GP requests had an explicit or implicit clinical question. The subsequent radiology reports explicitly addressed the questions in 91.3% of hospital reports, 90% of A&E reports and 85.7% of GP reports. The investigations were normal in 51.5% of hospital requests, 82.5% of A&E requests and 62.3% of GP requests. Clinical information was graded as satisfactory in 74% of hospital requests, 78% of A&E requests and 38% of GP requests, which was lower than anticipated.

Guidance to junior staff at induction, and encouraging senior staff to discuss complex clinical problems in radiology meetings, would certainly improve the picture. GPs should be encouraged to communicate more with radiologists about unclear requests and reports.

More importantly, an environment and approach whereby each request poses an explicit clinical question and the report attempts to answer the questions should be developed [1].

Yours etc.,

P A Nedumaran

43 Park Circus, Ayr KA7 2DJ, UK

References

1. Godwin R, de Lacey G, Manhire A. Do the Reports Address the Questions? Clinical audit in radiology 100+ recipes. London: Royal College of Radiologists, 1996:44–5.
2. Department of Health. The Ionising Radiation (Medical Exposure) Regulations 2000, Statutory Instrument No. 1059. London: HMSO, 2000.
3. Walker A, Tuck JS. Ionising Radiation (Medical Exposure) Regulations: impact on clinical radiology. Br J Radiol 2001;74:571–4.[Free Full Text]

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