Proposal @2022
Proposal @2022
Proposal @2022
BY
KIDIMA ROBERT
UAHEB 031/013/18
MANAGEMENT SCIENCES
SCHOOL OF RADIOGRAPHY
APRIL 2022
APPROVAL
This research report titled “Assessment Of The Level Of Completion Of X Ray Request
Forms Received At The Radiology Department Of Mulago National Referral Hospital” has
been submitted in partial fulfillment of the requirements for an award of a diploma in medical
radiography of Uganda Allied Health Examination Board with the approval of my supervisor.
……………………………………………………..
Supervisor
ii
Declaration
I Kidima Robert declare that this research report is my original work and has never been
…………………………………………………….
Signature date
Student
iii
DEDICATION
I dedicate this study to my parents Mr Kule Jemu and Mrs Biira Alice Kule, my brothers and
sisters, my friend Janet Kabajungu and the entire MUSASA family, for their love, trust,
encouragement and support given unto me for the success in my career. May God continue to
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ACKNOWLEDGEMENT
I thank the Almighty God who has been my guide from the inception of this career until now,
had it not been His Everlasting Love and Grace I would have been nowhere. His provisions,
Mercy and Faithfulness have always encouraged me, Glory and Honor be Unto Him always,
amen.
I extend my sincere gratitude to my parents, brothers and sisters for their love, support and
encouragement throughout the period of this study. My friends Janet, Nsumba, Allen, Isaac and
the entire MUSASA family am very grateful for all, words can not express how sincere I
appreciate all your support both physically, financially and spiritually, may GOD abundantly
bless you.
Much appreciation goes to my beloved supervisor Mr. Katongole Nobert for guiding me through
the entire process of research, thank you very much. My humble appreciation goes to Mr Fulutu
Stephen the principal school of Radiography for the timely guidance during the time of study,
Finally, I thank the research and ethics committee of Mulago National Referral Hospital for
support and guidance given unto me. I thank the radiology staff for the guidance, support,
encouragement, practical skills and a free learning environment rendered to me during the course
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Table of contents
Contents page
Approval..........................................................................................................................................ii
Declaration.....................................................................................................................................iii
Table of contents............................................................................................................................iv
Operational definitions...................................................................................................................ix
Executive summary.........................................................................................................................x
CHAPTER ONE..............................................................................................................................1
INTRODUCTION...........................................................................................................................1
1.0 Introduction............................................................................................................................1
1.2Problem statement...................................................................................................................3
1.7.1Geographical scope..............................................................................................................5
CHAPTER TWO.............................................................................................................................6
LITERATURE REVIEW................................................................................................................6
1.0 Introduction............................................................................................................................6
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1.1 X ray request form.................................................................................................................6
CHAPTER THREE.......................................................................................................................13
METHODOLOGY........................................................................................................................13
3.0 Introduction..........................................................................................................................13
3.11Pilot study............................................................................................................................16
REFERENCES..............................................................................................................................19
Appendices....................................................................................................................................22
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ix
List of Acryonymns and Abbreviations
x
Operational definitions
Clinical history: information gathered by medical practitioners about a patient’s past and present
Medical practitioner: a person who holds a valid registration and practicing license as such
under any law in force in Uganda governing the registration of medical and dental practitioners.
provided at the moment by the patient. Or Clinical opinion which may also be informed by
X ray request form: template forms whose form fields define minimum radiology request
information required by a radiology department to review the justification of the request, decide
on examination protocol and to verify x ray request information before exposing the patient.
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Executive summary.
Adequate and eligible filling of x- ray request forms is paramount if the radiological
investigations required by Medical practitioners are to improves patient management plans. The
x ray request form template provides the minimum information required by the radiology
department to justify the requested examination, select the appropriate exposure factors and
protocol to help in answering the clinical questions posed. This request template attempts to
provide standard information for all patients in an effort to give standard care. X ray request
forms are the basis of communication between the referring physicians/ clinicians and the
imaging specialists. These are the sole documents on the basis of which a justification to carry
out a radiological procedure is carried out. However, across the globe, there is a problem of
inadequately filled x ray request forms. This study will assess the level of completion of x ray
request forms received at the radiology department, Mulago National Referral Hospital by
analyzing patient information, clinical information and medical practitioner’s identification data
A descriptive cross sectional study approach will be adopted for this study to analyze the
information provided on the XRF. This will be in consideration of ethical issues and
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CHAPTER ONE
INTRODUCTION
1.0 Introduction
This chapter covers the background of the study, problem statement, general and specific
objectives, research questions, justification of the study and scope of the study.
Medical imaging has led to improvements in the diagnosis and treatment of numerous medical
request is through the use of a properly designed form known as x ray request form. This form in
addition to anatomical part needed also contains other essential details which must be provided
X ray request forms are the basis of communication between the referring physicians/ clinicians
and the imaging specialists. These are the sole documents on the basis of which a justification to
carry out a radiological procedure is carried out. However, across the globe, there is a problem of
The Royal College of Radiologists (UK) 2017 guideline states: “Requests should be completed
accurately and legibly to avoid any misinterpretation; ideally, they should not be handwritten.
In a hospital setting with computerized record system, this information is digitally entered by a
referring clinician and passed to the radiologist or radiographer designated as the imaging
specialist. However in settings like ours where the record system is not computerized, the patient
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carries the request form to the imaging practitioner; in effect the X ray request forms (XRFs) are
essential means of communication between referring medical practitioners and the imaging
specialist.
The reasons for the request should be clearly stated, and sufficient clinical details should be
supplied to enable the imaging specialist understand better what the clinician wants in terms of
information to the clinical questions and modalities to use in generating the information.
A comparison of the American College of Radiology and the Royal College of Radiology shows
that x ray request form should contain the following information (Akinola et al. 2012): the
clinical background; the question to be answered; the patient’s name, age, address, and telephone
number; the ward; the name and signature of the requesting doctor; the name of the consultant
Currently however, the patient’s and clinician’s address, telephone number, email, contact
Abubakar, M.G et al. 2015, stated that inadequate request filling is a worldwide problem. From
the study there were a relatively high number of uncompleted fields on the request form. None of
The forms provide the clinical question to be answered by the imaging specialist. Some diseases
have similar radiographic patterns, and their clarification requires adequate patient information.
An incompletely filled form will make it difficult for the imaging specialist to narrow the
differential diagnosis for certain imaging patterns. It may also lead to unnecessary investigations,
increased hospital stay, repeated exposure to radiation, and delayed management of the patient
with increased cost to the patient and the hospital. (Bashiru B. Jimah 2021)
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1.2Problem statement
The standard is that all request forms received should contain the patient’s name, age, sex,
address, telephone numbers (patient’s and medical practitioner’s), ward, clinical history, the
specific question to be answered, the name and signature of referring clinician and the name of
the consultant responsible for the patient’s ward and name of the institution or hospital. The
patient’s status (either walking, stretcher, wheel chair or bedside), hospital registration number,
x ray number and date of examination, investigations required and imaging modality to be used.
Reviewed literature shows that request forms are often inadequately filled globally. (Akinola et
al. 2012)
Filling in the request forms adequately cannot be overemphasized as it reduces the number of
unhelpful radiographic examinations performed and aids concise radiographic diagnosis. It also
indirectly helps to reduce the investigation time as patients are not sent back for clarity and
improve the quality of service offered to the patients. It also helps in the justification for
radiation exposure to reduce radiation dose to the patient (Barakzai et al. 2021)
According to a study conducted in Mulago National referral Hospital in 2007, by Kiguli and
Nabaweesi on views of radiology staff about clinical information given on x ray request forms, it
was revealed that some radiographs were not reported because of insufficient clinical
information given on request forms. Despite the recommendations from this study which
emphasized continuous medical education about the importance of adequately filled XRF fields,
most XRF received lack sufficient patient identification details, clinical information and medical
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practitioner’s details. Therefore, there is need to assess the level of completion of the x ray
request forms received at the radiology department, Mulago national referral hospital.
To assess the level of completion of the x ray request forms received at the radiology
1. To determine whether patient bio data information is given on request forms received in the
department.
2. To find out whether patient clinical history is provided on the XRF received
forms.
1. Is patient bio data information filled on the request forms received in the department?
The study will be aimed at determining the level of completion of plain x ray request forms for
investigations done. The results will be used in emphasizing the need to provide the adequate
information on the request. This provided information helps the radiological team in selecting the
appropriate modality and projections which will answer the clinical questions given by the
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requesting medical practitioner, thus help improve patient management. The information will
The study results will be used to ensure continuous medical education to medical practitioners
emphasizing the importance of filling all areas on the request forms as this will improve the
Most imaging products are not reported on, for lack of adequate clinical history that helps in
The results of the study will be used by future researchers to assess the implementation of the
At the end of the study the researcher will be awarded a diploma in medical radiography of the
The study was conducted at the radiology department, Mulago National Referral Hospital.
The study was conducted on plain x ray request forms received at the radiology department,
Mulago National Referral hospital. Incomplete x ray request forms often drive the imaging
personnel to probe patients for more clinical information. However, this study did not involve
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CHAPTER TWO
LITERATURE REVIEW
1.0 Introduction
This chapter contains reviewed literature from similar studies addressing the study objectives.
An x ray request form is a clinical document completed by a licensed medical practitioner stating
examination needs to be done, why the examination needs to be conducted and on whom the
According to ICRP 2013, the following guidelines were issued for justification of any medical x
ray examination requested; All requests must be in writing and signed by the person requesting
the examination(s); the clinical indication for the examination(s) must be indicated; X-ray
examinations may only be requested by a Medical Practitioner, Dentist; or any health care
professional as defined in the National Health Act, 2003 (Act No. 61 of 2003).
A radiographer in his/her professional capacity may refuse or agree to the request provided that
good and sufficient grounds exist for his/her decision. Should the radiographer question the
qualifications and competency of the professional making the request, or the possibility of an
unsubstantiated request, for example, clinical history indicated does not justify or necessitate the
performance of the x-ray examination, the radiographer may refuse to perform the examinations.
X ray Request Forms (XRFs) are template forms whose form fields define minimum radiology
request information required by a radiology department to review the justification of the request,
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decide on examination protocol and to verify x ray request information before exposing the
template forms which in turn form a framework for requesting a radiological examination. The
use of x ray request forms in radiology attempts to provide standard radiological request
information across the board for all patients in an effort to provide standardized care (Spurgeon
et al., 2011)
A request form is a document of immense importance with medico-legal standing. It ensures that
the correct procedure is performed on the right patient; the procedure which involves the use of
ionizing radiation must be justified. A study by Salim & Saif in 2013 about x ray request forms a
neglected document; the only parameter fulfilled in all the forms was the presence of referring
doctor’s signature. The commonest blank fields were as follows: patient location: 62%, clinical
notes: 67.26%, doctor's name: 47.33% and date of referral: 14.2% in 1500 request forms
analyzed.
Mung’omba (2011) estimated that about 30-50% medical decisions are based on x-rays
examinations. Today, radiology comprises different imaging modalities with both ionizing and
non-ionizing radiations. X ray request forms are essential communication tools used by hospitals
and doctors referring patient for radiological investigations. (Akinola et.al. 2012 and Irurhe et.
al.2012).
According to IAEA-HHS4 (2010: 29), an x ray request form that has this prescribed information
completely and accurately filled in meets minimum prescribed radiological request information.
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Table 1 minimum information on x ray request form (IAEA-HHSS 2010).
examination
The patient’s full name is required so as to avoid confusion with others of similar names. The
patient’s name helps in proper identification of the patient and ensuring that the right
examination is performed on the right person. According to Irurhe et al., (2012) and Akinola et
al., (2010) revealed that the name field was completely filled in their studies.
This also helps in proper patient identification and assists the radiographer in evaluation and
justification of exposure factors. A study by B. Jimah 2021 indicated that only 88% of the
analyzed request forms in cape coast teaching hospital had this field filled.
Asare HK 2021, a significant number of x ray request forms 31% did not have the ages of
patients filled.
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Gender is not only required for patient identification but also pertinent in disease classification
and predilection. It is well known that certain disease conditions may have the predisposition for
male or females as the case may be, thus proper documentation of the gender will enhance
effective and precise radiologic diagnosis and improve the overall patient outcome. (Robinson et
al.2021)
This is needed so that the radiologists report will be directed to the right place and prevents
A study conducted by Asare HK in 2018 revealed that 39% of the request forms did not indicate
the patients ward or clinic. This may result in sending the results or radiographs to the wrong
address.
The ward or clinic from which a patient is referred is important in identifying and recalling the
patient. It enables locating the patient and eliciting more information about the patient. It also
makes it possible to obtain the patient’s folder and make enquiries about the attending clinician.
It may help in envisaging the severity of the patient’s illness and consider necessary adjustments
in the radiological investigation. In as much as this field is important in the request forms most
clinicians ignore it while filling the request forms. (Onwuchekwa RC and Maduforo, 2017)
Patient’s address helps in recalling patient when there is absence of demographic data, and
incorrect information which may cause serious errors even in identifying the patient. (Abubakar.
et al. 2015)
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The address of patient is necessary for some reasons, where an outpatient needs to be recalled or
if in the course of investigation, something goes wrong with the patient and there is need to
This describes the patient’s condition whether he or she is walking, on stretcher, in a wheel chair,
ambulated or at bedside.
Mobility status of patient prepares the radiographer for the selection of an appropriate technique.
However, the patient’s mobility status was not filled in 87% 0f 339 request forms analyzed in the
If there is a lack of proper communication in the form of inadequate clinical history of the
patient, then the imaging specialist may perform an unnecessary procedure or perform the
An x ray request form is a clinical document completed by a physician stating what procedure or
examination is desired. This document tells why the examination is to be conducted, and on
whom the examination will be performed. Also, inherent in the x ray request form is the clinical
The Clinician is required to state the reason for referral as this helps radiographer to better
understand the patient’s clinical condition so that the required expertise maybe utilized to proffer
the necessary information to aid appropriate patient management (Irurhe et al., 2012).
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It aids the imaging specialist to determine the justification for radiation exposure and the
conformity of these requests to the Royal College of radiologists (RCR) guidelines. Radiologists
and radiographers can only justify exposure when enough clinical history is given.
Before the radiographer applies ionizing radiation to the patient, the acceptable and ethical
practice of radiography should involve reviewing whether the benefits outweigh the risks
associated with requested examinations. Therefore justification in radiography forms part of the
duty of patient care in clinical practice and requires the evaluation and clarification of requested
examinations basing on clinical history and investigation requested. (J. Vom 2017).
Sufficient clinical detail to justify performance of the diagnostic imaging examination and to
confirm appropriate choice of the examination and imaging modality should be provided.
(Pitman 2016)
Clinical information concerning the patient was indicated in 51.39% of the forms while 48.61%
of the forms do not contain the patient’s clinical information (Robinson et.al 2021)
It is important to know the consultant in charge of the patient as well as the Clinician working
with the consultant who in most cases refers the patients for investigation. Their signature is
important especially for medico legal reasons, because an impersonator could fill a form and
write a doctor’s name but wouldn’t be able to sign the signature correctly, hence the doctor’s
The requesting doctor’s phone number is necessary for contacting the doctor and eliciting more
information about the patient or for giving feedback, especially where urgent attention to
patient’s condition is required. As important as the doctor’s phone number is for ease of
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communication, it was not included in hospital request forms and creates communication
difficulty and a dislocation to the idea of managing the patient as a team which gives better
patient outcome. In this era of GSM (Global System for Mobile communication) which had
made communication easy, all medical requests should include requesting clinician’s phone
In a study at James cook university teaching hospital,188(93.1%) had the name of consultant in
charge of the patient. Majority 180(89.1%) had names and signature while 7(3.5%) had only
names without signature and 14(6.9%) had only signature without names. (Mohamed et.al 2011)
The registration number indicated on the x ray request is the patient’s medical file number given
X ray number is a departmental number used in accounting for the supplies used in terms of film
sizes per examination requested. It also indicates if previous imaging studies have been
performed for this patient at this department, old films are an excellent source of information as
Adequate information on history of pervious X rays was volunteered in 72(35.6%) of the request
form and only 6(3.0%) indicated that the film was sent along with the request form to the
radiology department. Only 12 (5.9%) had previous X-ray number filled. (Mohamed et.al 2011)
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2.2.4.2 Radiographers remark
The imaging technologist should print his name or signature on the x-ray request form. The film
sizes used and exposure factors used and date of the examination and dispatch of results. The
radiologic technologist should carefully review the patient before introducing the patient into
radiographic room. This will enable the technologist to have the x-ray room prepared, having all
equipment and accessories readily available. Scope of practice to supply additional, unrequested
positions, but the technologist should advice the physician of other projections or modifications
that might enable him or her to better visualize the affected area, accurate terminology and
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CHAPTER THREE
METHODOLOGY
3.0 Introduction
This chapter describes how the study will be carried out to achieve the study objective.This
section consists of the study design, study area, study population, sample size determination,
sampling technique, sampling procedure, inclusion criteria, exclusion criteria, data collection
method and tool, data collection procedure, piloting the study, quality control, data analysis and
A descriptive cross sectional study design was adopted for this study.
This research design attempts to describe, explain and interpret conditions of the present. It was
used to analyze and examine the level of x ray request form completion received at the time of
study
This study was carried out at Mulago National Referral Hospital Kampala.
Mulago National Referral Hospital was founded in 1913 by Albert Ruskin Cook and later in
1962 the hospital was further extended with the construction of Lower Mulago commonly
known as new Mulago. Mulago national referral hospital which is located on mulago hill,
Kawempe division Kampala district in Uganda. The coordinates of the hospital are 0 020’16” N,
department has different modalities both ionizing and non-ionizing; ultrasound unit,
mammography, fluoroscopy, plain x rays, dental x rays, Computed tomography (CT) and
magnetic resonance imaging (MRI). This study was conducted only in the plain x ray unit.
The study involved all the x ray request forms received in the radiology department at the study
time.
The Kish and Leslie (1965) formula was used to calculate sample size as it’s appropriate for
n = Z2P (1-P)
d2
n = 384.
Since the total number of x ray request forms involved is less than 10,000 the following formulae
applies.
nf = n
N = 500 (the total estimated number of plain x ray request forms received in two weeks)
nf = __n__ = 384__
1 + n/N 1+ 384/500
= 384__
1 + 0.768
= 384_
1.768
= 217.19
The sample size used for this study was 217 request forms.
The researcher used non-random convenient sampling technique on the basis of received x ray
request forms until the 217th request form. This enabled the investigator to collect data from the
received x ray request forms in the department, thus obtaining the required information saving
All x ray request forms received in the department were sorted according to their categories as:
CT, fluoroscopic studies, mammography, dental and plain x ray request forms.
The sample size was determined from the plain radiography request forms received during time
All plain X ray request forms received at the department were included in the study.
All other X ray request forms like CT, fluoroscopic studies, mammography or dental requests
The researcher and his assistant collected data using observation method with pens, notebook,
and checklist from the x ray request forms received in the plain x ray unit.
The researcher collected data using a checklist that was filled by himself or his assistant giving a
score of one (1) for a properly filled area on the x ray request form and zero (0) for incomplete
A letter of acceptance from Mulago national referral hospital research committee was presented
to the radiology department, plain radiography unit to allow the investigator collect data from
3.11Pilot study
The study was first carried out at Murchison bay hospital one week before the actual study, 40
xxix
x ray request forms were assessed for completeness and the data collection checklist was
adjusted and errors corrected before actual data collection at Mulago national referral hospital.
The checklist consisted of agreed upon areas/fields as indicated on the x ray request form; patient
The data collection checklist was pretested at Murchison bay hospital luzira before being used in
the study. The checklists were given enough time to be filled while assessing the information
provided on the x ray request forms. The x ray request form information provided was coded, 1
for appropriately filled and 0 for incomplete/ unfilled gaps and the checklists were stored
properly in a file.
After data collection, the x ray request forms were kept by the data entrant focal person at the
department. Data was cleaned, sorted and entered into a Microsoft excel for analysis using
A permission letter was obtained from the principal school of medical radiography which
introduced the researcher to the Research and Ethics committee of Mulago National Referral
Hospital.
The research proposal was submitted to the research and ethics committee of Mulago national
referral hospital for review and was authorized to conduct the study.
xxx
The patient’s clinical information provided on the request forms was kept with extreme
confidentiality.
Nonstandard XRF templates may be used by medical practitioners or clinicians and it becomes
Inadequate financial resources to complete this study may limit the study, however I will strictly
The findings of the study were used to write a research report, and copies were submitted to the
following stakeholders;
medical radiography.
Supervisor
Student researcher
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CHAPTER FOUR
PRESENTATION OF FINDINGS
4.0 Introduction
This chapter shows the study findings according to the objectives. Data presented was analysed
using Microsoft excel and a calculator. The study findings were used to answer the research
identification information is provided on the x-ray request forms received in the radiology
department of Mulago National Referral Hospital. The study involved assessment of the level of
completion of 217 x-ray request forms received during the study period.
The following fields pertaining patient information to be provided on the x-ray request forms
were studied; patient’s name, age, sex, patient’s address, contact number, patient’s
mobility(physical) status, hospital name and ward. The findings were as follows.
filled
abbreviations
Nothing 04 6.64
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91.24% (198) of the request forms had patients surname and other names, 5.07 % (11) had only
one name, 1.84% were written on unknown and 1.84% (4) did not have any names or
4.1.2 Table showing frequency distribution of how patient age was filled on the XRF
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N = 217
155 (71.43 %) of the x ray request forms had the age column well filled indicating patient’s age
in years, months or days. 06 (2.77%) of the request forms did not indicated whether the age filled
was in years, months or days. 15(6.91%) of the request forms had the age column filled as adult
and 41 (18.89%) of the request forms age field were not completely filled.
4.1.3 Table 4 shows how the patients gender was filled on the request forms N=217
Indicated 181
Not indicated 36
Only 87 (40.1%) the request forms had the patient’s hospital ward indicated while the rest
xxxv
12 (5.53%) of the request forms had patient’s address indicated and only 2 (0.92%) had the
Only 19.8% (43) of the request forms indicated whether the patient was ambulant or not.
xxxvi
4.2 Table 5: the distribution frequency of how patient’s clinical information was given on
investigations
Investigations only
indicated
indicated
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4.3 Distribution of referrer’s information on the request forms N = 217
name given
REFERENCES
Abubakar, M.G., C.N. Ivor, A. Waziri, D.Z. Joseph, G. Luntsi, A. Obotiba, and E. Mathew.
Akinola R, Akinkunmi M , Wright K, Orogbemi O. Radiology request forms are they adequately
xxxviii
Asare HK (2018) Audit of X-Ray Requisition form at Tamale Central Hospital, Ghana. J Radiol
Barakzai M, Sheer Z, Muhammad A, et al. (February 14, 2021) Evaluation of Radiology Request
Forms in a Tertiary Care Hospital: An Audit With a Focus on the Impact of Technological
IAEA‐HHS4. 2010. International Atomic Energy Agency. Human Health Series no. 4.
Comprehensive clinical audits of diagnostic radiology practices: A tool for quality improvement.
Vienna: IAEA.
Irurhe NK, Sulaymon FA, Olowoyeye OA, Adeyomoye AA. Compliance rate of adequate filling
of radiology request forms in a Lagos university teaching hospital.World J Med Sci 2012;7:10-2.
Jason Vom, Justification of radiographic examinations: What are the key issues? Journal of
Kiguli R & Nabaweesi F (2007) views of radiology staff about clinical history given foor
radiological investigations Pub Med 23;412 Hemert and valkincreased radiation exposure
xxxix
Mohamed Abbas, A. Omer and M. Hamad Adequacy of clinical information on radiology
request cards from medical assessment unit. Clinical Audit. James Cook University Hospital, UK
Nucl Med Biomed Imaging, 2016 doi: 10.15761/NMBI.1000103 Volume 1(1): 5-6
Mung’omba, B. 2011. “Factors Influencing Patient’s Demand for X-Ray Examinations in Rural
Robinson ED, Ijeruh OY, Wonodi W, Abam R. Clinical governance in radiologic practice:
Royal College of Radiologists. iRefer: RCR referral Guidelines 8th edition London: RCR 2017
https://www.irefer.org.uk/guidelines/aboutguidelines/communication-radiology-service
Salam A, Saif S. Radiology request form; A neglected medical document. Professional Med J
2013;20(2): 308-312.
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Spurgeon, A., Hiser, B., Carol Hafley, C., Litofsky, S.N. 2011. Does Improving Medical Record
https://doi.org/10.1002/jmrs.211
Vom J, Williams I. Justification of radiographic examinations: what are the key issues? J Med
Appendices
information info.
Consultant
Investigati
Telephone
Telephone
Questions
signature
Remarks
Clinician
Address
number
’s name
Xray
Date
on
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Key
Re = remarks by radiographer
RESPONSIBLE
proposal Supervisor
xlii
3. Handing in research October 2021 UIAHMS-Mulago Investigator
prisons
compiling
Supervisor
research report
xliii
Note book 2 5000 10,000
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