Rational Use of Neurological Computerized Tomography Scan at Shifa Hospital
عبد الرازق عبد القادر إبراهيم بيرم
Computerized tomography (CT) scan utilization in Gaza strip has dramatically increased in recent years. This has likely reflected the improved diagnostic capability of CT scan. However, the utilization of CT is tempered by the high radiation exposure to patients as well as cost and long waiting list of patients. An increase in the number of neurological CT scan examinations has been noticed since the establishment of the CT scan department which is still form the biggest problem facing the work in the department. So the rational utilization of the CT scan is a goal of all CT scans’ health providers and radiology department administrators. This study aimed to assess the rational use of neurological CT scan examination in order to decrease the medical radiation exposure for patient and the cost of financial expenditure burden on the patient and Ministry of health. A triangulated cross sectional quantitative and qualitative study was conducted in order to assess the rational use of neurological CT scan examination at Shifa hospital. The instruments used in this study were 300 self-constructed questionnaires for patients who have had CT scans examination during the period of the study; reviewing of 1780 CTs requests for availability and completeness of these requests and in-depth interview for 8 stakeholders at AL Shifa hospital. A total of 2501 neurological CTs requests has been searched to detect the 1780 requests with a detective rate of 71%. The study findings show that multiple factors affect the decision of physicians to write a CT scan request; these are complex combination of considering patients or his family and patient-health provider relationship. Most of the physicians did not write the initial diagnosis and medical history in the CT scan requests. The study also shows that 90% of the patients didn’t have the previous examination before the physician writes the CT scan request for him. The study results also reveal that there is no clear and standard request which in turn affect the writing of CTs request. The study findings indicate that 2501 neurological CT scans were performed, of them 1129 brain CT scans were reviewed and males represented 57% of the patients. Headache was noted as the main reason for referral (31%) and the urgent requests represented 55% of the brain CT scan requests. The findings were completely normal in 56% of the CTs results. Patients between the ages of 0 to 9 years were exposed to radiation at higher rate than the other age groups with 28% from brain CTs examination which represents a serious problem because the infants and young children are the most vulnerable group to radiation risk. The study results also show that 615 spine CT scans were reviewed and males represented 47% of the patients. LBP with neurological sign was noted as the main reason for referral (64%) and urgent requests represented 11% of the CT scan requests. The findings were completely normal in 25% of the CTs results. Patients between the ages 40-49 were exposed to radiation at higher rate than the other age groups with 27% from spine CTs examinations. The researcher concluded that clear guidelines are not available and the physician has to use his best clinical judgment, taking into account multiple factors such as the patient-health providers' relationship and the patient-physician relationship. The main recommendations include: reforming the policy, establishing standard protocols in order to improve the quality of health care services, creating a standard CT scan request form, conducting a training course for the benefit versus risk of CT scan radiation dose for the health providers, conducting training course for physicians who write the request of CT scan on the proper way of completing CT scan requests, and finally, launching an awareness program to the public on the risk of medical radiation.