Can radiology requisition quality reflect clinical reasoning? Insights from a RI-RADS evaluation of emergency CT referrals.

OBJECTIVES

To determine radiology requisition quality using reason for exam imaging reporting and data system (RI-RADS), and the associated clinical variables, and whether it can reflect the clinical reasoning quality in emergency CT referrals.

MATERIALS AND

METHODS

This single-center retrospective study randomly selected emergency CT referrals between 01 January 2024 and 31 December 2024. One radiologist scored the requisition quality using the RI-RADS, and assessed the clinical reasoning quality, evaluating the extent to which the differential diagnoses on the requisition form matched the CT diagnosis on the issued report. The clinical variables associated with RI-RADS A were investigated using logistic regression analysis. The clinical reasoning quality among different RI-RADS grades was compared.

RESULTS

We included 1291 emergency CT referrals. RI-RADS grades A (adequate), B (barely adequate), C (considerably limited), D (deficient), and X (no information) were assigned to 287 (22.2%), 71 (5.5%), 851 (65.9%), 53 (4.1%), and 29 (2.2%) requisitions, respectively. The requisitions from the fever clinic and thoracic surgery were less likely to be assigned to RI-RADS A compared to internal medicine (odds ratio 0.10-0.11), and so were those of abdomen and head scans compared to chest scans (odds ratio 0.06-0.30). The RI-RADS A requisitions had better clinical reasoning quality than those of RI-RADS grades C, D, and X (all adjusted p < 0.001), but not those of RI-RADS B (adjusted p = 0.100).

CONCLUSION

The majority of emergency CT requisitions were inadequate, especially those from the fever clinic and thoracic surgery. Suboptimal requisitions were associated with poorer clinical reasoning quality.

CRITICAL RELEVANCE STATEMENT: Radiologists' concerns are valid that low-quality radiology requisitions may reflect poorer clinical reasoning. The use of standardized requisition frameworks like RI-RADS may help bridge the gap between diagnostic imaging and clinical reasoning, promoting safer and more effective patient care.

KEY POINTS: Radiologists often complain about low-quality radiology requisitions with low clinical reasoning quality from clinicians. The radiological requisitions with lower quality according to RI-RADS were associated with worse clinical reasoning quality. Improving the quality of radiological requisitions after detailed clinical reasoning is warranted to improve radiology workflow for better medical practice.