RPS 1030 - Imaging wisely: balancing protection, practice, and performance

Author Block: J. Sarnecki, M. T. Meyer, T. Heye; Basel/CH
Purpose: To investigate trends in per-patient imaging utilization and follow-up intervals over the last
decade
Methods or Background: Trends in imaging utilization per patient and the time intervals between examinations were
analyzed for 332’008 adult patients who underwent 1’660’034 studies (CR, US, CT, MRI, PET-CT)
between 2014-2024 at a tertiary referral hospital. Patients were categorized into two age groups:
<65yrs. and ≥65yrs.
Results or Findings: Over the last decade, examinations per patient increased by 12% for inpatients (1.66 to 1.86)
versus 2.7% for outpatients (1.30 to 1.35). The main driver of change was CT imaging, with
12.0% (<65yrs.) and 12.7% (>65yrs.) increase among inpatients (MRI: -4% and +1.6%,
respectively). The strongest increase was in CTs of abdomen/pelvis (+14%), chest (+12.5%), and
chest-abdomen-pelvis (+8.9%).
Exemplarily, the number of patients with 5 examinations rose by 31.9% (7’183 to 9’477), those
with 15 by 112.4% (1’875 to 3’983), with 30 examinations by 341.5% (342 to 1’510).
In 2014 the most frequent repeat-imaging modality was CR; in 2024, CR, US, CT were similar,
with CT most frequent in the older group.
Median time between CT examinations decreased by 29.1%, from 70 days in 2014 to 49.7 days
in 2024 (25th percentile: 11.8 to 7 days). Among inpatients, the reduction was greater at 55.4%
(36 to 16 days) versus 7.7% among outpatients (91 to 84 days).
Repeat CT examinations increased across all follow-up intervals: within 7 days (+53.3%), within
30 days (+46.9%), within 90 days (+52.6%), and >90 days (+47%).
Conclusion: The results show an increase in imaging utilization per patient and a reduction in the time
between examinations, underscoring the growing role of radiology in patient care. The most
significant increase is seen in CT imaging during inpatient stays.
Limitations: Retrospective, single-centre study.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: C. Singer¹, M. Saban², L. Bergovoy-Yellin¹, B. Brkljačić³, A. Karoussou-Schreiner⁴, J. Sosna⁵; ¹Ramat Gan/IL, ²Tel Aviv/IL, ³Zagreb/HR, ⁴Luxembourg/LU, ⁵Jerusalem/IL
Purpose: To evaluate the quality and completeness of CT referrals using audited data from the EU-JUST-CT project across seven European countries: Belgium, Denmark, Estonia, Finland, Greece, Hungary, and Slovenia (n=6,734 referrals).
Methods or Background: Each referral was evaluated using seven binary indicators: Clinical data sufficient; Examination specified; Referrer specialty; Prior exams; Patient status (in-/outpatient); Patient gender and age. We computed a Completeness Score (sum of all seven indicators) and a Critical Score based on four essential items (clinical data, exam type, gender, and age). We examined the distribution of both scores by country and calculated the proportion of fully complete referrals (Completeness Score = 7) and fully critical-complete referrals (Critical Score = 4).
Results or Findings: The median Completeness Score was 7 in Denmark; 6 in Belgium, Greece, Hungary, and Slovenia; 5 in Estonia; and 4 in Finland. Denmark had the highest mean Completeness Score (6.6), while Finland had the lowest (4.3). The proportion of fully complete referrals ranged from 60.6% (Denmark) to 0.3% (Finland). For the Critical Score, all countries had a median of 4, but inter-country variation in the proportion of referrals with full critical data was observed: (67-98%). The mean Critical Score was highest for Belgium (3.98) and lowest for Slovenia (3.64).
Conclusion: Incomplete information on CT referrals was prevalent, with differences observed between countries. The results presented raise the need for unified protocols and standards, possibly anchored in the national legislation, which dictates what minimal information is required in a CT referral in order to be approved.
Limitations: Our dataset, while large and geographically diverse within Europe, may not generalize to other regions with different healthcare structures, referral styles, or disease prevalence. Additionally, this study did not assess the clinical consequences of incomplete referrals.
Funding for this study: No
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: local research ethics committees or IRBs at each of the 125 participating imaging facilities across the seven countries. At each site, the IRB either approved the study or waived the requirement for informed consent due to the retrospective nature and de-identification of the data.

Author Block: P. Reschke, K. Eichler, T. Vogl, A. M. Bucher; Frankfurt/DE
Purpose: Radiology appointment delays compromise healthcare efficiency and patient satisfaction, yet referring physicians’ perspectives on scheduling challenges remain underexplored. This study investigates these perspectives and identifies targeted strategies for improvement, comparing general practitioners (GPs) and hospital physicians.
Methods or Background: We conducted a cross-sectional survey across Germany from June 2023 to June 2024, recruiting 220 actively practicing physicians via systematic random sampling. This included 79 GPs, who regularly refer outpatients to hospital-based radiology departments, and 141 hospital physicians, who coordinate imaging for inpatients. An anonymous online questionnaire assessed the perceived impact of imaging delays and coordination difficulties (7-point Likert scales), preferred improvement strategies (multiple choice), and prioritization of quality metrics (weighted ranking).
Results or Findings: GPs had significantly more clinical experience than hospital physicians (20 ± 14 vs. 7 ± 9 years; p < 0.001), with no gender differences (p = 0.67). GPs reported a greater impact of imaging delays on patient care (4.39 ± 1.50 vs. 4.02 ± 1.49; p = 0.02) and more coordination challenges (4.55 ± 1.42 vs. 4.30 ± 1.50; p < 0.05). Hospital physicians preferred real-time workflow tracking (34.8% vs. 9.1%; p < 0.001) and automated reminders (20.2% vs. 6.1%; p = 0.007), while GPs favored centralized scheduling (33.3% vs. 19.1%; p = 0.03) and urgent case prioritization (42.4% vs. 23.6%; p = 0.008). Short-term appointment availability was the top priority across both groups (24.9%; χ²(4) = 107.2, p < 0.001).
Conclusion: Radiology scheduling delays remain a key barrier to timely patient care. The findings support the implementation of referrer-specific appointment management strategies in order to optimize imaging coordination.
Limitations: Our analysis focused exclusively on referring physicians' perspectives, excluding viewpoints from radiologists, administrative staff, and patients.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: T. Miller¹, N. Cook¹, J. Daly Lynn¹, L. McLaughlin², S. L. Mcfadden¹; ¹Derry/Londonderry/UK, ²Cork/IE
Purpose: It is a legal requirement to verify biological sex and pregnancy status prior to exposing people to the dangers of ionising radiation. Sensitivities that exist when ascertaining pregnancy status can result in ethically challenging scenarios for healthcare workers (HCWs) and leave TGNB people uncomfortable with their care.
Methods or Background: Two validated surveys were conducted: one assessing the radiology/radiotherapy experiences of TGNB people and the other examining HCWs attitudes towards TGNB identities. The surveys were disseminated via professional conferences, social media, and voluntary support organisations.

Data collection will be completed on 31st December 2025. SPSS version 28 is being used to conduct descriptive and inferential statistics.
Results or Findings: To date 76 HCWs and 53 TGNB participants have responded to the surveys.

Preliminary results report 37% (n=28) of HCWs had experienced transphobic behaviours from colleagues. While 20% (n=15) disagreed or strongly disagreed that knowing the gender identity of the person in their care was important. Of the TGNB respondents 51% (n=27) had not experienced affirming interactions with staff. Meanwhile 62% (n=33) had not been asked about their chosen name and 66% (n=35) had not been asked about their preferred pronouns. Additionally, 25% (n=13) of TGNB respondents did not understand the significance of pregnancy status questions.
Conclusion: Further education is needed for both sets of participants TGNB communities must be educated on the rationale for pregnancy status questions and HCWs must be provided with the tools to uphold legal obligations while maintaining the dignity of TGNB identities.
Limitations: This is a very sensitive topic which may hinder patients from participating. Hence, resulting in a limited sample size. The data is representative of the UK and Ireland population only and may not be fully reflective of the international opinion.
Funding for this study: Department for Education funding is enabling completion of the PhD
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical permission for this study has been granted by Ulster University's Nursing and Health Research Ethics Filter Committee on 15th March 2025.

Author Block: C. Debats, M. Van Deursen - Luijten, C. Adang, F. Van Kasteren, N. Visschers, E. Peters, F. M. Zijta, J. E. Wildberger, T. Van Nijnatten; Maastricht/NL
Purpose: Growing demand for advanced imaging techniques like MRI has resulted in long waiting lists and delayed patient diagnosis by exceeding facility capacity, with consequently prolonged MRI access time. This study defines MRI access time as the time-interval between requesting an MR exam and the performance of the MR exam. The aim of this systematic review was to provide an overview of the available evidence on interventions to reduce MRI access time.
Methods or Background: Pubmed, Embase, Cochrane and Web of Science databases were searched up to September 1st 2025. Two reviewers independently screened all studies and performed data extraction. Eligible studies were original investigations reporting on MRI access times and provided results before and after the proposed intervention to reduce access time. Reviews, meta-analyses, conference papers, editorials, technical reports and case reports were excluded.
Results or Findings: The literature search yielded 3875 records, of which 29 records were fully reviewed, and 10 met inclusion criteria. Five studies evaluated simulated interventions, three studies reported implemented interventions. Reported interventions can be subdivided in three categories: matching capacity and demand (e.g., increasing MRI capacity); waiting list segmentation (e.g., grouping patients with similar characteristics to reduce coil-changing time); and operational redesigns of the MRI scheduling process (e.g., implementing a decentralized integrated online booking system). Sample sizes ranged from 264 until 172,000 patients. Reported effectiveness of interventions varied widely: most successful solution combined multiple interventions, achieving a reduction in MRI access time of 73.3 days. Multiple intervention studies did not show any measurable improvement to reduce MRI access time.
Conclusion: Current interventions to reduce MRI access time have shown limited success, with insufficient evidence supporting the impact of specified interventions, necessitating urgent research on novel interventions to be performed.
Limitations: N/a
Funding for this study: N/a
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: N. Seiß, M. Mohamed, F. Yavuz, F. Biavati, M. Rief, T. A. Auer, M. Dewey, A-C. Stahl; Berlin/DE
Purpose: To assess patients' existing knowledge and their desired level of information about radiation exposure during CT.
Methods or Background: This single-centre survey was conducted at a large European university hospital. Patients (≥ 18 years) capable of giving informed consent and scheduled for a clinically indicated CT were eligible for inclusion. A 17-question survey covering demographic data, radiation exposure of different imaging examinations, and patients' desired level of information was used to assess patients´ existing knowledge and requests for information about radiation exposure. Analysis was done by calculating frequencies of given answers. As not all patients answered all questions, the denominators differ. Chi-Square and Mann-Whitney U tests were performed to determine differences between genders.
Results or Findings: 285 questionnaires were collected with recruitment still ongoing. The median age of the patients was 62 years (IQR: 53-73), with 42% (118/280) being female. The majority, 81% (171/211) correctly stated that CT is an examination with radiation exposure, with no significant difference between female and male (85% vs. 77%, p=0.187). Interestingly, also 35% (74/211) selected MRI as an examination involving radiation exposure. Patients estimated that the radiation exposure of a thoracic CT would only be two times higher (IQR: 1-4) than that of a thoracic X-ray in two planes, again without significant gender differences (p=0.794). Overall, 71% (147/206) felt to be sufficiently to very well informed about the radiation exposure of CT and 36% (78/219) requested to receive further information.
Conclusion: While most patients are aware that CT involves radiation exposure, they tend to underestimate this exposure compared to X-rays. Most of the patients felt adequately informed with a relevant number of patients still wishing for further information.
Limitations: This is a single-centre study limiting the generalisability of the results.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the local ethics committee at Charité - Universitätsmedizin Berlin (EA4/273/21).

Author Block: H. Said; Chelmsford/UK
Purpose: To explore physician knowledge regarding radiation doses, the different modalities used, and important safety precautions. To determine the follow up research necessary to improve safety.
Methods or Background: Radiology is a growing specialty, and ionising radiation is increasingly being used by physicians across specialties. It is essential to understand basic radiation safety and take necessary precautions. This review synthesises the evidence on whether doctors have adequate knowledge of radiation safety and risk.

A systematic review was performed, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Boolean operators were used to search Embase and PubMed databases. Inclusion criteria: English language articles within the last 10 years. Exclusion criteria: case reports, editorials, case presentations, animal studies, mammography articles. All relevant papers involved surveys; therefore a thematic analysis was performed.
Results or Findings: The initial search gave 52 results, after applying inclusion and exclusion criteria this reduced to 25 results. 11 articles were relevant to the research question.
Doctors’ knowledge of radiation safety and risk was inadequate across specialties, and geographical locations. Safety measures (e.g. providing and wearing appropriate personal protective equipment) were either ignored, or inadequate, despite clear legislation within this area. Seniority did not translate to better knowledge or safety practices.
Conclusion: The evidence demonstrates that doctors have inadequate knowledge of radiation safety. The provision of radiation safety training for physicians working with ionising radiation is inadequate. Standards and guidelines should follow national/international guidelines, rather than local policy.
Limitations: This review used Braun & Clarke’s reflexive thematic analysis, in which it is good practice to enlist a single coder. This means that there is one consistent approach throughout the review, but it lacks other reviewers and perspectives to corroborate paper selection and agree on the analysis.
Funding for this study: No funding was received for this study.

Ethical approval was not required as this was an systematic review using publicly available data.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: J. Lydia, F. Abubacker Sulaiman, R. Praveenkumar, M. Nivitha, D. Dharshini, D. Velan, A. Raashid Ibrahim, A. Selvam; Chennai/IN
Purpose: Radiology professionals are exposed to various health hazards due to the nature of their work. Occupational risks include radiation, chemical exposure, infections, and musculoskeletal strain, while non-occupational risks stem from sedentary work, screen exposure, shift duties, and stress.
Methods or Background: A structured Google Forms survey was conducted among radiologists, radiographers, and nurses to assess occupational and non-occupational hazards. Responses were analyzed, and the prevalence of each risk factor was expressed as a percentage. Preventive measures were also evaluated.
Results or Findings: The most common occupational hazards were radiation exposure (78%), musculoskeletal strain (65%), chemical/contrast exposure (42%), biological hazards (38%), and work-related stress (55%). Non-occupational risks included sedentary lifestyle (70%), eye strain (62%), sleep disturbances (48%), and lifestyle-related stress (50%). Key preventive strategies included personal protective equipment, ergonomic adjustments, vaccination, optimized shift schedules, and lifestyle modifications
Conclusion: Radiology professionals face multiple health hazards. Awareness and implementation of safety protocols, ergonomic practices, and healthy lifestyle measures are essential to reduce risks and ensure long-term professional well-being.
Limitations: The study relied on self-reported data from a limited sample, which may introduce bias and limit generalizability. Objective measurements of exposure and long-term effects were not included.
Funding for this study: No funding was provided
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: E. Solinas, L. Piscopo, G. De Paula, D. Turilli, M. Scaglione, S. A. Masala; Sassari/IT
Purpose: Virtopsy, or virtual autopsy, is an established method in post-mortem investigations, offering a non-invasive alternative to conventional autopsy. The recent introduction of photon-counting CT (PCCT) provides new perspectives in forensic medicine, thanks to its ability to directly convert incident photons into electrical charges, thereby reducing electronic noise and improving spatial resolution and offering spectral imaging, improving tissue and material characterization.
Methods or Background: We performed 15 post-mortem examinations using PCCT, comparing image quality and diagnostic performance with conventional CT, focusing on fracture detection, identification of foreign bodies, and differentiation of metallic materials. Particular attention was given to firearm-related deaths, where metallic artifacts often compromise conventional CT.
Results or Findings: PCCT provided high-definition images even at low energies, enabling detailed assessment of skeletal structures and soft tissues without contrast medium. Metallic artifact reduction allowed reliable discrimination between different bullets' type, significantly enhancing firearm injury evaluation. Improved visualization of trauma patterns and organ damage further support the diagnostic value. Compared to conventional CT, PCCT demonstrated superior accuracy, reproducibility, and artifact reduction.
Conclusion: Virtopsy with PCCT is a rapid, reliable, and body-preserving imaging method with clear advantages over conventional CT. Our preliminary series of 15 cases highlights its potential to improve forensic investigations and forensic anthropology, with promising applications in both forensic and academic contexts.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: R. Cusack, E. Jones, J. Drought, C. Murphy, S. O'Neill, R. Kernan, N. Sheehy, N. O'Leary; Dublin/IE
Purpose: Radiology plays a key role in diagnosis, monitoring, and intervention for advanced disease, yet its value at the end of life is debated. Prior studies have shown high imaging utilisation with limited impact on management¹,². This study evaluated the utilisation and clinical value of radiological imaging and image-guided procedures in palliative inpatients, aiming to identify opportunities to optimise practice in end-of-life care.
Methods or Background: We retrospectively reviewed inpatients who died in St James’s Hospital between January and December 2023. Patients were identified using the hospital’s RIP Excel Report, and imaging data were extracted from electronic records. Radiological investigations in the last four weeks of life were included: plain radiography, CT, MRI, ultrasound, nuclear medicine, and image-guided procedures (ultrasound- and interventional radiology–guided). Frequency, modality, timing, and interval between last imaging and death were recorded. Imaging was classed as high-value if it established a new diagnosis that altered management or informed prognosis; otherwise, it was low-value.
Results or Findings: A total of 260 patients were included. The median number of investigations was 5. Plain radiography (median 3) and CT (median 1) were most common, while MRI (n=32), ultrasound (n=41), and nuclear medicine (n=10) were less frequent. Forty-two image-guided procedures were performed. The median interval between last imaging and death was 4 days. Of imaging within three days of death, 44 (25%) were high-value and 131 (75%) low-value.
Conclusion: Imaging and procedures are common in the last month of life, often close to death, but most were of limited clinical value from a radiological perspective. Greater collaboration between radiology and palliative care may help reduce low-yield imaging.
Limitations: This study is limited by its retrospective, single-centre design and reliance on clinical documentation.
Funding for this study: No external funding was received.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical approval was granted by the St James’s Hospital/Tallaght University Hospital Joint Research Ethics Committee.

Author Block: U. Pidvalna, D. Beshley; Lviv/UA
Purpose: Radiologists play an important, but often underrecognized, role in managing the medical consequences of crises: from natural disasters and mass-casualty events to armed conflicts and war zones. As global instability rises, the need for a structured and resilient radiology response becomes paramount.
Methods or Background: This abstract addresses the practical, technical, and ethical challenges faced by radiologists working under extreme conditions. It is not limited to power outages, air raid sirens, infrastructure damage, limited internet access, triage, and scarce resources, but also to moral and ethical issues.
Results or Findings: Drawing on experiences from war zones, this discussion provides a realistic, system-based overview of radiological practice in unstable environments. How to maintain imaging services during power outages? Do we need to adapt workflows without PACS/RIS systems? Should we ensure communication in the absence of digital networks? Managing triage imaging in high-pressure scenarios? Emphasis on the mental and physical strain placed on radiology teams, as well as the need for international cooperation, modular protocols, and mobile radiology units.
Conclusion: Sharing pragmatic strategies and organizational insights equips radiologists with the tools and mindset necessary to prepare for and function effectively during crises, wherever they may arise.
Limitations: Limitations include the variability of crisis settings, the lack of standardized protocols, and the reliance on personal experiences.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: