title: The effect of introducing guidelines for cervical spine radiographs in the accident and emergency department.
abstract: OBJECTIVE
  To assess the effect of guidelines for x ray requests on requests for cervical spine x rays.
  
  
  METHODS
  Accident and emergency (A&E) department of tertiary referral centre.
  
  
  METHODS
  Guidelines for all x ray requests were introduced in the (A&E) department of the Royal Infirmary of Edinburgh in February 1992. The effect of the guidelines on requests for cervical spine x rays was assessed by retrospective review of all such x rays taken over two 30 d periods, before and after the introduction of the guidelines. Junior staff had been in post for 3 months during both periods assessed. Films were reviewed for quality by a consultant radiologist.
  
  
  RESULTS
  Guidelines reduced the number of inappropriate requests significantly; however, 26% of requests were still unnecessary. The standard of radiography improved but 49% of x rays remained inadequate, usually because the C7/T1 level was not demonstrated on the lateral view. The A&E doctors correctly interpretated the radiographs in 95% of examinations.
  
  
  CONCLUSIONS
  Guidelines reduce inappropriate x ray requests. Further improvements can be expected with continued education.
authors.affiliation: Department of Accident and Emergency Medicine, Royal Infirmary of Edinburgh.
authors.forename: S
authors.initials: S
authors.lastname: Maurice
authors.forename: S
authors.initials: S
authors.lastname: Brown
authors.forename: C
authors.initials: C
authors.lastname: Robertson
authors.forename: I
authors.initials: I
authors.lastname: Beggs
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital / Q000592:standards / Q000639:trends; D006801:Humans; D017410:Practice Guidelines as Topic; D011859:Radiography / Q000592:standards; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging