Compliance with guidelines for choice of radiographic projections: a multicentre study.

A study of compliance with guidelines for choice of radiographic projections was carried out in each of six centres. The study concerned 5851 examinations undertaken by 116 radiographers under the supervision of 29 consultant radiologists. The results showed good compliance between centres for examination of the chest (range 81-93%), abdomen (range 73-100%), thoracic spine (range 82-96%), pelvis/hip (range 78-99%) but not for examination of cervical spine (range 0-85%), paranasal sinus (range 0-100%) and lumbar spine (range 52-84%). The reasons given for these wide variations are discussed and estimates are given for the potential reductions in exposure to the UK population consequent upon national implementation of guidelines such as these.

Radiology workload--a solution reviewed after 14 years' experience.

A method of controlling the radiological workload in a district general hospital, based on an estimation of the reasonable capacity of the department, was introduced in 1978. Measurement of the number of examinations performed compared with the estimated reasonable capacity shows that the method has been effective. An immediate 25% reduction in examinations was followed by a workload which varied between -4% and +16% of the capacity. An increase in the proportion of complex examinations in the period under review has been recognized. The method has encouraged referring doctors to exercise restraint and adopt guidelines, and helped persuade managers to increase capacity by appointing additional radiologists.

Children with urinary tract infection; a critical diagnostic pathway.

A protocol for the radiological investigation of children with urinary tract infection was introduced in a district general hospital in 1985. Every boy, and every girl under 5 years was investigated after one documented infection, and every girl over 5 years after two infections. Each child had an abdominal radiograph and a sonar scan of the urinary tract. Four years later the results were assessed by reviewing the radiology file or contacting the general practitioner of each of the first 200 children examined. Ten of 15 children diagnosed as not normal on screening and investigated further had an abnormality confirmed. Four of 25 children thought normal on screening had minor abnormalities shown on further examination. The results are assessed in the light of a review of recent literature and indicate that this screening protocol is efficient and effective.

Accuracy of early estimation of maturity at a district general hospital.

The accuracy of routine sonar scanning of patients attending the antenatal clinic of a general hospital before the 19th week of pregnancy was calculated and compared with the potential accuracy of the techniques used. Out of 200 patients who went into labour spontaneously, 164 delivered within nine days of the sonar prediction, and 152 delivered within nine days of the date estimated from the menstrual history. The discrepancy between the mean of the expected date of delivery from the sonar examination and that derived from the menstrual history was 2.24 days. When the two estimations differed by a week or more the sonar estimation was more accurate, and all 44 patients in this group delivered by the sixth day after the sonar prediction. These findings emphasise the need for those providing a similar service to review the accuracy of their own work.

Maternal alpha-fetoprotein screening: two years' experience in a low-risk district.

Over a two-year period, 3479 pregnant women in the Kings' Lynn Health District were screened for neural tube defects by estimation of maternal serum alpha-fetoprotein. Most pregnancies were scanned by sonar for fetal maturity. Eight women had fetuses with open neural tube defects; four with anencephaly were associated with very high alpha-fetoprotein values. Of the four with open neural tube defects without anencephaly, only one was detected by screening and confirmed after amniocentesis. One other had a raised serum alpha-fetoprotein but a normal amniotic fluid value. The other two affected fetuses were missed. This disappointing outcome was attributed to the poor predictive value of alpha-fetoprotein in detecting open neural tube defects (anencephaly apart) rather than to errors in its estimation or in assessment of fetal maturity by sonar scan. We question the validity of screening, particularly in areas of intermediate or low incidence.

A small computer at the radiology reception desk.

An intelligent terminal has been used at a radiology reception desk to maintain a master patient index and to assist documentation. It also yields valuable management information.