CT chest protocolling and vetting

The number of inappropriate CT requests is increasing, in part because the easier an investigation is to obtain the less thought will go into requesting it. Vetting is arguably more important now than ever, but for purely practical reasons a significant amount is performed by radiographers. In many instances this works well but it is asking a lot of the radiographers to filter out and reject the requests that are not appropriate. Ideally a consultant or senior SpR should be on hand to vet these, so we need to develop robust mechanisms for vetting scans to avoid performing an unacceptable amount of CT scanning.

In practical terms, it needs to be as easy to reject a request as it is to accept one. At our institution I have proposed an email-based notification system in which a rejection message is sent to a generic email account and the clinical team informed by clerical staff. This is a system we currently use for notifying clinicians of unexpected findings and has the advantage of generating an auditable trail.

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