Do family physicians request ultrasound scans appropriately?

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. Design: Analysis of 620 randomly chosen requests for US scans. Setting: The Radiology Department at the Capital District Health Authority in Halifax, NS, between October 1, 2008, and June 30, 2009. Participants: Two radiologists and 2 family physicians with clinical expertise and familiarity with the Canadian Association of Radiologists' 2005 guidelines. Main outcome measures: 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. Conclusion: 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.