title: Appropriateness of computed tomography and magnetic resonance imaging scans in the Eden and Central Karoo districts of the Western Cape Province, South Africa.
abstract: BACKGROUND
  Computed tomography (CT) and magnetic resonance imaging (MRI) are an essential part of modern healthcare. Marked increases in clinical demand for these imaging modalities are straining healthcare expenditure and threatening health system sustainability. The number of CT and MRI scans requested in the Eden and Central Karoo districts of the Western Cape Province, South Africa (SA), almost doubled from 2011 to 2013.
  
  
  OBJECTIVE
  To determine the appropriateness of CT and MRI scans and relate this to the requesting department and clinician.
  
  
  METHODS
  This was a retrospective analytical cohort study. All scans during October 2012 were analysed as a sample. Appropriateness of scans was determined using the American College of Radiologists (ACR) Appropriateness Criteria and the Royal College of Radiology Guidelines. Appropriateness was also correlated back to the requesting department and clinician.
  
  
  RESULTS
  Of a total of 219 scans, 53.0% were abnormal. Overall 6.4% of scans were considered inappropriate. Interns and registrars requested no inappropriate scans. The orthopaedics department scored the highest rate of appropriate scans (80.0%) and the oncology department the highest rate of inappropriate scans (20.8%).
  
  
  CONCLUSIONS
  The limited resources available for healthcare in a developing country like SA should be a motivation to implement control mechanisms aimed at appropriate utilisation of imaging examinations. The Eden and Central Karoo districts have a low rate of inappropriate scans (6.4%). We recommend that the current preauthorisation system by consultants and other senior clinicians continues, but with increased clinician awareness of the ACR Appropriateness Criteria and the Royal College guidelines.
authors.forename: J
authors.initials: J
authors.lastname: Becker
authors.forename: L S
authors.initials: LS
authors.lastname: Jenkins
authors.forename: M
authors.initials: M
authors.lastname: de Swardt
authors.forename: R
authors.initials: R
authors.lastname: Sayed
authors.forename: M
authors.initials: M
authors.lastname: Viljoen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013019:South Africa; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult