Effectiveness of clinical imaging guidelines to reduce inappropriate head computed tomography imaging: a case of Uganda

Abstract

Abstract Background Clinical imaging guidelines (CIGs) have been demonstrated to reduce inappropriate diagnostic imaging. There is insufficient evidence for CIG effectiveness to reduce inappropriate imaging in Africa. We assessed the effectiveness of CIGs training and implementation to reduce inappropriate diagnostic imaging at Mengo Hospital, Uganda. Methods A clinical audit of head CT examinations was conducted at Mengo Hospital. A baseline review of 262 requisitions was done to determine the level of appropriateness for imaging requisitions. We also determined the baseline knowledge level on radiation protection (RP) and CIG use among 15 referrers. 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. This was followed by a post-intervention assessment where we reviewed 154 requisitions to determine the level of appropriateness. We also assessed the post-intervention knowledge level on radiation protection (RP) and CIG use among the referring clinicians. Results We found 53% and 47% levels of inappropriate head CT requisitions for pre- and post-intervention, respectively. 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. Conclusions Implementation and training referring clinicians on CIGs are effective in reducing inappropriateness of head CT requisitions.