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Volume 6, Issue 5 (Suppl)
OMICS J Radiol, an open access journal
ISSN: 2167-7964
Radiology and Oncology 2017
October 19-20, 2017
World Congress on
October 19-20, 2017 | New York, USA
Radiology and Oncology
Assessment of the appropriateness of out-of-hours MRI spine imaging referrals for metastatic spinal cord
compression
Melosa D’souza, Mariyah Selmi, Thomas Rogers
and
Navin Khanna
Royal Oldham Hospital, England
Background:
Metastatic spinal cord compression (MSCC) occurs when a tumour spreads directly to the spine, or from collapse of the
tumour-infiltrated vertebra, resulting in spinal cord compression. This often presents as a neurological emergency with irreversible
damage occurring within hours or days. Rapid assessment, diagnosis and referral to a specialist centre is vital to prevent this. Current
NICE guidelines set out specific criteria to identify cases requiring urgent imaging andmanagement. Patients with known or unknown
malignancy which meet this criteria must be scanned urgently within 24 hours.
Aims:
We aimed to identify which out-of-hours referrals for MSCC met the current NICE guidelines, in order to ensure proper use
of limited out-of-hours resources.
Method:
Retrospective audit of trust wide MRI whole spines conducted between 5-9pm on weekday and 8am-9pm on weekends. We
analysed 5 years of data from 2012 to 2016 inclusive. Patients are characterized into 3 groups: (1) Appropriate referral for 24 hour
MRI, (2) Inappropriate referral for 24H MRI (no neurological symptoms) and (3) Insufficient clinical details.
Results:
A total of 276MRI scans were performed out-of-hours. Of these, 215 scans were 24-hour urgent MSCC requests. 67% of these
requests were appropriate (group 1), whereas 15% were inappropriate (group 2) and 18% contained inadequate clinical information
(group 3) to justify the imaging request. Of all the out-of-hour scans, only 3% showed a MSCC requiring urgent neurosurgical
assessment. 9.7% showed spinal cord compression secondary to alternative pathology, for example, a disc-osteophyte complex. Of the
group 2 and group 3 referrals, only 1.4% demonstrated MSCC.
Discussion:
Radiology on calls are busy; acquisition of adequate images and subsequent reporting of MRI scans is time consuming;
additionally, MRI scans are expensive, therefore to efficiently use the time and resources of the on-call radiology team, strict referral
pathways and vetting systems need to be in place. Our study showed 54% of groups 2 and 3 had insufficient clinical data to determine
whether a 24 hour scan was warranted. For example, some of the referrals had no mention of the presence of neurological symptoms,
making it difficult to determine the necessity of an urgent scan. In order to streamline this, we developed a proforma with stricter
criteria, which adheres to the NICE guidelines, as part of the vetting process. This has received promising feedback.
Conclusion:
To ensure that, patients with an oncological emergency are assessed, managed and treated appropriately, out-of-hours
MRI resources need to be used appropriately. This involves meticulous vetting of the requests to ensure inappropriate referrals are not
reducing availability of valuable out-of-hours scans.
Biography
Melosa D’souza has completed her MBBS iBSC from University College London. She has a keen interest in Raiology with a specialist in management of Oncological
emergencies. She is currently working at the Royal Oldham Hospital, Pennine Acute NHS Trust, UK.
melosadsouza@doctors.org.ukMelosa D’souza et al., OMICS J Radiol 2017, 6:5 (Suppl)
DOI: 10.4172/2167-7964-C1-015