Referring Physicians’ Knowledge on Justification of Medical Exposure in Diagnostic Imaging in a Sub-Saharan African Country, Cameroon

Abstract

Background: Justification is the process of weighing the potential benefit of the exposure against potential detriment for that individual. Its role has been largely delegated to imaging professionals. Nevertheless, justification process involves referring physicians, radiographers and radiologists. Objective: To assess the knowledge of referring physicians regarding justification of irradiating examinations in medical imaging at the university-affiliated hospitals in Yaoundé Cameroon. Materials and Methods: A questionnaire (18 questions) based on the French guide for the proper use of medical imaging tests in relation to the justification of irradiating examinations, was self-administered to 151 referring physicians in Yaounde (Cameroon) between October 2012 and January 2013. The pre-tested questionnaire was completed in the presence of the investigator. A scoring system was then adopted with a total of 15 points from the level of knowledge on justification which could be classified as satisfactory or not. Results: Referring physicians were 75 (49.7%) GPs, 53 (35.1%) residents and 23 (15.2%) specialists. Knowledge on justification was unsatisfactory for 79.5% of referring physicians with no significant difference in terms of professional experience (p = 0.95) or specialty (p = 0.119). The concepts of “useful exam” and “justified exam” were not known by 113 (74.8%) and 95 (62.9%) practitioners. MRI was selected as irradiating by 62 (41.1%), SPECT and PET-scan as non-radiating examinations by 98 (64.9%) and 115 (76.1%) participants. The main reasons for repeating a giving radiology exam were: unsatisfactory interpretation, unknown of where it was performing and poor quality exam respectively for 23 (15.2%), 37 (24.5%) and 43 (28.5%) referring physicians. Justification was the responsibility of the referring physician alone for 57% of respondent. Only 11 clinicians knew the reference of “Justification-Optimization-Limitation” to radiation protection. Conclusion: The knowledge of physicians on radiating medical procedures and justification of requests for these procedures is inadequate. Training in radiation protection and the introduction of guidelines for the proper use of imaging tests could improve physicians’ justification of radiating examinations.