Chest X-ray ordering related to varied clinical scenarios: a survey of Saskatchewan physicians.

INTRODUCTION: The chest X-ray (CXR) is one of the most commonly requested diagnostic imaging examinations. It is estimated that over 250,000 CXRs are ordered in Saskatchewan annually. Judicious use of the CXR is valuable in patient care, while unnecessary use increases costs, adds to patient irradiation, and may be in conflict with standards of patient care. In 1993, the Saskatchewan Health Services Utilization and Research Commission (HSURC) developed clinical practice guidelines (CPGs) for the CXR. These guidelines were based on a metaanalysis of validated literature. We were uncertain about whether Saskatchewan physicians were ordering CXRs based on the HSURC CXR CPGs.
MATERIALS AND METHODS: A survey, based on recommendations from the HSURC CXR CPGs, was developed and distributed to 363 physicians in Saskatchewan by mail (30/363) and by email (333/363). The survey asked physicians if they would order, or not order, a CXR for 5 basic clinical scenarios. The question of whether to order a CXR was then repeated when the basic scenario was altered one variable at a time, to determine if the physicians would change their CXR orders.
RESULTS: According to our assessment of physician responses to the initial clinical scenarios, the surveyed physicians correctly followed the HSURC CXR CPGs in the following frequencies: 100% scenario 1, 91.9% scenario 2, 35.4% scenario 3, 100% scenario 4, and 61.2% scenario 5. Alteration of the basic clinical scenarios resulted in very unpredictable ordering of CXRs by the survey participants.
CONCLUSION: The Saskatchewan physicians we surveyed are not ordering CXRs on the basis of HSURC CXR CPGs. They order too many nonindicated CXRs. Further communication with, and education of, the physician population about the HSRUC CXR CPGs may be warranted.