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Background:
Systematic Review

Assessing, Advising, and Advancing the Filling Practices of the Radiology Request Form in Africa: A Systematic Review

by
Mohamed Hajalamin
1,*,
Almontasir Awadalla
2 and
Mahmoud Mukhtar
2
1
St Mary’s Hospital Phoenix Park, D20 TY72 Dublin, Ireland
2
Beaumont Hospital, Beaumont Road, Beaumont, D09 V2N0 Dublin, Ireland
*
Author to whom correspondence should be addressed.
Diagnostics 2024, 14(15), 1694; https://doi.org/10.3390/diagnostics14151694
Submission received: 4 July 2024 / Revised: 31 July 2024 / Accepted: 31 July 2024 / Published: 5 August 2024
(This article belongs to the Section Medical Imaging and Theranostics)
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Versions Notes

Abstract

:
Despite the increased use of diagnostic imaging in Africa, the completion of the Radiology Request Form (RRF) remains suboptimal, often relying on paper-based communication. To examine the practices surrounding RRF completion in the African continent, on 25 March 2024, we conducted a systematic review of peer-reviewed articles describing the practice in African settings. Non-African studies, studies involving non-human subjects, and articles examining the practice of the RRF for interventional usage were excluded. Our search involves PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, Google Scholar, and African Journals Online. The included studies were 3004, of which 30 met the inclusion criteria. These studies span eight countries and highlighted several shortcomings, including the usage of informal forms, unconventional abbreviations, illegibility, inaccuracy, and the lack of important fields from institutional forms, commonly the last menstrual period and the referrer’s contact details. We also found widespread non-compliance in all RRF fields; half of the studies did not have an adequately filled form. Incomplete RRFs lead to delayed imaging, increased workloads for radiographers and radiologists, and potential misdiagnoses due to insufficient information. It will also impede the application of radiation protection principles. To address these challenges, empowering radiographers and radiologists and encouraging best practices is essential. Regular audits and educational initiatives aimed at clinicians are recommended. While transitioning to a paperless communication system might help, implementing nationwide quality improvement projects to standardise radiology request forms is currently more feasible.

1. Introduction

Africa has used diagnostic imaging more extensively, which has had favourable outcomes in patient care. However, there is a risk that the negative consequences resulting from unjustified exams could outweigh these benefits [1]. Because of the expanding imaging service nowadays, medical practice has become the primary source of ionising radiation exposure, surpassing any other human activity [2]. Therefore, the principles of radiological protection, which include justification, optimisation, and application of dose limits, must govern the use of diagnostic radiology [2]. The responsibility of applying those principles is shared between the radiology personnel and the referring clinicians. Effective communication will ensure that the benefits outweigh the harm and the exam is optimised.
At the heart of this communication lies the Radiology Request Form (RRF), a vital tool for referring patients for radiological examinations. Despite its significance, the proper completion of the RRF is often overlooked [3]. Through the years, efforts have been made to raise awareness and address the issues of unjustified imaging exams; several initiatives like AFROSAFERAD, Technical Cooperation in Africa, and Global Initiative on Radiation Safety in Healthcare Settings have made forward steps and even started to establish national guidelines for clinical imaging referral [4]. However, those achievements will face the hazard of non-continuity if a central tool such as the RRF is not given the attention it deserves by healthcare practitioners.
Globally, inadequate provision of the RRF has been a matter of concern. Studies conducted in Australia [5], Brazil [6], Greece [7], India [8], Italy [3], Nepal [9,10,11], Pakistan [12,13], Saudia Arabia [14,15], Sri Lanka [16], United Kingdom [17,18,19], and the United States [20,21,22,23] have all shown substandard practice in the provision of adequate RRFs. This reflects a worldwide challenge affecting various healthcare settings across diverse regions and extending to all imaging modalities. According to the Royal College of Radiology, the RRF must include sufficient clinical and demographic information that details the patient’s clinical context and the intended recipient of the report [24]. This issue was also emphasised by many radiological societies, e.g., the American College of Radiology [25], the European Society of Radiology [26], and the Royal Australian and New Zealand College of Radiologists [27].
This study aims to provide insights into the practice surrounding RRFs in Africa by systematically reviewing the published African literature. While this issue has been reported in many non-African countries, we chose to review the practices on our continent. We believe these issues are more relevant in areas with limited resources, making focusing on our local context important. To our knowledge, this is the first review of its kind on a continental level.

2. Material and Methods

This study is a systematic review following the recommended Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [28]. This study was not registered prior.

2.1. Literature Search

On 25 March 2024, we conducted a systematic and comprehensive literature search for peer-reviewed publications across multiple databases, including PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science (WOS), and Google Scholar. We applied no language, year, or study design filters to the search. We employed the search terms “radiology request form”, “radiological request form”, and “imaging request forms” to assemble relevant articles. Additionally, we extended our search to the reference lists of eligible articles and conducted a manual search in PubMed, Google Scholar, and African Journals Online. A detailed search strategy is outlined in Table S1.

2.2. Inclusion and Exclusion Criteria

The inclusion criteria were (a) African study, (b) observational design, (c) report relevant data on RRF practice, and (d) studies intended for diagnostic use. The exclusion criteria were (a) overlapping datasets, (b) where only abstract is available, (c) animal or in vitro studies, (d) duplicated and irrelevant data, and (e) non-peer-reviewed articles.

2.3. Selection Process

Identified studies were imported into EndNote X9.3.3 (Clarivate, Philadelphia, PA, USA) and grouped to remove duplicates automatically and under supervision based on matching fields of title, authors, year of publication, and journal name. Furthermore, studies were imported to Microsoft Excel version 16.87 (Microsoft Corporation, Redmond, WA, USA) and underwent manual duplicate removal through alphabetical sorting. M.H. managed the search, importing, and duplicate removal while two reviewers (A.A. and M.K.) independently screened the titles and abstracts against the predetermined inclusion and exclusion criteria. Where possible, the full texts of included articles are retrieved and subjected to full-text screening by M.H., A.A., and M.M. to make a final inclusion decision. Any conflicts in screening were resolved through consensus.

2.4. Data Extraction

After final inclusion, all authors independently extracted the following data: author name, country, number of evaluated RRF, percentages of adequately filled forms, and percentages of adequate completion of patient’s name, age, gender, LMP, hospital number, residential address, location, clinical information, provisional diagnosis, request exam, anatomical site, previous imaging studies, referrer’s name, referrer’s phone number, referrer’s signature, consultant name, the urgency of the exam, ambulatory status, date of the request, request number, status of Diabetes Mellitus, Creatinine or eGFR, and allergy. We also extracted whether issues of illegibility, inappropriate abbreviations, and informal forms were reported. Extracted data were then cross-checked, and any disparities were resolved through consensus. Our original data extraction sheet is accessible in the Supplementary (Data Extraction Sheet S1).

2.5. Quality Assessment

In this systematic review, we used the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist [29] to assess the quality of the included observational studies. The checklist consists of 22 items that cover all aspects of observational research. Each study was evaluated against these criteria and categorised as adequate, inadequate, or no information for each item. The quality metrics were filled in an Excel sheet and then uploaded into the Robvis tool [30] to generate visual representations of the quality assessments, including traffic light and summary plots. The quality assessment was independently conducted by A.A. and M.M., with any conflicts resolved through discussions and the involvement of the main author, M.H.

2.6. Statistical Analysis

Given the limitations and variability of the studies, we did not conduct a meta-analysis; instead, we mentioned the descriptive statistics of the extracted data. For each field of RRF, the maximum, minimum, mode, and median were reported using Microsoft Excel version 16.87 (Microsoft Corporation, Redmond, WA, USA). We chose not to report the median if the dataset was small, i.e., less than five studies. We also documented the presence or absence of issues related to illegibility, unconventional abbreviations, and the use of informal forms.

3. Results

3.1. Search Results

The initial electronic search across seven databases yielded 3004 studies. Following duplicate removal and title/abstract screening, 43 relevant studies underwent full-text screening. Of these, 24 studies were eligible.
The manual search yielded six relevant studies. In total, 30 eligible studies were included in the synthesis [31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60], as illustrated in the PRISMA flow chart (Figure 1). The eligible studies span from 2009 to 2023, representing eight countries: Nigeria, Ghana, Zambia, South Africa, Sudan, Kenya, Namibia, and Cameroon, as shown in Figure 2.

3.2. General Characteristics of the Studies

The number of reviewed RRFs ranged from 80 to 4465, involving various modalities, including plain X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (U/S), mammography, and hysterosalpingography. The majority of the healthcare facilities were teaching hospitals. It was often unclear what the standard was—whether it adhered to local or global guidelines or literature. Except for two facilities [38,42], all used paper forms. In Table 1, we detail the general characteristics of the included studies.

3.3. Quality Assessment

As shown in Figure 3, generalisability and addressing bias were the primary concerns. Numerous studies failed to address the applicability of their findings to other settings or populations, and only a limited number discussed potential bias sources or their mitigation strategies. However, most of the studies demonstrated satisfactory adherence to several STROBE guidelines. A detailed assessment of each study is provided in Figure S1.

3.4. Completion Practice per Fields

In Table 2, we classified the information in the RRF into five categories and reported the number of evaluating studies and the descriptive statistics of completion rates of each field. The completion rates of all fields in all studies are reported in Table S3. It is noted that researchers tended to focus on evaluating some RRF components and ignore others. Fields like clinical information, patient’s name, and age are consistently reviewed, but others, such as the urgency of the exam, exam date, and last menstrual period (LMP), are often neglected.
Patient’s biodata
Name
We found that 25 studies evaluated the completion rate of the name, which ranged from 70.2% to 100%. Most of these studies reported near-full completion, with full compliance observed in 15 studies. The median and mode values were 100%, indicating a high level of adherence. This field was the only parameter that achieved a median of 100%.
Age and Date of Birth
Our analysis reveals a wide variation in age completion, with full completion observed only in one study [38]. The median value was 86%, suggesting higher compliance in general. However, the minimum was 20.57%.
Gender and LMP
In our review, 21 studies revealed completion rates ranging from 74% to 100%. Approximately 75% of these studies reported gender completion rates exceeding 94%, demonstrating generally high compliance. In contrast, the completion rate of LMP was notably poor. It was only investigated in 11 studies, and ranged widely, from as low as 0.9% to 62.32%.
Address
It was evaluated in 16 studies, with completion rates ranging from 2.1% to 65.3%. The results generally indicate poor compliance, with several studies reporting completion rates below 10%, and more than half had completion rates below 50%.
Hospital Number
The completion of the hospital number was investigated in 15 studies and showed the greatest variability, ranging from none to full completion. While some studies report relatively high completion rates, such as 80.40%, 86.55%, 87.1%, 92.3%, 92.7%, and 93.7%, many others indicate much lower completion rates, including 2.7% and 10%.
Location and ambulatory status
Nineteen studies evaluated the patient’s location, revealing a considered variability in completion rates from 35% to 100%. With many studies reporting rates above 90%, others recorded moderate rates, like 64.6%, 72.4%, and 75%. Oppositely, only eight studies examined the patient’s ambulatory status, making it one of the least studied fields. Despite higher completion rates in the patient location field, ambulatory status generally showed lower completion rates, with most studies below 20%.
Clinical information and the clinical question
The median completion rate for clinical information is 82.8%, indicating an average but wide variability ranging from 18.2% to 99.4%. On the other hand, the clinical question was the fourth least examined field and was only investigated in 10 studies, with completion rates ranging from 23.7% to 98.4% and a median of 67%.
Requested exam
As anticipated, most studies report high completion rates for requested exams, with many achieving near or full completion. A few studies report completion rates slightly below 90% [31,39,54,58]. Despite this, the median completion rate across studies remains high at 99.45%.
Anatomical site
The anatomical site was the second least examined field, with only five evaluating studies. Two studies had near-full and full completion [44,46], while the remaining did not exceed 93.1%, with a minimum of 42.6%.
Previous imaging studies
Fifteen studies evaluated the completion of previous radiological exams, and the rates ranged from 0% to 69%. The median and mode rates were 7.4% and 0.0%.
Previous surgical history
Eight studies assessed the completion rates of previous surgeries and exhibited considerable variability, ranging from 0.35% to 59.8%.
Referrer’s contacts
The completion rates for the referrer’s name were examined in 23 studies, varying significantly from 2.3% to 99%. In contrast, the referrer’s phone number was the second least examined field, evaluated only in seven studies, with many reporting none or very low completion rates, making it amongst the most poorly filled fields.
Consultant in charge
Many studies report high completion rates for the consultant’s name, with several studies achieving rates exceeding 90% and generally maintaining above 70%. The median stands at 83.17%.
Urgency
Two studies examined the completion rates, which were 3.9% and 63%. It was the least examined field by the researchers. The scarcity of data will not allow for the drawing of interpretable conclusions.
Date of request
Generally, there are high completion rates for the date of the request, with rates ranging from 75% to full completion.
Diabetes, allergy, and kidney function
Only four studies reported allergies to radiopharmaceutical agents, each with extremely low completion rates below 8% [34,36,41,48]. Similarly, one study mentioned information on diabetic status and kidney function, which noted a poor completion rate [36].

4. Discussion

4.1. Outlines of the Current Practice

To our knowledge, this is the first paper to review the practice surrounding the RRF on a continental level. It aimed to shed light on the practice within Africa by systematically reviewing the published African literature. We found that inadequate provision of the RRF is a global issue [3,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. This pitfall might eventually result in inaccurate diagnostic conclusions, leading to inappropriate interventions and unnecessary exposure for patients and healthcare providers [32]. Therefore, accurate and adequate filling of the RRF cannot be overstated, especially in low-resource settings [31]. Garba et al. found that 20.9% of the examinations had been repeated due to missing or inappropriate information [39], which is an avoidable and unnecessary exposure.
In this review, we found variable degrees of non-compliance existed across all fields of the RRF. Fields such as the patient’s name, gender, and the requested exam show high completion rates, often reaching close to or at 100%. Meanwhile, the completion rates in other fields range from low to moderate. Of the 22 studies that reported the overall completion percentage of the RRFs, 14 found that none were fully completed, similar to a study in Pakistan [12]. Apart from this, several shortcomings were also noted: inaccurate filling, inappropriate use of abbreviations, illegibility, and the omission of critical parts from the formal RRF. In Table S3, we summarised important issues highlighted by the researchers in the studies.
While this paper does not focus on the appropriateness of the requested exams, four studies [31,33,37,38] highlighted that a significant number of requests were inappropriate (36%, 34.6%, 13.9%, and 9.2%), which, on the other hand, emphasises the importance of adequate filling of the RRF to allow the assessment of appropriateness. A study in Greece has found a similar degree of inappropriateness (41.2%) [7].

4.2. RRF Layout

Regarding the RRF layout and formality, we observed that some facilities received informal RRFs written on improvised plain sheets [37], drug prescriptions [36,47], laboratory forms, and continuation sheets [50]. Incorrect form usage, such as employing an X-ray request form for CT exams, was also noted [36]. The usage of unconventional forms is unsurprisingly prevalent in paper-based communication settings. A non-African study encountered this too [12]. The unavailability of standardised forms allows for omitting important information. The extent of informal form usage could be more significant than observed because nearly a third of the studies excluded them from the analysis [34,37,41,44,46,47,48,56].
Another fundamental problem was the design limitation and omission of critical parts from the institutional RRF, such as date of birth [36,47], gender [47], LMP [31,32,36,40,48], referrer’s contact details [31,47,48,60], referrer’s signature [47], previous imaging and surgeries [32,36,48], patient’s address [36], hospital number [40,47,48], clinical question [40], and ambulatory status [48]. In Table 3, we propose a categorised list that should be included in all radiology request forms to ensure adequate and effective documentation.
Additional concerns were the illegibility and inappropriate abbreviations, which can impede effective communication. Garba et al. reported that illegibility issues necessitated the repetition of 15% of plain X-rays [39]. In another study, a third of the requests, which is a massive number, were illegible and unclear [35]. Overall, ten studies found problems with legibility [31,35,36,39,41,50,51,56,58,59], and seven studies noted the use of unconventional abbreviations [35,41,48,52,56,58,60], which had been prevalent in more than half of the requests in the study of Jimah et al. [40]. However, this shortcoming had been widely reported outside Africa [8,10,12,16,20] with instances of good compliance like a study in Nepal [9]. Clarity of communication is mandatory in healthcare practices and should be tied to the highest possible standards.

4.3. Shortcomings in RRF Completion

Moving on to the next point, we noticed that overall, the name, age, and the requested exam are often filled out adequately in line with studies outside Africa [9,11,12] yet contrasting a study in India [8]. The name is the patient’s first identifier, and it must be legible and stated in full, i.e., first name and last name. Age is an essential identifier and has clinical and procedural relevance, too. Its omission from radiology request forms can lead to avoidable challenges in clinical decision making [39,44]. Age and its full version, the date of birth (DOB), are essential for accurate patient identification and can greatly benefit disease differentiation. However, none of the studies assessed the completeness of DOB, possibly due to its substitution with the age field, as suggested by two authors [36,47]. Another recorded issue is stating the age as a general category (adults or children) instead of specifying the number [41,52,56,60].
Gender is another identifier and is particularly relevant because some diseases are gender-specific [44]. The compliance in our study was relatively high, with a median of 96%. Conversely, despite the known risks associated with radiation exposure during pregnancy [61], the completion rate of LMP was notably poor, agreeing with a study in Pakistan [12]. It is, however, interesting that requests for procedures such as hysterosalpingography lacked LMP [44]. We also found that LMP is absent from some institutional forms [13,14].
Among the patient identifiers, the hospital number is unique and especially important when patients cannot communicate or when similar information exists [35]. The residential address is also an important identifier and is necessary for contacting and tracing patients [41]. Both were poorly reported in most of the reviewed studies. A reason for that could be the paper-based settings where the requesting method is not linked to a previously stored database and the patient registration shortfalls in Africa.
Regarding the location and ambulatory status, the ambulatory status was poorly examined and reported compared to the location. Stating the patient’s location enhances the accuracy of patient identification and can help prioritise examinations, as certain wards or settings may have higher rates of frailty and fatality [47]. Along with the patient’s mobility status, stating the location will also help the radiographer tailor the imaging technique accordingly [44]. Better results have been reported outside Africa [8,12].
When it comes to clinical information, in an updated systematic review by Castillo et al., well-provided clinical information was found to enhance the accuracy of interpretation, clinical relevance, and confidence in reporting [62]. Ahmed et al. found a significant correlation between inappropriate requests for ionising radiation tests compared to non-ionising [33]. This highlights the importance of optimum and accurate filling of clinical information to enable radiographers and radiologists to assess appropriateness and minimise the risk of unnecessary radiation exposure. In our study, the adequate completion rate ranged widely between 18.2% and 99.4%. Doctors should bear in mind that diagnostic radiologists, unlike referring clinicians, typically do not interact with patients and are not as familiar with them; thus, structuring the clinical information by mentioning the key findings in history, examination, and investigations besides stating a clinical question or provisional diagnosis is mandatory. The clinical questions have been much less evaluated and reported in our study compared to clinical information. Overall, there seems to be a trend where higher completion rates of clinical information correspond to higher completion rates of clinical questions and vice versa. However, this relationship is not absolute. It is worth highlighting that the main goal of diagnostic radiology is to address clinical inquiries through imaging techniques and assist in optimising care, which may involve the decision to refrain from conducting certain radiological tests [63]. The rationale for stating the clinical question is here. Globally, there is well-based work to improve RRFs by national standardisation of RRFs [15] and by specifying and tailoring the needed clinical information for different medical departments through Delphi studies [3,5]. Insufficient clinical information is an ongoing issue and is widely reported around the globe [8,10,11,12,13,16,18,20,21,22,23].
For the requested exam and the anatomical site, the requested exam was well reported as expected, but the anatomical site was reported in only five studies compared to 21 for the requested exam. It is important to accurately and legibly state the requested exam to prevent delay and unnecessary repetition. Garba et al. [39] found that 24% of radiological exams were repeated due to a lack of clarity regarding the requested exam, which is apparently unnecessary radiation, waiting time, and workload. The urgency of requests was the field that was examined the least, with only two evaluating studies, despite its central role in prioritising exams.
This review also showed that the past medical history involving surgeries and previous imaging studies has been evaluated in 8 and 15 studies with generally poor completion rates, pointing to widespread non-compliance. Similarly, the adequate completion of previous radiological studies was noted to be 23.4% in a study in Greece [7]. Stating past surgical and medical history is important to avoid misinterpretations related to anatomical distortions.
Reviewing the referrer’s details, we found very poor practice, especially in recording the phone or bleep numbers, which was the second worst parameter echoing results in Pakistan [12,13], Nepal [9,11], and the U.K. [17]. The reasons behind this may be the availability of alternative communication methods, limitations in the design of the RRFs, or a general lack of awareness. RRFs should contain complete referrer contact information to facilitate two-way communication and must also be signed to ensure medicolegal validation.
Consistent with findings outside Africa [12,13], we observed most forms lacked information regarding patients’ diabetic and allergic statuses and kidney function—even in studies involving CT scans or other contrast-enhanced exams. They also lacked information about medical devices or implants, similar to a study in Brazil [6].

4.4. Potential Drivers of Poor Compliance

Africa has inefficient health administration and management systems that face challenges on multiple levels [64]. In such a setting, quality and safety in imaging are more relevant to maintaining and improving gains from the increased imaging use [1]. Before addressing the possible obstacles to adequate provision of RRFs, it is important to note that, due to the shortage of radiologists in Africa, imaging interpretations are sometimes performed by the requesting physician [65,66] or radiographers [66]. This can result in these practitioners neglecting to fill out the forms adequately or not filling them out at all.
However, fundamental and core barriers play a role in the shortcomings noticed in our study. For example, the high turnover [67] of radiology and radiography personnel makes it challenging to sustain good practices over time. The lack of consistent policies and guidelines to organise radiation exposure at the level of the continent will make local professional bodies less adherent to the standards. The financial and organisational infrastructure challenges impede the transition to an electronic health system [68]; as a result, issues like illegibility, non-compliance, and inappropriate abbreviation become inevitable with paper-based communication and are found to be significantly addressed following the transition into an electronic-based RRF [13,14].
On the other hand, some addressable issues do exist. For example, it was unclear what the local standard was for filling the RRF, which made it difficult to audit and identify the gaps in local practice. The higher prevalence of defensive medicine practice in Africa [69] will lead practitioners to follow the norm rather than evidence at the expense of radiation safety. The poor awareness of radiation exposure risks [70] and the paucity of proper training led professionals to be naive to the efficient and safe use of diagnostic radiology, which in turn ended in overuse or underuse [67]. The design limitations of the RRF and the omission of important parts will imply the unimportance of some information, which is contrary to the truth.
The culture of medical dominance in the cycle of radiology acquisition has also been found to hinder the vigilant role of radiographers [71]. However, radiographers are the final point of contact before patients are exposed to radiation. They must advocate for patients, ensuring protection from unnecessary exposure, as this is their legal, ethical, and professional obligation [72].
To alleviate this situation, joint efforts between local institutions, professional bodies, and radiology departments should be made to empower radiographers and radiologists and promote a sense of professional accountability among medical practitioners.

4.5. Study Limitation

While this study provides insights into the practices surrounding RRF completion in Africa, several limitations must be considered. Our review is based on data from only eight African countries, which may not fully represent the entire continent. The variability in evaluated modalities, sample sizes, and healthcare settings could affect generalisability.
We noticed that the researchers tended to focus on evaluating some RRF components and ignoring the others. Fields like clinical information, patient’s name, and age are consistently reviewed, but others, such as the urgency of the exam, exam date, and LMP, are often neglected. Also, as revealed by the quality assessment, there are concerns about generalisability and managing bias. Therefore, an accurate picture is still to be obtained.
Finally, our review is the first of its kind, laying the groundwork for future research. By conducting similar reviews on other continents, we can enhance the contextualisation of our findings, contributing at the end to a more inclusive understanding of the subject globally.

5. Conclusions

Negligence in completing radiology request forms is prevalent across Africa and mandates being addressed. A variable degree of non-compliance was observed across all fields. Radiographers, radiologists, and institutions could create ample room for impactful changes based on the ALARA principle, value-based healthcare, and evidence-based medicine principles. Effective communication in the patient’s best interests requires a thorough, clear, and complete message.

6. Recommendations and Future Directions

  • Radiographers should exercise their authority to return any RRFs that are inadequately filled, including those that are improvised.
  • Local radiological departments should conduct educational meetings highlighting the clinical and medicolegal importance of adequate RRFs, particularly targeting junior radiographers and doctors, along with regular local audits to maintain adherence to the best available practices.
  • Implement nationwide projects to unify and standardise a national RRF.
  • Local institutions should establish policies and guidelines to govern the use of diagnostic radiology services and their aiding tools, especially the radiology request form.
  • Integrate Radiation Protection Acts and regulations into medical school curricula and emphasise their mandatory application in clinical practice.
  • While transitioning to a paperless system could significantly address current issues, developing a well-designed, institutional RRF is a more immediately feasible and cost-effective solution.
  • We encourage African researchers to conduct studies evaluating RRF practice in their countries to draw a clearer picture of African problems and solutions from an African point of view.
  • Future studies should evaluate all fields of the RRF, especially those that were least examined in this review, such as LMP, clinical questions, ambulatory status, anatomical site, past medical history, referrer’s contact details, and exam urgency.
  • We finally recommend conducting similar reviews on continental levels to draw actual contextualisation and global understanding.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/diagnostics14151694/s1, Table S1: Detailed search strategy; Figure S1: Quality assessment per study; Table S2: Completion rates of RRF fields; Table S3: Issues highlighted by researchers; Data Extraction Sheet S1.

Author Contributions

Conceptualisation, M.H.; methodology, M.H.; formal analysis, M.M. and A.A.; writing—original draft preparation, M.H., A.A. and M.M.; writing—review and editing, M.H., A.A. and M.M.; supervision, M.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

All data are available within the manuscript and its Supplementary Material.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Kawooya, M.G.; Kisembo, H.N.; Remedios, D.; Malumba, R.; Perez, M.d.R.; Ige, T.; Hasford, F.; Brown, J.K.; Lette, M.M.; Mansouri, B.; et al. An Africa point of view on quality and safety in imaging. Insights Imaging 2022, 13, 58. [Google Scholar] [CrossRef] [PubMed]
  2. The International Commission on Radiological Protection. Radiological Protection in Medicine; Valentin, J., Ed.; ICRP Publication 105, Annals of the ICRP; Elsevier: Amsterdam, The Netherlands, 2007; Volume 37, ISSN 0146-6453. [Google Scholar]
  3. Salaffi, F.; Mazzei, M.A.; Aliprandi, A.; Martino, F.; Moretti, B.; Silvestri, E.; Di Meglio, N.; Bagnacci, G.; Di Carlo, M.; Sinigaglia, L.; et al. Structured request form in musculoskeletal radiology examinations (CONCERTO): Results of an expert Delphi consensus—Structured radiology request form for correct classification of patients to undergo radiological examinations of the Italian Society of Medical and Interventional Radiology (SIRM), the Italian Society of Rheumatology (SIR) and the Italian Society of Orthopedics and Traumatology (SIOT). La Radiol. Medica 2024, 129, 307–314. [Google Scholar]
  4. Kawooya, M.G.; Kisembo, H.N.; Malumba, R.; Nsereko, E. Effectiveness of clinical imaging guidelines to reduce inappropriate head computed tomography imaging: A case of Uganda. Egypt. J. Radiol. Nucl. Med. 2022, 53, 164. [Google Scholar] [CrossRef]
  5. Castillo, C.; Steffens, T.; Livesay, G.; Sim, L.; Caffery, L. IMPACT (Information Medically Pertinent in Acute Computed Tomography) requests: Delphi study to develop criteria standards for adequate clinical information in computed tomography requests in the Australian emergency department. J. Med. Radiat. Sci. 2022, 69, 421–430. [Google Scholar] [CrossRef]
  6. Anger, J.; Elias, P.E.; Moraes, P.D.C.; Hamerschlak, N. A review of data in medical request and the patient questionnaire for magnetic resonance evaluation of silicone breast implants. Einstein 2017, 15, 465–469. [Google Scholar] [CrossRef]
  7. Triantopoulou, C.; Tsalafoutas, I.; Maniatis, P.; Papavdis, D.; Raios, G.; Siafas, I.; Velonakis, S.; Koulentianos, E. Analysis of radiological examination request forms in conjunction with justification of X-ray exposures. Eur. J. Radiol. 2005, 53, 306–311. [Google Scholar] [CrossRef]
  8. Rao, V.R. Audit of radiology request forms—“Are they adequately filled?”. J. Med. Sci. Res. 2014, 2, 41–44. [Google Scholar]
  9. Badu, M. Study of Missing Clinical Details in Computed Tomography Radiology Request Forms: A Descriptive Cross-sectional Study. J. Nepal Med. Assoc. 2020, 58, 719–723. [Google Scholar] [CrossRef]
  10. Sah, R.; Lohani, B.; Singh, Y.P. Inadequate Completion of Computed Tomography Request Forms of Patients Visiting the Department of Radiology and Imaging in a Tertiary Care Centre. J. Nepal Med. Assoc. 2023, 61, 878–881. [Google Scholar] [CrossRef]
  11. Aabesh, K.; Bhandari, S. Are Clinicians Communicating adequately with Radiologists through Radiological requisition? A Clinical Audit assessing Current local practice. Nepal Med. J. 2022, 4, 56–59. [Google Scholar] [CrossRef]
  12. Zafar, U.; Abid, A.; Ahmad, B.; Ahmad, H.A.; Zafar, F.; Baig, M.U.; Akram, S. Adequacy of Completion of Computed Tomography Scan Request Forms at a Tertiary Care Center in Pakistan: A Clinical Audit. Cureus 2018, 10, e3470. [Google Scholar] [CrossRef]
  13. Barakzai, M.D.; Sheer, Z.Z.; Muhammad, A.; Alvi, A.; Khan, N.; Nizamani, W.M.; Beg, M.; Siddiqui, S. Evaluation of Radiology Request Forms in a Tertiary Care Hospital: An Audit With a Focus on the Impact of Technological Intervention. Cureus 2021, 13, e13335. [Google Scholar] [CrossRef]
  14. Al Muallem, Y.; Al Dogether, M.; Househ, M.; Saddik, B. Auditing The Completeness and Legibility of Computerised Radiological Request Forms. J. Med. Syst. 2017, 41, 199. [Google Scholar] [CrossRef]
  15. Albahiti, S.; Khafaji, M.; Jamjoom, L.; Badeeb, A. Improving inappropriate radiology referrals: A template for imaging requests in Saudi Arabia. Egypt. J. Radiol. Nucl. Med. 2023, 54, 138. [Google Scholar] [CrossRef]
  16. Wettasinghe, M.C.; Rosairo, S.; Wickramasinghe, N. Data quality of request forms for lumbar spine X-rays: A clinical audit form a tertiary care hospital in Sri Lanka. Sri Lanka J. Radiol. 2023, 9, 27–31. [Google Scholar] [CrossRef]
  17. Oswal, D.; Sapherson, D.; Rehman, A. A study of adequacy of completion of radiology request forms. Radiography 2009, 15, 209–213. [Google Scholar] [CrossRef]
  18. Abbas, M.; Omer, A.; Hamad, M. Adequacy of clinical information on radiology request cards from medical assessment unit, Clinical Audit. Nucl. Med. Biomed. Imaging 2016, 1, 5–6. [Google Scholar]
  19. Rawoo, R. Clinical audit of the completion of C.T. scan request forms. Br. J. Radiol. 2018, 91, 20180272. [Google Scholar] [CrossRef] [PubMed]
  20. Cohen, M.D.; Curtin, S.; Lee, R. Evaluation of the quality of radiology requisitions for intensive care unit patients. Acad. Radiol. 2006, 13, 236–240. [Google Scholar] [CrossRef]
  21. Shah, C.C.; Linam, L.; Greenberg, S.B. Inappropriate and cloned clinical histories on radiology request forms for sick children. Pediatr. Radiol. 2013, 43, 1267–1272. [Google Scholar] [CrossRef]
  22. Gunderman, R.B.; Phillips, M.D.; Cohen, M.D. Improving Clinical Histories on Radiology Requisitions. Acad. Radiol. 2001, 8, 299–303. [Google Scholar] [CrossRef] [PubMed]
  23. Pack, J.R.; Yuh, W.T.C.; Sonnad, J.R.; Maley, J.E.; Petropoulou, K.; Wegner, K.F.; Loftus, C.M.; Mayr, N.A.; Whitehead, D.P.; Maier, G.J. Request form history, clinical indication, and yield of brain magnetic resonance studies. J. Magn. Reson. Imaging 2004, 20, 228–232. [Google Scholar] [CrossRef] [PubMed]
  24. Adequate Completion of Radiology Request Forms [QSI Ref: XR-501]|The Royal College of Radiologists. Available online: https://www.rcr.ac.uk/career-development/audit-quality-improvement/auditlive-radiology/adequate-completion-of-radiology-request-forms-qsi-ref-xr-501/ (accessed on 17 May 2024).
  25. The American College of Radiology. ACR Practice Parameter for Communication of Diagnostic Imaging Findings; Revised by Mark J. Adams, MD, MBA, FACR, and the Committee on Practice Parameters—General, Small, Emergency and/or Rural Practices. Revised 2020, amended 2021 and 2023; American College of Radiology: Reston, VA, USA, 2020. [Google Scholar]
  26. European Society of Radiology. ESR communication guidelines for radiologists. Insights Imaging 2013, 4, 143–146. [Google Scholar] [CrossRef] [PubMed]
  27. Garling, D. Standards of Practice for Clinical Radiology. 11.2. Sydney: The Royal Australian and New Zealand College of Radiologists. 2020. Available online: www.ranzcr.edu.au (accessed on 17 May 2024).
  28. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
  29. Von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ 2007, 335, 806–808. [Google Scholar] [CrossRef] [PubMed]
  30. McGuinness, L.A.; Higgins, J.P.T. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualising risk-of-bias assessments. Res. Synth. Methods 2020, 12, 55–61. [Google Scholar] [CrossRef]
  31. Ademola, A.O.; Adeyeye, O.O.; Ojo, O. Audit of Completion of Radiology Request for Thoracic Imaging in a Tertiary Health Care Facility in Lagos, South West Nigeria. Niger. Hosp. Pract. 2023, 32, 3. [Google Scholar]
  32. Bwalya, M.; Bwanga, O.; Mvula, J.Y.; Munsanje, F.; Muntanga, B. Adequacy of completion of radiology request forms at St. Francis’ Hospital of Katete District: A clinical audit in Zambia. Malawi Med. J. 2023, 35, 111–116. [Google Scholar] [CrossRef] [PubMed]
  33. Ahmed, S.S.; Onyambu, C.K.; Omamo, E.; Odhiambo, A. Appropriateness of imaging modality choice by doctors at the Kenyatta National Hospital’s Accident and Emergency Department. S. Afr. J. Radiol. 2022, 26, 4. [Google Scholar] [CrossRef]
  34. Chi, D.; Mohammad, H.; Annongu, I.; Abdullahi, A.; Ugande, A.; Kator, P. Quality of Completion of Computed Tomography Request Forms by Clinicians: A Simple Audit Assessing Local Experience. West J. Med. Biomed. Sci. 2022, 3, 115–124. [Google Scholar]
  35. Kuvare, M.; Amkongo, M.; Karera, A.; Daniels, E.R. An Audit of X-Ray Request Form Completion at Two Namibian State Hospitals: How Compliant are the Doctors? S. Afr. Radiogr. 2022, 60, 42–48. [Google Scholar] [CrossRef]
  36. Chanda, E.; Bwanga, O.; Sindaza, N.; Chipampe, M.N.; Chisha, M. Audit of Completion of Computed Tomography (C.T.) Request Forms at the Cancer Diseases Hospital (CDH) of Zambia. Med. J. Zambia 2021, 47, 289–296. [Google Scholar] [CrossRef]
  37. Robinson, E.; Ijeruh, O.; Wonodi, W.; Abam, R. Clinical governance in radiologic practice: Evaluating the appropriateness of radiologic investigation considering patient clinical information using the radiology request form. Biomed. Res. J. 2021, 8, 20. [Google Scholar] [CrossRef]
  38. Edzie, E.K.M.; Dzefi-Tettey, K.; Gorleku, P.N.; Brakohiapa, E.K.; Botwe, B.O.; Amankwa, A.T.; Idun, E.A.; Kusodzi, H.; Asemah, A.R. Audit of the appropriateness of the indication for obstetric sonography in a tertiary facility in Ghana. Pan Afr. Med J. 2021, 40, 1–12. [Google Scholar]
  39. Lawal, Y.; Garba, I.; Bashir, H.S.; Mohammed, S.; Dambele, M.; Hikima, M.S.; Yahuza, M.A. Evaluation of inadequately filled radiology request forms with its impact on patient radiation exposure and waiting time in a tertiary care hospital: A preliminary report from Northwest Nigeria. West Afr. J. Radiol. 2021, 28, 55. [Google Scholar] [CrossRef]
  40. Jimah, B.B. Audit of Radiology Request Form for Completion and Usefulness of Clinical History: Teaching Hospital Experience, Ghana. Radiol. Res. Pr. 2021, 2021, 5583442. [Google Scholar] [CrossRef] [PubMed]
  41. Robinson, E.; Ijeruh, O.; Wonodi, W.; Abam, R.; Wekhe, C. Radiology request form: Evaluating its complete filling in South-South, Nigeria. J. Radiat. Med. Trop. 2021, 2, 18–23. [Google Scholar] [CrossRef]
  42. Beviss-Challinor, K.B.; Kidd, M.; Pitcher, R.D. How useful are clinical details in blunt trauma referrals for computed tomography of the abdomen? S. Afr. J. Radiol. 2020, 24, 1–6. [Google Scholar] [CrossRef] [PubMed]
  43. Alameen, A.A.; Abdelrahim, M.; Salih, A.; Bahar, M. An Audit of the completion of Radiology Request Form in Soba University Hospital (SUH) “are they appropriately filled in. IOSR J. Dent. Med. Sci. 2019, 18, 40–43. [Google Scholar]
  44. Chukwuma, J.N.; Ugwuanyi, D.C.; Abonyi, L.; Ugwoke, C. Evaluation of Compliance of Adequate Filling of Radiology Request Forms in Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Nigeria. Middle East J. Sci. Res. 2019, 27, 250–254. [Google Scholar]
  45. Khadija, M.A.; Musa, D.Y.; Hassan, M.; Mohammed, S. Audit of Radiology Request Cards in a Tertiary Hospital in NorthWest Nigeria. J. Radiogr. Radiat. Sci. 2019, 33, 21–24. [Google Scholar]
  46. Mohammed, H.; Teryima Iortile, J.; Ekeme Ikubor, J.; Ejeh, E. An Assessment of The Adequacy of Filling of Radiology Request Cards in A Teaching Hospital in Makurdi, North Central Nigeria. IOSR J. Dent. Med. Sci. 2018, 15, 71–74. [Google Scholar]
  47. Hk, A. Audit of X-Ray Requisition form at Tamale Central Hospital, Ghana. J. Radiol. Radiat. Ther. 2018, 6, 1–5. [Google Scholar]
  48. Onwuchekwa, R.; Maduforo, C. Analysis of the Adequacy of Radiological Request Form Completion: A Multicentre Evaluation. Pak. J. Radiol. 2017, 27, 233–238. [Google Scholar]
  49. Agi, C.; Alagoa, P.J.; Fente, B.G. A Simple Audit of Radiological Request Forms at the University of Port Harcourt Teaching Hospital. Niger. Health J. 2015, 15, 151–154. [Google Scholar]
  50. Akintomide, A.; Ikpeme, A.; Ngaji, A.; Ani, N.; Udofia, A. An audit of the completion of radiology request forms and the request practice. J. Fam. Med. Prim. Care 2015, 4, 328–330. [Google Scholar] [CrossRef] [PubMed]
  51. Abubakar, M.; Nwobi, I.C.; Zira, D.J.; Luntsi, G. Evaluation of the Adequacy of Completion of Radiology Request Forms in a Tertiary Hospital, Northeast, Nigeria. Pac. J. Sci. Technol. 2015, 16, 219–224. [Google Scholar]
  52. Oyedeji, O.A.; Ogbenna, A.A.; Iwuala, S.O. An audit of request forms submitted in a multidisciplinary diagnostic center in Lagos. Pan Afr. Med. J. 2015, 20, 423. [Google Scholar] [CrossRef] [PubMed]
  53. Danfulani, M.; Musa, M. Radiology Request Forms (RRF) Inadequately Completed; the Case of a Tertiary Health Center in Northwest Nigeria. Int. J. Clin. Biomed. Res. 2015, 1, 1–4. [Google Scholar]
  54. Moifo, B.; Kamgnie, M.N.; Fointama, N.F.; Tambe, J.; Tebere, H.; Fotsin, J.G. Assessment of the completeness of medical imaging request forms in a sub-Saharan African setting. Med. Sante Trop. 2014, 24, 392–396. [Google Scholar] [CrossRef]
  55. Schouwenburg, F.; Ackermann, C.; Pitcher, R. An audit of elective outpatient magnetic resonance imaging in a tertiary South African public-sector hospital. S. Afr. J. Radiol. 2014, 18, 1–5. [Google Scholar] [CrossRef]
  56. Afolabi, O.A.; Fadare, J.O.; Essien, E.M. Audit of Completion of Radiology Request Form in a Nigerian Specialist Hospital. Ann. Ib. Postgrad. Med. 2012, 10, 48–52. [Google Scholar] [PubMed]
  57. Irurhe, N.; Sulaymon, F.A.; Olowoyeye, O.A.; Adeyomoye, A.A.O. Compliance Rate of Adequate Filling of Radiology Request Forms in a Lagos University Teaching Hospital. World J. Med. Sci. 2012, 7, 10–12. [Google Scholar]
  58. Yousef, M.O.; Ayad, C.; Sulieman, A. Evaluation of Radiology Request Forms in Diagnostic Centers in Khartoum State. Sudan Med. Monit. 2011, 6, 201–210. [Google Scholar]
  59. Adebayo, S.; Awosanya, G.; Balogun, B.; Osibogun, A. Multicentre Assessment of Radiology Request Form Completion in South-West Nigeria. Niger. Hosp. Pr. 2009, 3, 80–83. [Google Scholar] [CrossRef]
  60. Akinola, R.; Akinkunmi, M.; Wright, K.; Orogbemi, O. Radiology request forms: Are they adequately filled by clinicians? Internet J. Radiol. 2009, 12, 1–5. [Google Scholar]
  61. The International Commission on Radiological Protection. Pregnancy and Medical Radiation; ICRP Publication 84, Annals of the ICRP; Elsevier: Oxford, UK, 2000; Volume 30, ISSN 0146-6453. [Google Scholar]
  62. Castillo, C.; Steffens, T.; Sim, L.; Caffery, L. The effect of clinical information on radiology reporting: A systematic review. J. Med Radiat. Sci. 2021, 68, 60–74. [Google Scholar] [CrossRef] [PubMed]
  63. Brady, A.; Brink, J.; Slavotinek, J. Radiology and Value-Based Health Care. JAMA 2020, 324, 1286. [Google Scholar] [CrossRef] [PubMed]
  64. Muthuri Kirigia, J.; Pathe Barry, S. Health challenges in Africa and the way forward. Int. Arch. Med. 2008, 1, 27. [Google Scholar] [CrossRef] [PubMed]
  65. Nigatu, A.M.; Yilma, T.M.; Gezie, L.D.; Gebrewold, Y.; Gullslett, M.K.; Mengiste, S.A.; Tilahun, B. Medical imaging consultation practices and challenges at public hospitals in the Amhara regional state, Northwest Ethiopia: A descriptive phenomenological study. BMC Health Serv. Res. 2023, 23, 787. [Google Scholar] [CrossRef]
  66. Van de Venter, R.; ten Ham-Baloyi, W. Image interpretation by radiographers in South Africa: A systematic review. Radiography 2019, 25, 178–185. [Google Scholar] [CrossRef] [PubMed]
  67. Aderinto, N. Diagnosing the disparities: An analysis of the current state of medical imaging in Africa and strategies for improvement: A correspondence. Int. J. Surg. Glob. Health 2023, 6, e138. [Google Scholar] [CrossRef]
  68. Koumamba, A.P.; Bisvigou, U.J.; Ngoungou, E.B.; Diallo, G. Health information systems in developing countries: Case of African countries. BMC Med Inf. Decis. Mak. 2021, 21, 232. [Google Scholar] [CrossRef] [PubMed]
  69. Zheng, J.; Lu, Y.; Li, W.; Zhu, B.; Yang, F.; Shen, J. Prevalence and determinants of defensive medicine among physicians: A systematic review and meta-analysis. Int. J. Qual. Health Care 2023, 35, mzad096. [Google Scholar] [CrossRef] [PubMed]
  70. Allam, S.M.E.; Algany, M.M.A.; Khider, Y.I.A. Radiation safety compliance awareness among healthcare workers exposed to ionising radiation. BMC Nurs. 2024, 23, 208. [Google Scholar] [CrossRef] [PubMed]
  71. Chilanga, C.C.; Olerud, H.M.; Lysdahl, K.B. Radiographers’ actions and challenges when confronted with inappropriate radiology referrals. Eur. Radiol. 2022, 32, 4210–4217. [Google Scholar] [CrossRef]
  72. Vom, J.; Williams, I. Justification of radiographic examinations: What are the key issues? J. Med. Radiat. Sci. 2017, 64, 212–219. [Google Scholar] [CrossRef]
Diagnostics 14 01694 g001
Figure 1. PRISMA flowchart demonstrating the inclusion process.
Figure 1. PRISMA flowchart demonstrating the inclusion process.
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Figure 2. Countries of the studies created by mapchart.net.
Figure 2. Countries of the studies created by mapchart.net.
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Figure 3. Summary plot for quality assessment.
Figure 3. Summary plot for quality assessment.
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Table 1. General characteristics of the studies.
Table 1. General characteristics of the studies.
ReferenceAuthor, Year of PublicationCountryRRF NumbersModalityType of Healthcare FacilityRRF FormatPercentage of Completely Filled Forms
[31]Ademola et al., 2023Nigeria96CT ChestPublic teaching hospitalFormalNone
[32]Bwalya et al., 2023Zambia974Plain radiographyTertiary hospitalFormal9.50%
[33]Ahmed et al., 2022Kenya1053X-ray, CT, U/S, and MRIPublic hospitalFormal-
[34]Chi et al., 2022Nigeria303CTUniversity teaching hospitalMixed *None
[35]Kuvare et al., 2022Namibia172Pelvic and cervical spine plain X-rayPublic hospitalsFormal6.6%
[36]Chanda et al., 2021Zambia80CTPublic hospitalMixedNone
[37]Donald et al., 2021Nigeria2053X-ray, U/S, CTPublic tertiary hospitalMixed-
[38]Edzie et al., 2021Ghana527Obstetric sonographyPublic tertiary hospitalFormal E-
[39]Garba et al., 2021Nigeria158Plain X-rayTertiary hospitalFormalNone
[40]Jimah 2021Ghana500CT, general and vascular U/S, hysterosalpingography, mammography, and other special studiesPublic tertiary hospitalFormalNone
[41]Robinson et al., 2021Nigeria1131U/S, X-ray, CT, and MRIPublic tertiary hospitalFormal-
[42]Beviss-Challinor et al., 2020South Africa139CT abdomenPublic tertiary hospitalFormal ENone
[43]A. Alameen et al., 2019Sudan216-Public tertiary hospitalFormalNone
[44]Chukwuma et al., 2019Nigeria700-Public teaching hospitalFormal24.8%
[45]Khadija et al., 2019Nigeria400U/S, CT, and plain X-rayTertiary hospitalFormal0.98%
[46]Mohammed et al., 2018Nigeria163X-ray and CTTeaching hospitalFormal42.9%
[47]Hk 2018Ghana189X-rayPrimary public hospitalFormalNone
[48]Onwuchekwa et al., 2017Nigeria X-ray, U/S, MRI, CTMulticentre (three public hospitals)FormalNone
[49]Agi et al., 2015Nigeria2053-Public teaching hospitalFormal-
[50]Akintomide et al., 2015Nigeria580Plain X-rayPublic tertiary teaching hospitalMixedNone
[51]Abubakar et al., 2015Nigeria339Plain X-rayTertiary teaching hospitalFormalNone
[52]Oyedeji et al., 2015Nigeria4465-Private tertiary diagnostic centre-≤1.3%
[53]Danfulani et al., 2015Nigeria214Plain X-rayPublic tertiary health centreFormal2.3%
[54]Moifo et al., 2014Cameron262U/S, CT, and plain radiographyPublic university hospitalFormal1.1%
[55]Schouwenburg et al., 2014South Africa516MRIPublic tertiary hospital--
[56]Afolabi et al., 2012Nigeria202Plain and contrast studies X-rayPublic specialist hospitalMixed89.1%
[57]Irurhe et al., 2012Nigeria300Plain X-ray, CT, and U/SPublic teaching hospitalFormalNone
[58]Yousef et al., 2011Sudan350X-rayMulticentre (four governmental teaching hospitals and one private specialised hospital)MixedNone
[59]Adebayo et al., 2009Nigeria600Plain radiography, U/SMulticentre (three public teaching tertiary hospitals)Formal4.8%
[60]Akinola et al., 2009Nigeria145CT and MRITertiary teaching hospitalFormalNone
* means the facility received formal and informal RRF. E stands for electronic RRF.
Table 2. Completion rates as per fields.
Table 2. Completion rates as per fields.
Field (Number of Evaluating Studies)Maximum %Minimum %Median %Mode %, (Number of Frequencies)
Patient’s biodataName (25)100%70.20%100%100% (13)
Age (25)100%20.57%86%None
Gender (21)100%74%96%None
LMP (11)62.32%0.9%18.4%18.4% (2)
Address (16)65.3%2.1%12.65%None
Hospital No (15)100%0.0%71.4%None
Location (19)100%35.1%86.3%92.4% (2)
Ambulatory status (8)57%1.4%3.8%1.4% (2)
D.M. (1)----
Creatinine (1)----
Allergy (4)8%2.5%-None
Clinical dataClinical information (29)99.4%18.2%82.35%98% (2)
Clinical diagnosis or question to be answered (10)98.4%23.7%66.6%None
Anatomical site (5)100%42.6%93.1%None
Radiological exam dataRequested exam (21)100%60%99.45%100% (6)
Urgency (2)63%3.9%-None
Date (19)100%75.5%92%97% (2)
Medical backgroundPrevious imaging studies (15)69%0.0%7.4%0.0% (2)
Previous surgeries (8)59.8%0.35%10.4%None
Referrer’s dataName (23)99%2.3%86%None
Phone or bleep number (7)10%0.0%0.0%0.00% (4)
Signature (19)100%44%89.3%None
Consultant name (14)99.7%56.4%82.2%None
Table 3. Proposed components to be included in the Radiology Request Form.
Table 3. Proposed components to be included in the Radiology Request Form.
BiodataName
Date of birth (DD/MM/YYYY)
Gender
LMP if child-bearing-age female
Residential address
Hospital number
Ambulatory status
Clinical informationClinical information
Clinical question or provisional diagnosis
Previous medical and surgical histories
Previous imaging studies
Location/department
Requested exam informationRequest exam
Anatomical site
Urgency
Date of the exam
Allergies, eGFR or creatinine levels, and diabetic status for contrast studies
Medical devices or safety checklist for MRI
Referrer’s informationReferrer’s name
Referrer’s mobile/bleep number
Referrer’s signature
Name of consultant in charge
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Hajalamin, M.; Awadalla, A.; Mukhtar, M. Assessing, Advising, and Advancing the Filling Practices of the Radiology Request Form in Africa: A Systematic Review. Diagnostics 2024, 14, 1694. https://doi.org/10.3390/diagnostics14151694

AMA Style

Hajalamin M, Awadalla A, Mukhtar M. Assessing, Advising, and Advancing the Filling Practices of the Radiology Request Form in Africa: A Systematic Review. Diagnostics. 2024; 14(15):1694. https://doi.org/10.3390/diagnostics14151694

Chicago/Turabian Style

Hajalamin, Mohamed, Almontasir Awadalla, and Mahmoud Mukhtar. 2024. "Assessing, Advising, and Advancing the Filling Practices of the Radiology Request Form in Africa: A Systematic Review" Diagnostics 14, no. 15: 1694. https://doi.org/10.3390/diagnostics14151694

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