Emergency Imaging Audit

Note this audit only applies to hospitals with an emergency (A&E) department. Please email [email protected] if any of the hospitals for which you are Audit Lead do NOT have an emergency department, so they can be excluded from the audit.

Acute chest, abdominal, and back pain are common presentations to the Emergency Department. Specifically, thoracic aortic dissection (TAD), acute abdomen, and cauda equina syndrome (CES) are all potential surgical emergencies that carry a significant risk of morbidity, disability, and mortality.  Clinical symptoms are often non-specific, and therefore urgent cross-sectional imaging is essential to enable timely diagnosis and intervention.  The role of CT imaging in operative planning has been highlighted by the ongoing National Emergency Laparotomy Audit¹, while The Royal College of Radiologists has recently released updated guidance on the use of prompt CT and MR imaging in the diagnosis of TAD² and CES³ respectively.  In addition, Getting It Right First Time has recommended that all trusts in England should have an on-site 24/7 emergency spinal MRI pathway by June 2024⁴. 

In face of the continually rising demands for cross-sectional imaging across all clinical areas, in combination with the considerable workforce pressures at present, timely imaging and reporting of emergency cases 24/7 can pose significant logistical challenges for radiology departments.  At the same time, a delayed or missed diagnosis is likely to have potentially life-changing implications for the patient.  To date, there has been a relative paucity of data on the delivery of emergency imaging services across UK centres, particularly for suspected TAD and CES, despite the recent upsurge in national guidance and recommendations.

The aim of this audit is to gain a better understanding of the nationwide provision of dedicated emergency imaging pathways for suspected TAD, non-traumatic acute abdomen, and CES during both normal and out-of-normal working hours.  The findings would allow us to review the current state of play with a view to providing future recommendations on achieving best practice. 

The two key elements of data collection are:

• an online SurveyMonkey questionnaire on the provision of emergency non-traumatic abdominal CT, CT aortogram for suspected acute TAD and MRI for suspected CES and

• three Excel workbooks capturing turnaround times for the most recent 20 adult patients undergoing each of the above scans requested by the emergency (A&E) department at your hospital (60 patients in total).

To facilitate local data collection, three editable PDFs have been created from the online SurveyMonkey questionnaire, which will take less than 15 minutes each. 

These can be completed by any consultant who feels competent to do so and returned to the audit lead, who is asked to submit the data to the RCR using the online SurveyMonkey questionnaire. The questionnaire may take a short while to load due to variation of security configurations between different NHS organisations. If it fails to load, please attempt to use a non-work device, or email [email protected]. Data will be anonymised prior to reporting of results.

We understand that the local IT/PACS setup may vary across departments, but completion of each workbook is anticipated to take no longer than a single morning or afternoon. Again, these can be completed by whomsoever feels competent to do so and the audit lead is asked to retain responsibility for returning completed Excel workbooks to [email protected]. 

If there is more than one audit lead within your department, please liaise with each other to avoid duplication of effort. Audit leads at multi-hospital departments may prefer to submit one online questionnaire and three Excel workbooks on behalf of more than one hospital. Please ensure the questions are compatible with local service configuration and tell us which hospitals you are submitting data for on the questionnaire / workbooks. 

Thank you for your time and effort in participating in this audit.  To recognise the contribution of audit leads and other RCR members, we ask you to provide us with up to 3 names per participating institution to be listed as collaborating authors (subject to successful publication in Clinical Radiology). If you do not provide a name(s), the current audit lead will appear on the list. Note also, CPD credit: 1 per hour in relation to work done, 1 for reflection, 1 for impact. In case of query or if you are no longer the audit lead, please email [email protected]. 

Dr Ganesh Retnasingam, Dr Jason Mak, Dr Syed Qadri

On behalf the Clinical Radiology Audit and Quality improvement Committee (CRAQIC), RCR

1. NELA Project Team. Eighth patient report of the National Emergency Laparotomy Audit [Online]. London: RCoA; February 2023. Available from: https://www.nela.org.uk/reports
2. The Royal College of Emergency Medicine and The Royal College of Radiologists. Best Practice Guideline on the Diagnosis of Thoracic Aortic Dissection in the Emergency Department [Online]. London: RCEM & RCR; January 2024. Available from: https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/diagnosis-of-thoracic-aortic-dissection-in-the-emergency-department/
3. The Royal College of Radiologists. MRI provision for cauda equina syndrome [Online]. London: RCR; February 2023. Available from: https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/mri-provision-for-cauda-equina-syndrome/
4. Getting It Right First Time. Spinal Surgery: National Suspected Cauda Equina Syndrome (CES) Pathway [Online]. London: GIRFT; February 2023 [Updated October 2023]. Available from: Interactive pathway to help diagnose and treat Cauda Equina Syndrome without delay is now live - Getting It Right First Time - GIRFT