ROYAL COLLEGE OF RADIOLOGISTS GUIDELINES FOR ABDOMINAL RADIOGRAPHY REQUESTS: ASSESSMENT OF REFERRING CLINICIANS’ ADHERERNCE

ABSTRACT
Plain abdominal radiography is believed to be over utilized as an investigation for acute abdominal complaints. Because of this, the Royal College of Radiologists published guidelines in order to minimise inappropriate requests. The aims of this research were to determine the level of referring clinicians’ adherence to these guidelines while making referrals, to determine whether professional status of the referring clinicians influences their adherence to the guideline, and finally to ascertain if abdominal radiography contribution to patients’ diagnosis is influenced by adherence to the guidelines. In this study, 206 referrals for abdominal radiography with clinical indication that fell within the guidelines were retrospectively collected and analysed. Initial clinical indications were compared with the indications in the guidelines. Also, requests were also analysed according to the professional status of the referring clinicians, and finally, adherence to the guidelines was compared to exams contribution to diagnosis. The results show that out of the 206 referrals used in this study, 133 were made in accordance with the guidelines. From the study, it was a discovered that the professional status of the referring clinicians affects their adherence to the guidelines, most of the non-adherence to the guidelines coming from the Junior Doctors. The study also shows that most of the cases where guidelines were followed contributed positively to patients’ diagnosis, while the reverse is the case where guidelines were not adhered to. Conclusively, from this study, referring clinicians adhere to a large extent to the royal college of radiologist guidelines. 
 LIST OF TABLES
Table 1: Distribution of appropriate referrals for abdominal                                           15                 radiography  Table 2: Distribution of inappropriate referrals for abdominal radiography                     16 Table 3: Distribution of adherence to the guidelines according to the                             17                referring clinicians’ professional status Table 4: Chi-square test to determine the relationship between the adherence to the guidelines and referring clinicians’professional status 18 Table 5: Relationship abdominal radiography guidelines and its contribution to patients’ diagnosis                              19 Table 6: Chi-square result of the relationship between abdominal radiography guidelines and its contribution to patients’diagnosis 20.                            TABLE CONTENT
Title page                                                                                                                  i Approval page                                                                                                               ii Certification                                                                                                                   iii Dedication                                                                                                                       iv Acknowledge                                                                                                                       v List of tables                                                                                                                   vi Abstract                                                                                                                        vii CHAPTER ONE                                                                                                                              Introduction                                              1.1 Backgrounds                                                                                                                  1 1.2 Statement of problems                                                                                                   3 1.3 Objectives of the study                                                                                                   3 1.4 Significance of the study                                                                                                4 1.5 Scope of the study                                                                                                          4 CHAPTER TWO   Literature review                                                                                                                5 CHAPTER THREE:                                                                                                              3.1 Research design                                                                                                            13 3.2 Sources of data                                                           13 3.3 Inclusion criteria                                                                                                          13 3.4 Exclusion criteria                                                                                                         13 3.5 Method of data collection                                                                                            14 3.6 Data analysis                                                                                                                14 CHAPTER FOUR: Data presentation                                                                               15 CHAPTER FIVE    4.1 Discussion                                                                                                                   21 4.2 Summary of findings                                                                                                   23 4.3 Conclusion                                                                                                                  24 4.4 Recommendations                                                                                                       24 4.5 Limitations of the study                                                                                              25 4.6 Areas for further research                                                                                           25 Reference Appendix 
INTRODUCTION
The performance of plain abdominal radiography is often considered to be an essential requirement for assessing acute abdominal complaints. It is commonly requested for acute medical emergences on patients with non-specific abdominal symptoms and signs1.  Often, plain abdominal radiography is requested routinely as part of the initial investigation on the day of admission, mainly by admitting junior doctors who may not be fully aware of the indications or appreciate the limitations of this investigation towards making diagnosis. There are only few indications in which the plain abdominal radiography is helpful, such as small bowel obstruction2. Majority of the conditions where these exams were performed have been taken over by newer modalities such as ultrasonography. In addition, only few doctors are aware of the relative high radiation dose patient is exposed to while undergoing plain abdominal radiography.  Patient undergoing plain abdominal radiography receives 35 times the dose they receive during normal chest radiography3. The limitations of plain abdominal radiography are consistently demonstrated in several series where the percentage of diagnostic radiography ranges only 10-20%4,5,6, 7. In order to minimize inappropriate requests, unnecessary radiation dose to the patient and to enhance the efficiency of this investigation, the Royal College of Radiologists (RCR) issued out clear guidelines for requesting for plain abdominal radiography8.