Neuroradiological Assessment of Referrals for MR Brain Scan: Our Experience

Abstract

The growing demand for brain MR scans in recent years has led to long waiting lists and indiscriminate referral with respect to the clinical need for imaging and appropriateness criteria for MR scanning. To overcome this problem, the Bologna Public Health Service in conjunction with S. Orsola-Malpighi Hospital devised an experimental project instituting a radiological assessment prior to booking MR scans, implemented on 1^st November 2003. The assessment is carried out by doctors in the Radiology and neuroradiology units to establish whether referral for MR scan is appropriate and to draw up a priority scale for access to MR diagnosis. If MR investigation is deemed inappropriate, the project provides for an alternative procedure or specialist clinical examination. The patient is admitted to the charge of the service and followed throughout the diagnostic work-up, i.e. the doctor undertaking the assessment will prescribe a possible specialist clinical consultation or other radiological procedures, generally CT scans performed by the same Radiology or Neuroradiology unit. We report on neuroradiological assessment of referrals for brain MR scans on behalf of the Public Health Service and carried out at the Neuroradiology Unit in Bellaria Hospital, Bologna. From 1^st November to 31^st July 2004, 2659 assessments were undertaken. Of these 2163 were approved for MR scanning whereas 496 referrals were modified, mostly into CT scans and some patients were referred for otorhinolaringology, endocrinology or neurology specialist consultation. To assess the impact of this “filter”, we compared a sample period of six months from 1^st February 2003 to 31^st July 2003 before the radiological assessment project had been implemented with a period of the same length the following year. We found that the number of negative MR scans was halved after the project had been implemented (from 24.49% in 2003 to 12.18% in 2004), showing that in addition to shortening waiting lists for MR scans, there has been a sharp rise in the number of appropriate scans.