title: The use of radiological guidelines to achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knees performed for GPs.
abstract: OBJECTIVE
  To determine if the use of request guidelines can achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knee joints performed for general practitioners (GPs).
  
  
  METHODS
  GPs referring to three community hospitals and a district general hospital were circulated with referral guidelines for radiography of the cervical spine, lumbar spine and knee, and all requests for these three examinations were checked. Requests that did not fit the guidelines were returned to the GP with an explanatory letter and a further copy of the guidelines. Where applicable, a large-joint replacement algorithm was also enclosed. If the GP maintained the opinion that the examination was indicated, she or he had the option of supplying further justifying information in writing or speaking to a consultant radiologist.
  
  
  RESULTS
  Overall the number of radiographic examinations fell by 68% in the first year, achieving a 79% reduction in the second year. For knees, lumbar spine and cervical spine radiographs the total reductions were 77%, 78% and 86%, respectively.
  
  
  CONCLUSIONS
  The use of referral guidelines, reinforced by request checking and clinical management algorithms, can produce a dramatic and sustained reduction in the number of radiographs of the cervical spine, lumbar spine and knees performed for GPs.
authors.affiliation: Department of Radiology, Chesterfield Royal Hospital, Chesterfield, UK. jeffglaves@tiscali.co.uk
authors.forename: J
authors.initials: J
authors.lastname: Glaves
mesh_terms: D000465:Algorithms; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005194:Family Practice; D019983:Guideline Adherence; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D011859:Radiography; D012017:Referral and Consultation