Fear of Malpractice Drives Many Rib X-rays

The lack of definite guidelines and social and medico-legal issues play a larger role in the prescription of radiographs of the ribs in minor chest trauma than do medical reasons or the lack of knowledge of the guidelines, according to a study published in the journal European Radiology.

Researchers from Belgium wanted to determine if referral guidelines regarding the prescription of radiographs for patients who had sustained minor chest trauma were sufficiently known by prescribers, and if medico-legal concerns could influence their prescription.

The researchers sent questionnaires to 112 physicians (33 residents, 18 surgeons, 7 internists, 24 general practitioners and 30 ER physicians), which included a typical clinical history and questions on reasons for prescribing radiographs of the ribs in minor chest trauma. All physicians agreed to participate.

The results showed that 58% of the prescribers proposed rib radiographs and most (89%) were unaware of the guidelines. Only 11% of the prescribers changed their intention to order radiographs after information on referral guidelines and radiation dose. The mean dose delivered by rib radiographs was 38 times higher than that of a chest X-ray. Legal and medico-legal concerns, which included requirements from insurance policies and avoidance of lawsuits, were the main reasons for requesting the radiographs.

The researchers concluded that the lack of definite guidelines in addition to social and medico-legal issues, rather than medical reasons or the lack of knowledge of the guidelines, strongly influenced the prescription of radiographs of the ribs in minor chest trauma.