Analysis of the Justification for Spinal Computed Tomography (CT) Scans Performed in Togo.

Abstract

Introduction: The undeniable benefits of irradiating examinations such as computed tomography (CT) scans should not overshadow their potential harmful effects, particularly late risks. Hence, it is important to justify CT scans requested for patients. The aim of this study is to analyse the justification for CT scans in all health facilities with a functional medical scanner in Togo.

Methods: This was a prospective descriptive study of spinal CT scans performed between 1st June and 31st August 2021 and interpreted by a radiologist in seven functional CT units in Togo. The analysis of the justification was based in particular on the formulation of the clinical indication, the consistency of the clinical indication with the requested CT scan, and the compliance of the clinical indication with the Best Practice Guidelines of the Société Française de Radiologie (SFR) and the Société Française de Médecine Nucléaire (SFMN).

Results: The 355 spinal CT scans included were exclusively cervical, dorsal and lumbar in 15.5%, 3.1% and 68.2% of the patients, respectively. The mean age of the patients was 48.2 years, with a sex ratio of 1.1:1.0. Approximately 69% of patients had a spinal CT scan within 3 days or less. Specialist (70.2%) and general practitioner (22.3%) were the most frequent requesters; 92.1% of the patients requested a non-radiating or less radiating imaging test before the CT scan. Non-physician staff (paramedics) accounted for 2.5% of requesters. The formulation of the clinical indication was good in 89.9%, acceptable in 7.6% and wrong in 2.5% of the patients. These indications were consistent with the examination requested in 98.9% of the cases and complied with the SFR's best practice guidelines in 72.1% of the cases. Spinal CT scans were pathological in 91% of the patients. The more clearly the clinical indications were formulated, the more significantly the results were pathological. Overall, in 34.1% of the cases, the CT scans performed were deemed not to be justified.

Conclusion: A significant number of spinal CT scans performed in Togo were not justified. Efforts must be made by both requesters and providers of medical imaging examinations to ensure judicious medical use of irradiating examinations in Togo.