The current RCR guidelines are now titled as” iRefer” and are available for mobile phone and tablet as apps, web-based and print form. The Royal College of Radiologists (RCR) developed their first set of imaging guidelines in 1990 and has since been revised at regular intervals of 5 years, and up to today, there are 14 editions. This document was to act as a guideline for making appropriate decisions for diagnostic imaging. The World Health Organization was the first organization to develop and publish a document in 1990 titled “Effective choices for diagnostic imaging in clinical practice”.

CIGs are systematically developed as evidence-based statements to aid referrers, radiological imaging practitioners and patients to make decisions for appropriate diagnostic imaging for specific conditions. Several organizations and countries have adapted or adopted clinical imaging guidelines (CIGs) also known as imaging referral guidelines. To make such appropriate imaging requisitions during routine work flow, clinical imaging guidelines have been evidenced to aid decision making for the most appropriate procedures. The investigation should be the best for the particular clinical condition especially if weighed against non-ionizing imaging alternatives like US and MRI.

The investigation should have the potential to change patient’s management, or to significantly increase the referrer’s confidence in the diagnosis or unveil a potentially treatable condition. In addition, if the results expected from the imaging procedure are already available from another type of imaging investigation, or from laboratory or physical assessment, that investigation is not necessary and may not be performed. If the same investigation has just been done, it should not be repeated. According to Fraser, an appropriate requisition consists of the following: The imaging examination should be indicated as per clinical features. To enhance justification of imaging procedures, imaging through appropriate requisitions has been proposed. There are many reasons for overutilization of radiation in imaging and these include self-referral, patient self-presentation, financial incentives and failure of referring clinicians to understand and use the most appropriate examination for patient evaluation. Although such principles have been put in place, there has been reports of over and underutilization of radiation in imaging world over. The exposure to the patient must provide a net benefit, and this is well defined by ICRP as 3 levels of justification. Ionizing radiation carries both benefits and risks, and justification of its use in the medical aspect is one of the ICRP (International Commission on Radiation Protection) principles of radiation protection. It is estimated from UNSCEAR data that there are about 3.6 billion imaging procedures utilizing ionizing radiation and 33 million diagnostic nuclear medicine procedures performed annually worldwide. There has been a rapid upsurge in the application of diagnostic imaging over the last two decades. Implementation and training referring clinicians on CIGs are effective in reducing inappropriateness of head CT requisitions. At pre-intervention, we found a 73% level of knowledge on radiation protection and CIGs use while we found a 93% at post-intervention assessment among referrers. We found 53% and 47% levels of inappropriate head CT requisitions for pre- and post-intervention, respectively. We also assessed the post-intervention knowledge level on radiation protection (RP) and CIG use among the referring clinicians. This was followed by a post-intervention assessment where we reviewed 154 requisitions to determine the level of appropriateness. We trained these referrers on RP, awareness and use of CIGs and uploaded the iGUIDE onto their smart phones and computer work stations for use. We also determined the baseline knowledge level on radiation protection (RP) and CIG use among 15 referrers.

A baseline review of 262 requisitions was done to determine the level of appropriateness for imaging requisitions. MethodsĪ clinical audit of head CT examinations was conducted at Mengo Hospital. We assessed the effectiveness of CIGs training and implementation to reduce inappropriate diagnostic imaging at Mengo Hospital, Uganda. There is insufficient evidence for CIG effectiveness to reduce inappropriate imaging in Africa. Clinical imaging guidelines (CIGs) have been demonstrated to reduce inappropriate diagnostic imaging.

Guideliner used for interventional