Abstract：
With the annual increase in medical imaging demand, the appropriateness of the lumbar spine magnetic resonance imaging LSMRI referrals is worldwide gaining attention. This study aims to determine the appropriateness of LSMRI referrals and compare radiology clinical decisions to iRefer compliance based solely on referral text content.
Referral text was extracted from 1021 LSMRI referrals. Two review panels were recruited: three expert radiologists and three MRI radiographers. Radiologists classified cases as indicated or not indicated for scanning based on their clinical judgement. The radiographers classified based solely on iRefer guidelines. Majority voting for each case was applied to both review panels and reviewer agreement was tested using Kappa analysis. Logistic regression models were developed to identify medical disciplines associated with high rates of indicated referrals.
21.7% and 11.9% of the cases were found not indicated for MRI for radiologists and radiographers, respectively. Radiology review identified 18% of the GPs referrals as not indicated and 17% in the radiographers\' review. Panel agreement was fair: Kappa values of 0.23 and0.26 for the radiologists and radiographers respectively. Neurosurgery was associated with the highest rate of indicated referrals across both review panels: oncology referrals raised the highest number of open comments.
The study identified a lower number of not indicated referrals compared to previous research. Findings indicate the importance of both guidelines compliance and clinical judgement to optimise practice.
Findings in this study found that even when strict instructions were given to the MR radiographers to vet referrals using the iRefer guidelines, ambiguity within the guidelines resulted in variations in decision-making. This suggests that detailed protocols are required to support radiographers in the vetting process to ensure a standardised approach.
Referral text was extracted from 1021 LSMRI referrals. Two review panels were recruited: three expert radiologists and three MRI radiographers. Radiologists classified cases as indicated or not indicated for scanning based on their clinical judgement. The radiographers classified based solely on iRefer guidelines. Majority voting for each case was applied to both review panels and reviewer agreement was tested using Kappa analysis. Logistic regression models were developed to identify medical disciplines associated with high rates of indicated referrals.
21.7% and 11.9% of the cases were found not indicated for MRI for radiologists and radiographers, respectively. Radiology review identified 18% of the GPs referrals as not indicated and 17% in the radiographers\' review. Panel agreement was fair: Kappa values of 0.23 and0.26 for the radiologists and radiographers respectively. Neurosurgery was associated with the highest rate of indicated referrals across both review panels: oncology referrals raised the highest number of open comments.
The study identified a lower number of not indicated referrals compared to previous research. Findings indicate the importance of both guidelines compliance and clinical judgement to optimise practice.
Findings in this study found that even when strict instructions were given to the MR radiographers to vet referrals using the iRefer guidelines, ambiguity within the guidelines resulted in variations in decision-making. This suggests that detailed protocols are required to support radiographers in the vetting process to ensure a standardised approach.
摘要：
随着医学影像需求的逐年增加,腰椎磁共振成像LSMRI转诊的适当性正在全球范围内引起关注.本研究旨在确定LSMRI转诊的适当性，并将放射学临床决策与仅基于转诊文本内容的iRefer依从性进行比较。
转诊文本摘自1021份LSMRI转诊。招募了两个审查小组：三名放射科专家和三名MRI射线技师。放射科医师根据其临床判断将病例分类为指示或不指示扫描。射线技师仅根据iRefer指南进行分类。每个案例的多数投票都适用于两个审查小组，并使用Kappa分析对审查者的协议进行了测试。开发了Logistic回归模型来识别与高转诊率相关的医学学科。
21.7％和11.9％的病例未发现放射科医师和放射技师需要进行MRI检查，分别。放射学审查发现，18％的全科医生转诊未显示，而17％的放射技师审查。小组协议是公平的：放射科医师和放射技师的Kappa值分别为0.23和0.26。在两个审查小组中，神经外科与指定转诊率最高相关：肿瘤学转诊提出的公开评论数量最高。
与以前的研究相比，该研究发现了较低的未指示转诊数量。研究结果表明，指南依从性和临床判断对优化实践的重要性。
这项研究的结果发现，即使使用iRefer指南对MR放射技师进行严格的指导以审查转诊，指南中的歧义导致了决策的变化。这表明需要详细的协议来支持放射技师在审查过程中，以确保标准化的方法。
转诊文本摘自1021份LSMRI转诊。招募了两个审查小组：三名放射科专家和三名MRI射线技师。放射科医师根据其临床判断将病例分类为指示或不指示扫描。射线技师仅根据iRefer指南进行分类。每个案例的多数投票都适用于两个审查小组，并使用Kappa分析对审查者的协议进行了测试。开发了Logistic回归模型来识别与高转诊率相关的医学学科。
21.7％和11.9％的病例未发现放射科医师和放射技师需要进行MRI检查，分别。放射学审查发现，18％的全科医生转诊未显示，而17％的放射技师审查。小组协议是公平的：放射科医师和放射技师的Kappa值分别为0.23和0.26。在两个审查小组中，神经外科与指定转诊率最高相关：肿瘤学转诊提出的公开评论数量最高。
与以前的研究相比，该研究发现了较低的未指示转诊数量。研究结果表明，指南依从性和临床判断对优化实践的重要性。
这项研究的结果发现，即使使用iRefer指南对MR放射技师进行严格的指导以审查转诊，指南中的歧义导致了决策的变化。这表明需要详细的协议来支持放射技师在审查过程中，以确保标准化的方法。
