Analysis of Compliance with the Principle of Justification for CT Scans Performed in the University Hospitals of Ouagadougou, Burkina Faso

Abstract

The principle of justification is one of the fundamental principles of radiation protection, and even the most important one, as it is the first that must be considered before any request for an X-ray examination. The objective of this study is to assess compliance with the justification principle for CT scans performed in the University Hospitals of Ouagadougou through an analysis of the relevance of examination requests. This is a descriptive analytical study combining two approaches, a quantitative approach and a qualitative approach, based on 516 CT scans performed between August 1, 2024, and January 15, 2025. The analysis of justification was based on the consistency between the stated clinical indication and the requested CT scan. This conformity analysis was carried out using the “Good Practice Guidelines” (Guide de Bon Usage, GBU) for medical imaging examinations published by the French Society of Radiology (SFR) and the French Society of Nuclear Medicine (SFMN). Overall, 51 out of the 516 examinations (9.88%) in our study were deemed inappropriate. Among these, males were the most represented, accounting for 74%, with a sex ratio of 2.84. Lumbar and brain CT scans were the most affected by inappropriate requests, with respective rates of 23.53% and 19.61%. Spinal syndromes and tumor and/or abdominal masses were the most common inappropriate indications in our sample, representing 45.1% and 17.7% respectively. Physicians who had received training in radiation protection had a relevance rate of 92.88%, compared to 66.66% among those who had not received such training. Training physicians in radiation protection in general, and in the justification principle in particular, therefore appears to positively influence the relevance of X-ray examination requests, with a p-value of 0.036 (p < 0.05).