ANALYSIS OF THE ADEQUACY OF RADIOLOGICAL REQUEST FORM COMPLETION: A MULTICENTRE EVALUATION

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1 ANALYSIS OF THE ADEQUACY OF RADIOLOGICAL REQUEST FORM COMPLETION: A MULTICENTRE EVALUATION Onwuchekwa RC, Maduforo CO ORIGINAL ARTICLE De partm e ntofradiology, Faculty ofclinicalscie nce s, Co le ge ofh e alth Scie nce s, Unive rs ity ofporth arcourt, Rive rs State, Nige ria. PJR July - September 17; 7(): -8 ABSTRACT BACKGROUND AND AIM: Radiology re q ue s t form s (RRFs ) are clinicaldocum e nts th ats tate th e patie nt s biodata, re q uis ite inve s tigation, jus tification for th e inve s tigation and ide ntitie s ofth e re fe rring clinician. Th e aim ofth e s tudy is to de te rm ine th e rate ofinade q uacy in com ple ting th e radiology re q ue s tform s in orde r to cre ate aw are ne s s on th e im port ofth e inform ation on th e m e dicalre q ue s t form s am ongs t th e clinicians. METHODS: Th is w as a de s criptive s tudy de s igne d to m e as ure th e com pliance ofth e re fe rring clinicians in com ple ting th e radiology re q ue s tform s. Radiology re q ue s tform s w e re co le cte d from th e radiology de partm e nt of th e th re e large s tpublic h os pitals in our locality ove r five cons e cutive ye ars and th e rate ofcom ple tion ofe ach fie ld in th e re q ue s tform s w e re analys e d. RESULTS: Th e le as tcom ple te d fie ld in th e patie nts biodata are patie nts addre s s, folde r num be r, ph one num be r and las tm e ns trualpe riod(lm P) w h ich are %,1 %, 1 and.% re s pe ctive ly for h os pitala, and %, 1%,.% and11.% for h os pitalb. Folde r num be r and LMP w e re note nlis te d in h os pital C re q ue s tform s. Clinicalde tails, date, patie nt s nam e and s urnam e h ave th e h igh e s tcom ple tion rate in th e th re e h os pitals. O f th e clinician s de tails, th e re s ide nt/doctor s ph one num be r is th e le as tcom ple te d. CONCLUSION: Th e re is ge ne ralde ficie ncy in ade q uate and com ple te fi ling ofth e re q ue s t form s for radiologicalinve s tigation in a lth e th re e m ajor public h os pitalin our locality. Patie ntm anage m e nt s h ould be s e e n as te am w ork and a l im pe dim e nts s h ould be re m ove d to facilitate prope r patie nt s m anage m e nt. Key words: Re q ue s tform, Clinician, Radiology, Surnam e, H os pital. Introduction Radiology re q ue s t form s (RRFs ) are clinicaldocum e nts th ats tate th e patie nt s biodata, re q uis ite inve s tigation, jus tification for th e inve s tigation and ide ntity of th e re fe rring clinician. In a h os pitals e tting w ith com pute riz e d re cord s ys te m, th e s e inform ation are digita ly e nte re d by a re fe rring clinician and pas s e d to th e radiologis tor radiograph e r de s ignate d as th e radiologicalpractitione r. H ow e ve r in s e ttings lik e ours w h e re th e re cord s ys te m is notcom pute riz e d, th e patie ntcarrie s th e re q ue s tform to th e radiological practitione r;in e ffe ct th e radiology re q ue s t form s (RRFs ) are e s s e ntialm e ans ofcom m unication be t- w e e n th e re fe rring clinicians and th e radiological practitione rs on th e patie nt s cas e. Th e de s ign ofth e re q ue s tform s h ould be s uch th at inform ation obtaine d are e nough to jus tify th e s tudy. And s h ould conform to th e guide line s by RoyalCo le ge of Radiologis t and ioniz ing Radiation (M e dical Expos ure ) Re gulation. 1, Th e re fe rring doctor is re s pons ible for th e co le ction ofa ldiagnos tic inform ation th atjus tify th e re q ue s te d radiologicalinve s tigations as w e las inform ation about pre vious e xpos ure s. Th e s e inform ation are s e ntto th e radiologis tvia th e RRFs. Incom ple te and inappropriate re q ue s t for radiologicalinve s tigations is a w as te d e xe rcis e and cre ate s s cope ofe rrors w ith Correspondence : Dr. O nw uch e k w a RC De partm e ntofradiology, Faculty ofclinicalscie nce s,co le ge of H e alth Scie nce s, Unive rs ity ofport H arcourt, Rive rs State, Nige ria. Em ail: ch ich e k w yah oo.com Subm itte d 1 April17, Acce pte d May 17 PA KI S TAN JOURNAL O F R A DIOLO G Y PJR July - September 17; 7()

2 re s ultantunne ce s s ary re pe tition ofinve s tigation and radiation e xpos ure to th e patie nt. A de taile d and th orough radiology re port is a vital com pone ntofth e com m unication be tw e e n th e radiologis t and th e orde ring ph ys ician, culm inating in providing vitalinform ation to th e ph ys ician for prope r patie nttre atm e nt. Inade q uate inform ation can le ad to m is tak e s in patie nt ide ntification and de lay in re turning of re ports for patie nt s m anage m e ntand can re duce th e value of th e re port. A lre q ue s tform s h ave cle arly m ark e d fie lds, for e as e ofcom ple tion by re q ue s ting clinicians as w e las am ple s pace for pe rtine ntclinicalh is tory w h ich m us tbe com ple te ly fi le d by th e clinician be fore th e inve s tigation is carrie d out. Ove r th e ye ars, radiologis tin our ins titution (including th e auth ors ) h ave obs e rve d th at vitalinform ation w h ich m ay be ne ce s s ary for s m ooth re porting ofth e radiologicalinve s tigations and m ak ing prope r diagnos is w e re lack ing from th e re q ue s tform s ;e s pe cia ly as th e y do noth ave dire ctcontactw ith th e patie nts be fore s om e ofth e inve s tigations w e re carrie d out w h ich w ould h ave e nable d th e m e licitm ore inform ation from th e patie nts. W e als o note d th ats im ilar obs e r- vations h ad be e n re porte d in lite rature s.,,,7 Due to th e s e difficultie s e ncounte re d by radiologis t in our ce ntre w ith s om e ofth e s e inade q uate ly fi le d form s in re ach ing a com pre h e ns ive diagnos is, an audit s tudy w as conducte d in our ce ntre to as s e s s th is inade q uacy, 8 h ow e ve r th is s tudy w as notcom pre h e ns ive as itfaile d to as s e s s a lth e inform ation in th e radiology de partm e ntre q ue s tform for our ins titution w h ich are ve ry vitalin patie nts e valuation radiologica ly. In vie w ofth e s e w e s e toutto analys is re q ue s tform s s ubm itte d to th e radiology de partm e ntofth e th re e m ajor public h os pitals s e rving our localare a w ith th e aim ofde te r- m ining th e rate ofinade q uacy in com ple ting th e radiology re q ue s tform s in our locality in orde r to cre ate aw are ne s s on th e im port ofth e inform ation on th e m e dicalre q ue s tform s am ongs tth e clinicians. Materials and Methods Th is w as a de s criptive s tudy de s igne d to m e as ure th e com pliance of th e re fe rring clinician s in th e com ple tion ofth e radiology re q ue s tform s. Radiology re q ue s t form s w e re co le cte d from th e radiology de partm e nt of th e th re e large s t public h os pitals in our locality. Us ing s tratifie d random s am pling, for e ach im aging m odality available in th e h os pital, 1 cards w e re co le cte d from e ach ye ar for five cons e cutive ye ars, Th e th re e h os pitals w e re re pre s e nte d w ith th e alph abe ts A, B & C. Th e re are im aging m odalitie s in h os pitala & B (conve ntionalx- ray, com pute d tom ograph y (CT), m agne tic re s onance im aging (M RI) and ultras onograph y) w h ile h os pital C h as only tw o m odalitie s (conve ntionalx-ray and ultras onograph y). Tw o h undre d form s w e re re trie ve d from h os pitala & B butonly one h undre d form s from h os pitalc. Th e s e gave a totalof form s for analys is. Th e data w as co late d for e ach m odality and for th e diffe re nth os pitals s e parate ly. Each form w as as s e s s e d for com ple te ne s s ofth e fie lds. A fie ld is tak e n as com ple te d w h e n s om e th ing is w ritte n in th e fie ld and a s core of1 (one ) is as s igne d to e ach com ple te d fie ld. A blind fie ld is as s igne d a (z e ro). Th e total s core is bas e d on th e num be r offie lds on th e re q ue s t form s Th e inclus ion crite ria w as for any radiology re q ue s t form for radiologicalinve s tigation pe rform e d in th e re s pe ctive h os pitals and re q ue s tm ade by a q ualifie d clinician practicing in th e h os pital. Exclus ion crite ria w as for any re q ue s tnotm ade on prope r radiology re q ue s tform s ofth e h os pital. Als o e xclude d w e re m utilate d re q ue s tform s. Th is s tudy doe s notinvolve h um an s ubje ctdire ctly and th e re w as no as s e s s m e nt ofpatie nt s dis e as e e ntity, h e nce no ins titutionale th icalapprovalw as re q uire d. Th e data w as analys e d us ing s tatis ticalpack age for s ocials cie nce s (SPSS ve rs ion ) for w indow s. Th e re s ults w e re pre s e nte d in form oftable s and te xt. Results W e did not e valuate th e appropriate ne s s of th e re s pons e s to th e de tails on th e re q ue s tform s. Th e us e ofunconve ntionalabbre viations w e re com m on e s pe cia ly for age and clinicalinform ation or diagnos is. Th e le as tcom ple te d fie ld in th e patie nt s biodata are patie nts addre s s, folde r num be r, ph one num be r and las tm e ns trualpe riod (LM P) w h ich are %, 1 %, 1% and.% re s pe ctive ly for h os pitala, and %, PJR July - September 17; 7()

3 Biodata information Ward/Clinic Home address Patient s phone no: Folder no: Physical state/mobility LMP(only females) Exam required Allergies Previous x-rays Previous operations Resident s name. Resident s signature Resident s phone no: Consultant s name CT MRI USS CX-Ray Filled Filled Filled Filled / / / / Total (%) 17(.) 1(%) 1(7.%) 1(%) (%) (%) 7(%) (1%) 8(1%) (7%) /77(.%) (%) (%) 18(%) (1%) 1(.%) 17(88%) 1(81%) 1(%) 1(8%) Table 1: Fre q ue ncy ofcom ple tion ofth e radiology re q ue s tform s de tails in h os pitala Request form Ward/Clinic Home address Patient s phone no: Folder no: Physical state/mobility LMP Exam required Allergies Previous x-rays Previous operations Resident s name Resident s sign. Resident s phone no Consultant s name CT MRI USS CX-Ray Percentage Filled Filled Filled Filled filled / / / (%) 1 (77%) 17 (8.%) 1 (%) (%) (%) (%) (.%) (1%) 1 (1.%) (11.%) (%) (%) 1(.%) 1 (.%) 1 (.%) 1 (%) 1(7%) (%) 1 (7%) Table : Fre q ue ncy ofcom ple tion ofradiology re q ue s tform s de tails in h os pitalb 1%,.% and11.% for h os pitalb. Folde r num be r and LM P w e re not e nlis te d in h os pitalc re q ue s t form s and for patie nt s addre s s only % w e re fi le d (Tab. 1, & ). W ard/clinic and ge nde r w e re als o found to h ave ve ry low com ple tion in h os pitalc, % and 1% re s pe ctive ly (Tab. ). Request form Ward/clinic Patient s address Exam requested Doctor s name Doctor s signature Doctor s phone no: USS CX-Ray Percentage Filled Filled filled (7%) (%) 1(1%) 1(1%) (%) (%) (%) 88(88%) (%) 8(8%) (%) (%) Table : Fre q ue ncy ofcom ple tion ofth e radiology re q ue s tform de tails in h os pitalc Clinicalde tails, date, patie nt s nam e and s urnam e h ave th e h igh e s tcom ple tion rate in th e th re e h os pitals (Tab. ) butpas ts urgicaland radiologicalh is tory w as ve ry low in h os pitala and B (Tab. & ). Th e s e w e re note nlis te d in h os pitalb re q ue s tform. Ofth e clinician s de tails, th e re s ide nt/doctor s ph one num be r is th e le as tcom ple te d, only % in h os pital A and z e ro in h os pitalb and C. Th e doctor s nam e and s ignature h ad be tte r re s pons e in h os pitala. Request form Ward/clinic Patient s address Exam requested Doctor s name Doctor s signature Doctor s phone no: Percentage of request form completion (%) Hospital A Hospital B Hospital C Table : Com paring th e de gre e ofcom ple tion ofth e radiology re q ue s tform s in th e th re e h os pitals PJR July - September 17; 7()

4 Request form Ward/clinic Patient s address Patient s phone no: Folder no: Physical state LMP(females) Exam requested Allergies Previous operation Previous surgery Resident s name Resident s signature Resident s phone no: Consultant s name Percentage of completion Hospital A Hospital B Table : Com paring th e de gre e ofcom ple tion ofth e form s in th e tw o te rtiary ins titutions w ith re s ide nttraining (A & B). Discussion Inade q uate fi ling ofth e radiology re q ue s tform s is a w orldw ide proble m, h e nce re gular auditing is crucial in orde r to incre as e th e aw are ne s s ofre fe rring clinicians on th e im portofth e de tails in th e radiology re q ue s tform s and th e ne e d to ade q uate ly com ple te th e m to e nh ance radiologicalre port and diagnos is. In th is s tudy non ofth e cards e valuate d w e re com ple te ly fi le d, th is is in k e e ping w ith pre vious s tudie s,1,11 e xce ptfe w w h ich re porte d %,1.% com - ple tion.,1 In m e dicalre cord, patie nt s biodata is ve ry e s s e ntial for patie nt s ide ntification. Th is s tudy re ve als th at am ong th e th re e h os pitals, patie nt s addre s s is th e le as tcom ple te d w ith rate s as fo low %, % and %. Th e addre s s ofpatie ntis ne ce s s ary for s om e re as ons, w h e re an outpatie ntne e ds to be re ca le d or ifin th e cours e ofinve s tigation, s om e th ing goe s w rong w ith th e patie ntand th e re is ne e d to contact th e re lations. Sim ilar finding w as re porte d by pre vious re s e arch e rs w h o s h ow e d th atonly 1%, 1.% of th e re q ue s tform s w e re com ple te d. De ficie ncy in com ple tion ofth e folde r num be r, patie nt s ph one num be r, ph ys icals tate / m obility and las t m e ns trualpe riod w as als o note d in h os pitala and B w h ich lis te d th e m in th e ir re q ue s tform s. Th e s e inform ation w e re lack ing in h os pitalc re q ue s tform s and th is is a ve ry im portantom is s ion, as th e am ountof inform ation in th e radiology re q ue s tform de te rm ine s th e e ffe ctive ne s s of th e de partm e nt. Th e biodata s e rve s as a guide for radiologis tto de cide th e appropriate radiologicalinve s tigations and lim it patie nts, e xpos ure to unne ce s s ary radiation w h ich m ay be h arm ful. K now le dge ofth e las tm e ns trualpe riod of a fe m ale patie nth e lps in de te rm ining ifth e re is ris k ofan e xis ting pre gnancy w h ich could face th e dange r ofradiation e s pe cia ly for com pute d tom ograph y and conve ntionalradiograph y. It is q uite path e tic th atin th is s tudy and pre vious s tudie s 1,1 LM P is one of th e as pe cts of th e re q ue s t form th at is com m only ignore d, itw as found notre corde d for a lcas e s ofct in h os pitalb and notlis te d in th e re q ue s te d form for h os pitalc. Sim ilar obs e rvation w as m ade in Sudan in e valuation ofradiology re q ue s tform s in s e ve n ce ntre s, four h ad z e ro pe rce ntfor fi ling in for LMP. 1 Th e w ard or clinic from w h ich a patie ntis re fe rre d is im portantin ide ntifying and re ca ling th e patie nt. It e nable s locating th e patie nt and e liciting m ore inform ation aboutth e patie nt. Itals o m ak e s itpos s ible to obtain th e patie nt s folde r and m ak e e nq uirie s aboutth e atte nding clinician. Itm ay h e lp in e nvis aging th e s e ve rity ofth e patie nt s i lne s s and cons ide r ne ce s - s ary adjus tm e nts in th e radiologicalinve s tigation. In as m uch as th is fie ld is im portantin th e re q ue s tform s m os tclinicians ignore itw h ile fi ling th e re q ue s tform s. O nly 77% w as re corde d in h os pitalb and % in h os pitalc, Th e rate w as e ncouraging in h os pitala ( % ). Th e h igh rate in h os pitala m ay be due to its h igh ly s pe cializ e d de partm e ntaland units ys te m of a Unive rs ity training te rtiary ins titution. Sim ilar to th e obs e rvation in pre vious s tudie s,,1,1 w e re corde d % com ple tion ofpatie nts nam e and s urnam e. Th e clinicalinform ation or diagnos is as w e l as th e inve s tigation re q ue s te d w e re com ple te ly fi le d in tw o of th e h os pitals (A & B), for h os pitalc only 88% ofth e form s w e re com ple te d for clinicalinform ation;s im ilar findings h ave be e n re porte d in pre vious s tudie s w e re only 8. %, 1. % 1 ofth e form s w e re com ple te d for clinicalinform ation. Notgiving th e clinicalinform ation abouta patie ntunde rgoing radiologicalinve s tigation is notacce ptable as th is PJR July - September 17; 7()

5 inform ation is re le vantin jus tification ofth e re q uis ite inve s tigation as de clare d by th e Re gulation ofth e De partm e ntofh e alth, UK on m e dicalioniz ing radiation. It h as be e n s tate d by pre vious s tudie s th at inade q uate or unce rtain clinicalinform ation is re s pons ible for incre as e d le ve lof irre le vant re port from radiologis ts. 1 Th e radiologis tre portare e xpe cte d to ans w e r s pe cific q ue s tion and th is w ouldn tbe pos s ible ifth e re fe rre r fails to s pe cify a clinicalq ue s tion. Inform ation on pre vious s urge ry, pre vious x-rays and a le rgie s w e re not give n in m os t of th e cas e s in h os pitala & B and w as not include d in h os pitalc re q ue s tform. Th e s e inform ation are im portantbe caus e pre vious s urge ry in th e are a of inte re s t m ay h ave caus e d anatom icalch ange s th atm ay be e rrone ous ly attribute d to a le s ion, s im ilarly h is tory ofa le rgy e s pe - cia ly w h e re contras tm e dium and s om e oth e r ph arm a- ce uticals w e re to be us e d are ve ry im portant in ave rting a dange rous re action. A re cord ofa lth e pre vious e xpos ure s is im portant in orde r to avoid re pe at. Itis als o re q uire d for com paris on in fo low up cas e s. Clinician s de tails are are as w e found in th is s tudy to be inade q uate ly fi le d. It is im portant to k now th e cons ultantin ch arge of th e patie nt as w e las th e re s ide ntdoctor w ork ing w ith th e cons ultantin a training ins titution w h o in m os tcas e s re fe rs th e patie nts for inve s tigation. Th e ir s ignature is im portante s pe cia ly for m e dicole galre as ons, be caus e an im pe rs onator could fi la form and w rite a doctor s nam e butw ouldn t be able to s ign th e s ignature corre ctly, h e nce th e doctor s s ignature auth e nticate s th e re q ue s t. Th e re q ue s ting doctor s ph one num be r is ne ce s s ary for contacting th e doctor and e liciting m ore inform ation aboutth e patie ntor for giving fe e dback, e s pe cia ly w h e re urge nt atte ntion to patie nt s condition is re q uire d. As im portantas th e doctor s ph one num be r is for e as e ofcom m unication, itw as notinclude d in h os pitalc re q ue s tform s and th is w i lcre ate com m u- nication difficulty and a dis location to th e ide a of m anaging th e patie ntas a te am w h ich give s be tte r patie ntoutcom e. In th is e ra ofgsm (GlobalSys te m for Mobile com m unication) w h ich h ad m ade com m u- nication e as y, a lm e dicalre q ue s t s h ould include re q ue s ting clinician s ph one num be r for e as y com m u- nication in th e h os pitale nvironm e nt. Conclusion Th e re is ge ne ralde ficie ncy in ade q uate and com ple te fi ling ofth e re q ue s tform s for radiologicalinve s tigation in a lth e th re e m ajor public h os pitals in our locality. Th is w i lh ave e ffe ct in th e ove ra lm anage m e ntof patie ntas th e re m ay be de lay in carrying outth e inve s - tigation or w riting up re porton th e im age s. Patie nt m anage m e nts h ould be s e e n as te am w ork and a l im pe dim e nts s h ould be re m ove d to facilitate prope r patie nt s care. Recommendations Se m inars and w ork s h ops s h ould be organiz e d for clinicians to e nligh te n th e m on th e im portance ofth e re q ue s tform s de tails and th e ne e d to com ple te th e m ade q uate ly. Orie ntation cours e s on com ple tion of re q ue s tform s h ould be organiz e d for h ous e office rs and re s ide ntdoctors as th e y be gin th e ir training. A l re q ue s tform s s h ould contain bas ic inform ation about th e patie nts and clinicians to e nable th e radiologis t k now th e patie ntand able to com m u-nicate w ith th e clinicians w ith e as e. Poorly fi le d form s s h ould be re turne d to th e clinicians w ith note on re a-s on for re je ction. Limitations Th e lim itation in th is s tudy is our inability to com pare s om e ofth e data in th e form s as th e th re e h os pitals do nots h are s im ilar inform ation in th e re q ue s tform s. References 1... London: Th e RoyalCo le ge ofradiologis t. Good practis e guide For ClinicalRadiologis t: 1;pp. -8 Analys is ofradiologicale xam ination re q ue s tform s in conjunction w ith jus tification for x-ray e xpos ure s De partm e nt of H e alth. Th e ioniz ing Radiation (m e dicale xpos ure s Re gulations w ith s upple - m e ntary guidance on good practice (h ttp://w w w. doh.gov.uk /irm e r.h tm ):. Rajanik anth Rao V. Audit of radiology re q ue s t form s - Are th e y ade q uate ly fi le d? J Me d Sci Re (1): -. PJR July - September 17; 7() 7

6 Afolabi OA, Fadare JO, Es s ie n EM. Auditofcom - ple tion of radiology re q ue s t form in a Nige rian Spe cialis th os pital. Ann Ibd pg 1;1(): -. Os w ald, Saph e rs on D, Re h m an A. A s tudy of ade q uacy ofcom ple tion ofradiology re q ue s tform s. Radiograph y ;1(): -1. Agw u KK, O k oye IJ. Auditofradiologicalre q ue s t atunive rs ity ofnige rian Te ach ing H os pitalenugu. Nig J H os p Me d ;1: Ak inola R, Ak ink unm i M, W righ tk, Orogbe m i O. Radiology re q ue s tform s are th e y ade q uate ly fi le d by clinicians?th e inte rne tjournalofradiology. ;1(1): Ade bayo SB, Aw os anya GO, Balogun BO, Os ibogun A. Multice ntre as s e s s m e ntofradiology re q ue s t form com ple tion in s outh -w e s tnige ria. Nige rian H os pitalpractice Journal. ;: 1-. O lufe m i AO, Abiola AO, Iw uala SO. An audit of re q ue s t form s s ubm itte d in a m ultidis ciplinary diagnos tic ce nte r in Lagos. Pan African M e dical Journal. 1;:. Dh ings a R, Finlay DB, Robins on GD, Liddicoat AJ: As s e s s m e ntofagre e m e ntbe tw e e n ge ne ral practitione rs and radiologis ts as to w h e th e r a radiation e xpos ure is jus tifie d. Britis h JournalofRadiology. ;7(8): Ch uk w ue m e k a A, Paingh a JA, Be le udanyo GF. A s im ple auditofradiologicalre q ue s tform s atth e Unive rs ity ofporth arcourtte ach ing H os pital. Th e Nige rian H e alth Journal1;1(): De s pas q uale R, Crocford MP. Are radiology re q ue s t form s ade q uate ly fi le d in?an audit as s e s s ing localpractice. M alta M e d J ;17: Irurh e NK, Sulaym on FA, Olow oye ye OA, Ade yom oye AAO. Com pliance rate ofade q uate fi ling of radiology re q ue s tform s in a Lagos Unive rs ity te a- ch ing h os pital. W orld JournalofM e dicalscie nce s. 1;7(1): Jum ah K B, G ordon- H arris and Agah ow a J. Com m on faults in fi ling ofradiology re q ue s tform s. Eas tafrican M e dicaljournal1 ;7: Moh am e d OY, Caroline EA, Am in AEE, Abde l- m one im S. Evaluation ofradiology re q ue s tform s in diagnos tic ce ntre s in K h artoum State. Sudan M e dicalm onitor. 11;(): Ak intunde AO, Ik pe m e AA, Afiong IN, Nch ie w e EA, Udofia AT. An audit of th e com ple tion of radiology re q ue s tform s and th e re q ue s tpractice. J Fam ily Me d Prim Care. 1;: 8-. PAKISTAN JOU RNAL OF RADIOLOGY PJR July - September 17; 7() 8

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