Abstract
Introduction:
The appropriate use of CT scans is essential for patient safety and effective healthcare delivery. This audit aimed to evaluate whether resident doctors in the NHS are requesting CT scans in line with the Royal College of Radiologists (RCR) guidelines, and to assess the impact of educational interventions on improving compliance.
Method:
A retrospective audit was conducted in two cycles. Cycle 1 involved reviewing CT scan requests made by resident doctors (up to ST2 level) for patients aged 80+ fin August,2024. The compliance with RCR guidelines was assessed on several criteria, including presenting complaint, clinical scenario, scan indication, prior tests, and background information. Following educational interventions such as posters and teaching sessions, Cycle 2 was conducted in October, 2024, using the same criteria and assessment tools.
Results:
Cycle 2 demonstrated significant improvement in the documentation of presenting complaints (69.35% to 90.77%), scan indications (69.35% to 83.08%), and previous tests (38.71% to 64.62%). Request and imaging details showed high compliance (100%) in both cycles. However, documentation of examination findings showed only a modest improvement (40.32% to 49.23%), indicating an area requiring further focus.
Conclusion(s):
Educational interventions including posters in the wards led to substantial improvements in resident doctors’ compliance with RCR guidelines, especially in documenting key clinical information. To sustain these improvements, integrating checklists into the CT request process and ongoing teaching are recommended.
Comments
Who decides the CT needs requesting?
An important topic with encouraging results. Is it possible to identify retrospectively what grade of clinician decided the investigation needed to be done, and whether that has any bearing on the quality of the request? I think there's certainly a responsibility on the senior decision maker to make it clear why they want a particular investigation (and it's a good educational opportunity!)
Thank you for your comment…
Thank you for your comment. Although our e-request system records who submitted the CT request, we were unable to confirm the grade of the clinician who initially made the investigation decision. Most requests are entered by resident doctors after discussion with their seniors, and the radiology registrar or consultants usually review them before approval. Often, during emergency or on-call situations, an SHO may may decide independently. Including the grade of the clinician who decides to request a CT scan in future audits could provide useful insight into whether it influences request quality.
Outcomes of requests
Did the improvement in concordance with guidelines lead to a change in the number of CT requests accepted/refused, or prompt changes to a more appropriate imaging modality?
Good Question
That's an insightful question, and it's something we'd like to look into further. In this audit, we didn't specifically measure how many requests were accepted or declined, or whether it led to changes in choice of image modality. Our main focus was on improving the quality of information for CT Scan requests provided by junior doctors. The improvements we saw were really encouraging, and they've opened the door to new ideas; for instance, how we might design smarter request forms that prompt doctors to include all key information before submission. It would be exciting to see how that kind of system could further support radiologists in making the best imaging decisions for patients.
This poster is really well…
This poster is really well done. It tackles something we all deal with day-to-day—CT scan requests—and explains the problem and improvements in such a clear way. I like how the results are presented; you can genuinely see the difference the interventions made, which makes the project feel very real and practical. The layout is easy to follow, and the conclusions are honest and useful. Overall, it’s a thoughtful piece of work that shows real effort to improve how we request imaging and ultimately improve patient care.
Thank you
Thank you so much for your kind words and encouragement. We’re really pleased the project resonates with colleagues, and it’s rewarding to know the interventions are seen as practical and relevant. Our goal was to create lasting awareness about quality imaging requests and their impact on patient care, so your feedback truly means a lot.