engleski

NEUROIMAGING ABUSE BY HOSPITAL NEUROLOGISTS AT UNIVERSITY HOSPITAL SPLIT

Aim Neuroimaging is a common area of physician abuse that causes several adverse events, including patient’s unnecessary radiation exposure and enormous medical costs. Physicians often request neuroimaging even if they expect the study will be normal, being fearful of missing an incidental brain tumor or other lesion. Especially concerning is use of repeated multiple imaging of the same anatomic area, ie brain, or an unnecessary order of high radiation exposure techniques, such as computed tomography (CT) and more sophisticated magnetic resonance angiography (MRA). To our knowledge, there are no published data at our institution’s level about this important issue. Methods A retrospective study of neurologist’s requests for the multiple brain imaging techniques, including CT, magnetic resonance imaging (MRI) and finally MRA during 2017 was conducted at University hospital Split. The study included analysis of referral patient’s diagnosis, number of repeated imaging techniques per patient and qualitative analysis of each radiological finding. Results A total number of 161 MRA tests ordered from Neurology department was found in 2017, with headache as the most common referral diagnosis. Prior to MRA, 86 (53.4%) patients completed brain CT, 15 (9.3%) brain MRI, 32 (19.8%) both techniques and in only 28 (17.4%) patients MRA test was done without prior CT or MRI. Radiological MRA test reading revealed a negative finding in 151 (93.8 %) patients, in the remaining ten patients a cerebral aneurysm was diagnosed. Similarly, the readings of CT and MRI tests were negative in more than 90% of patients. In the remaining number of patients, a subacute/chronic ischemia or exceptionally subarachnoidal or intracranial hemorrhage were diagnosed, without substantial overlap with final MRA results. Conclusion The present research elucidated a clear neuroimaging overuse by the neurologists form University hospital Split, confirmed by an abundant use of multiple neuroimaging techniques with predominantly negative radiological findings. This study result warned us that neurologists actually did screening tests without taking into consideration any of the neuroimaging guidelines. The study was also among the first to reveal the hospital neurologists responsible for the abuse, since previously published studies generally showed responsibility of the general practitioners and emergency physicians. Current guidelines and/or consultation of a radiologist might be helpful to avoid unnecessary or inappropriate imaging requests, keeping the continuity of patient’s medical care. We suggest the latest approach to reduce several important issues, such as reduction of patient’s radiation exposure, decrease of hospital costs and shortening of long neuroimaging wait lists

neuroimaging, MR angiography, headache

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