Unnecessary Medical Imaging and Determinant Factors in a District Hospital of Iran: A Cross-Sectional Study

Abstract

Background and Aims

Due to the increasing use of imaging services, this study aimed to estimate the number of unnecessary imaging services, normal and abnormal imaging examinations, and their determinant factors.

Methods

This cross-sectional study was conducted at a district hospital in East Azerbaijan, Iran. Retrospective data were collected from the electronic medical records of patients referred to the Imaging Department between March and August 2022, using the Hospital Information System (HIS). Descriptive statistics and χ² tests were performed, followed by hierarchical logistic regression with AOR, 95% CI, using SPSS-24 for analysis.

Results

About 28% of imaging examinations with abnormal results and 21% of the examinations with normal results were unnecessary. The probability of ultrasound abnormal imaging results was 67% lower than computed tomography (CT) scan (CT-scan) (adjusted odds ratio (AOR) = 0.33 (0.212–0.50); p < 0.001). One year increase of patient age is associated with a 1% lower likelihood of having normal imaging (AOR = 0.99 (0.98–0.99); p < 0/001). Women were 20% less likely than men to have abnormal imaging results (AOR = 0.80 (0.65–0.98); p = 0.035). The probability of necessary imaging decreases by 1% for 1 year increase in patient age (p = 0.017), on the other hand, the probability of unnecessary chest radiography was 5% higher than a brain CT-scan imaging (AOR = 2.05 (1.19–3.51); p = 0.009).

Conclusions

Unnecessary imaging were more frequently performed on the older patients. Additionally, ultrasound was less likely than CT-scans to show abnormal findings, while chest radiography was more frequently deemed unnecessary compared to brain CT-scans. These insights highlight the need for age- and modality-specific guidelines to reduce unnecessary imaging and improve diagnostic efficiency.