title: Do family physicians request ultrasound scans appropriately?
abstract: OBJECTIVE
  To review family physicians' requests for abdominal, thyroid, pelvic, soft tissue, and carotid ultrasound (US) scans, and to determine whether 5% or more of these tests were not clearly indicated based on the clinical history provided.
  
  
  METHODS
  Analysis of 620 randomly chosen requests for US scans.
  
  
  METHODS
  The Radiology Department at the Capital District Health Authority in Halifax, NS, between October 1, 2008, and June 30, 2009.
  
  
  METHODS
  Two radiologists and 2 family physicians with clinical expertise and familiarity with the Canadian Association of Radiologists' 2005 guidelines.
  
  
  METHODS
  Whether US requests were "indicated," "not clearly indicated," or "not legible" according to the Canadian Association of Radiologists' 2005 guidelines. Those that were illegible were discarded and replaced. Results More than 5% of requests for abdominal, thyroid, or carotid US scans were not clearly indicated. The percentages of requests for pelvic and soft tissue scans that were not clearly indicated were not significant. The reviewers found only 5 illegible request forms. Percentages of abdominal, thyroid, and carotid US scans not clearly indicated were 12.1%, 18.8%, and 25.2%, respectively. Reasons for inappropriate US requests included the following: wrong tests (3.2%), vague clinical questions (4.8%), and unfocused examinations (4.8%) for abdominal scans; wrong tests (3.2%), vague clinical questions (3.2%), unnecessary investigations (5.6%), and unnecessary follow-up examinations (5.6%) for thyroid scans; and unnecessary tests (10.5%), vague clinical questions (5.6%), and unnecessary tests for "dizziness" (10.5%) for carotid scans.
  
  
  CONCLUSIONS
  More than 5% of the abdominal, thyroid, and carotid US scans requested by family physicians were not clearly indicated based on the clinical history provided. Common trends in requesting these examinations reinforce the need to improve guidelines for requesting scans and for managing many presenting complaints in family practice.
authors.affiliation: Department of Radiology, Dalhousie University, Radiology Research Office, 1278 Tower Rd, Halifax, NS B3H 2Y9. balandry@dal.ca
authors.forename: Bret A
authors.initials: BA
authors.lastname: Landry
authors.forename: David
authors.initials: D
authors.lastname: Barnes
authors.forename: Valerie
authors.initials: V
authors.lastname: Keough
authors.forename: Adrienne
authors.initials: A
authors.lastname: Watson
authors.forename: Judy
authors.initials: J
authors.lastname: Rowe
authors.forename: Amy
authors.initials: A
authors.lastname: Mallory
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdolell
mesh_terms: D005194:Family Practice; D006801:Humans; D009674:Nova Scotia; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014463:Ultrasonography / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*