ASSESSMENT OF THE LEVEL OF COMPLETION OF X RAY REQUEST

FORMS RECEIVED AT THE RADIOLOGY DEPARTMANT OF

MULAGO NATIONAL REFERRAL HOSPITAL

BY

KIDIMA ROBERT

UAHEB 031/013/18

A RESEARCH REPORT SUBMITTED TO UGANDA ALLIED HEALTH

EXAMINATIONS BOARD IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE AWARD OF A DIPLOMA IN MEDICAL

RADIOGRAPHY OF UGANDA INSTITUTE OF ALLIED HEALTH AND

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.

……………………………………………………..

Mr. KATONGOLE NOBERT date

Supervisor

ii
 Declaration

I Kidima Robert declare that this research report is my original work and has never been

presented before in any institution for academic award or publication

…………………………………………………….

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

bless you and the work of your hands.

iv
 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,

may God bless you.

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

of study. May God bless you more.

v
 Table of contents

Contents page

Approval..........................................................................................................................................ii

Declaration.....................................................................................................................................iii

Table of contents............................................................................................................................iv

List of Acryonymns and Abbreviations.......................................................................................viii

Operational definitions...................................................................................................................ix

Executive summary.........................................................................................................................x

CHAPTER ONE..............................................................................................................................1

INTRODUCTION...........................................................................................................................1

1.0 Introduction............................................................................................................................1

1.1 Background of the study........................................................................................................1

1.2Problem statement...................................................................................................................3

1.3 General objective...................................................................................................................4

1.4 Specific objectives.................................................................................................................4

1.5 Research questions.................................................................................................................4

1.6 Significance of the study........................................................................................................4

1.7 Scope of the study..................................................................................................................5

1.7.1Geographical scope..............................................................................................................5

1.7.2 Content scope......................................................................................................................5

CHAPTER TWO.............................................................................................................................6

LITERATURE REVIEW................................................................................................................6

1.0 Introduction............................................................................................................................6
vi
 1.1 X ray request form.................................................................................................................6

2.1 Information on the x ray request form...................................................................................7

2.2.1 Patient information..............................................................................................................8

2.2.1.1 Patient’s name..................................................................................................................8

2.2.1.2 Age and Sex.....................................................................................................................8

2.2.1.3 Hospital name and ward/clinic.........................................................................................9

2.2.1.4 Patient’s address and contact number..............................................................................9

2.2.2 Relevant clinical history, provisional diagnosis and investigation required.....................10

2.2.3 Medical practitioner’s identification.................................................................................11

2.2.4 Other information..............................................................................................................12

2.2.4.1 Registration and x ray number.......................................................................................12

2.2.4.2 Radiographers remark....................................................................................................12

CHAPTER THREE.......................................................................................................................13

METHODOLOGY........................................................................................................................13

3.0 Introduction..........................................................................................................................13

3.1 Study design.........................................................................................................................13

3.2 Study area.............................................................................................................................13

3.3 Study population..................................................................................................................14

3.4 Sample size determination...................................................................................................14

3.5 Sampling technique..............................................................................................................15

3.6 sampling procedure..............................................................................................................15

3.7 Selection criteria..................................................................................................................16

3.7.1 Inclusion criteria...............................................................................................................16

vii
 3.7.2 Exclusion criteria..............................................................................................................16

3.8 Data collection method........................................................................................................16

3.9 Data collection tool..............................................................................................................16

3.10 Data collection procedure..................................................................................................16

3.11Pilot study............................................................................................................................16

3.12 Quality control...................................................................................................................17

3.13 Data analysis and presentation...........................................................................................17

3.14 Ethical consideration..........................................................................................................17

3.15 Study limitations................................................................................................................18

3.16 Dissemination of results.....................................................................................................18

REFERENCES..............................................................................................................................19

Appendices....................................................................................................................................22

Appendix i: Data collection checklist........................................................................................22

Appendix ii: Workplan...............................................................................................................23

Appendix iii: proposed budget...................................................................................................24

Appendix iv: Letter of permission.............................................................................................25

viii
ix
List of Acryonymns and Abbreviations

GSM: Global system for mobile communication

HHS4: Human health series number 4

IAEA: International atomic energy agency

ICRP: International commission on radiation protection

MNRH: Mulago national referral hospital

XRF: x ray request form

x
Operational definitions

Clinical history: information gathered by medical practitioners about a patient’s past and present

medical condition in order to make informed clinical decisions.

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.

Provisional diagnosis: medical diagnosis by a medical practitioner based on the information

provided at the moment by the patient. Or Clinical opinion which may also be informed by

biopsy, radiological and or other investigations.

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.

xi
 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

provided on the XRF.

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

confidentiality of patient information given on the XRF.

xii
 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.

1.1 Background of the study

Medical imaging has led to improvements in the diagnosis and treatment of numerous medical

conditions in children and adults. (ICRP 2013)

Before any radiological examinations, a request is made by a referring physician/clinician. This

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

to aid diagnosis of the patient. (Mung’omba, 2011)

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. (Barakzai et al. 2021)

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

xiii
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

responsible for the patient’s well-being; and the date.

Currently however, the patient’s and clinician’s address, telephone number, email, contact

number should be included on the x ray request form.

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 request forms received and analyzed was holistically filled.

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)

xiv
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

xv
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.

1.3 General objective

To assess the level of completion of the x ray request forms received at the radiology

department of Mulago national referral hospital, kampala Uganda.

1.4 Specific objectives

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

3. To establish whether the medical practitioner’s identification is provided on the request

forms.

1.5 Research questions

1. Is patient bio data information filled on the request forms received in the department?

2. Is the relevant clinical history provided on the x ray request forms?

3. Is the medical practitioner’s identification provided on x ray request forms?

1.6 Significance of the study

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

xvi
requesting medical practitioner, thus help improve patient management. The information will

enhance examination justification hence reducing unnecessary radiation to the patients.

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

quality of examinations/procedure requested, reports, and accountability.

Most imaging products are not reported on, for lack of adequate clinical history that helps in

narrowing the differentials.

The results of the study will be used by future researchers to assess the implementation of the

recommendations and filling of found gaps.

At the end of the study the researcher will be awarded a diploma in medical radiography of the

Uganda Allied health examinations board.

1.7 Scope of the study

1.7.1 Geographical scope

The study was conducted at the radiology department, Mulago National Referral Hospital.

1.7.2 Content scope

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

clerking patients for more information.

xvii
 CHAPTER TWO

LITERATURE REVIEW

1.0 Introduction

This chapter contains reviewed literature from similar studies addressing the study objectives.

1.1 X ray request form

An x ray request form is a clinical document completed by a licensed medical practitioner stating

what procedure or examination is desired. This document contains information of what

examination needs to be done, why the examination needs to be conducted and on whom the

examination will be done.

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,

xviii
decide on examination protocol and to verify x ray request information before exposing the

patient. (ICRP 2013)

Completeness of radiological request information is underpinned in the design of x ray request

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)

2.1 Information on the x ray request form

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.

xix
 Table 1 minimum information on x ray request form (IAEA-HHSS 2010).

Patient information Clinical information Referrer’s information

Patient’s name Clinical history Consultant’s name

Age and sex provisional diagnosis Clinician’s name and

Patient’s address Clinical question to be signature

Contact details such as answered Clinicians contact details such

hospital ward and telephone Examination required as telephone number

number Date of requesting

examination

2.2.1 Patient information

2.2.1.1 Patient’s name

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.

2.2.1.2 Age and Sex

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.

xx
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)

2.2.1.3 Hospital name and ward/clinic

This is needed so that the radiologists report will be directed to the right place and prevents

losing the radiographs.

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)

2.2.1.4 Patient’s address and contact number

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)

xxi
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

contact the relatives. (Onwuchekwa RC and Maduforo 2017)

2.2.1.5 Patient’s mobility/ physical status

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

study. (Abubakar. et al. 2015)

2.2.2 Relevant clinical history, provisional diagnosis and investigation required.

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

inappropriate procedure. Lack of clinical history on radiology requisition is a universal problem.

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

questions that needs to be answered. (Salam A and Saif S. 2013).

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).

xxii
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)

2.2.3 Medical practitioner’s identification

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

signature authenticates the request. (Onwuchekwa.RC and Maduforo 2017)

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

xxiii
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

number for easy communication in the hospital environment.(Robinson et.al 2021)

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)

2.2.4 Other information

2.2.4.1 Registration and x ray number

The registration number indicated on the x ray request is the patient’s medical file number given

at reception of the patient.

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

they enable you to compare images over time.

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)

xxiv
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

appropriate request. (Mohamed. et. al.2011

xxv
 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

presentation, ethical consideration, study limitations and dissemination of results.

3.1 Study design

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

3.2 Study area

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,

32034’32’’E. (Latitude: 0.337786; Longitude: 32.575550

xxvi
The radiology department is one of the diagnostic departments in the national hospital. The

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.

3.3 Study population

The study involved all the x ray request forms received in the radiology department at the study

time.

3.4 Sample size determination

The Kish and Leslie (1965) formula was used to calculate sample size as it’s appropriate for

descriptive studies of this type.

n = Z2P (1-P)

d2

Where n is the sample size.

Z is the standard normal deviation = 95% confidence level (i.e. 1.96)

P is the portion of target population which is (50 % or 0.5).

d is the acceptable degree of error in this case (5% or 0.05).

n = (1.96)2 x 0.5 x 0.5/0.052

n = 384.

Since the total number of x ray request forms involved is less than 10,000 the following formulae

applies.

Sample size estimation (nf) will be calculated as follows.

nf = The desired sample size ( when population< 10,000)

xxvii
 n = The desired sample size (when population> 10,000)

N = The estimate of the population size.

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.

3.5 Sampling technique

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

time and other resources.

3.6 Sampling procedure

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

of study at the convenience of the researcher.

xxviii
3.7 Selection criteria

3.7.1 Inclusion criteria

All plain X ray request forms received at the department were included in the study.

3.7.2 Exclusion criteria

All other X ray request forms like CT, fluoroscopic studies, mammography or dental requests

were excluded from the study.

3.8 Data collection method

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.

3.9 Data collection tool

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

areas in terms of patient information, clinical information and referrer’s information.

3.10 Data collection procedure

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

x ray request forms of finished examinations during time of study.

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.

3.12 Quality control

The checklist consisted of agreed upon areas/fields as indicated on the x ray request form; patient

information, clinical information and referrer’s information.

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.

3.13 Data analysis

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

descriptive statistics and percentages of completion levels per area determined.

3.14 Ethical consideration

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.

3.15 Study limitations

Nonstandard XRF templates may be used by medical practitioners or clinicians and it becomes

hard for all fields to be considered in such setting.

Inadequate financial resources to complete this study may limit the study, however I will strictly

follow the budget and proposed work plan properly.

3.16 Dissemination of results

The findings of the study were used to write a research report, and copies were submitted to the

following stakeholders;

 Uganda Allied Health Examinations Board.

 Uganda Institute of Allied Health and Management Sciences – Mulago, School of

medical radiography.

 Administration of Mulago national referral hospital, radiology department.

 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

questions on whether patient identification information, sufficient clinical and referrer’s

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.

4.1 Patient information

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.

Field on XRF Number filled Percentage of completeness

Name 213 98.15
Age 176 81.11
Sex 181 83.40
Ward 87 40.10
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Address 12 5.53
Telephone 02 0.92
Mobility status 43 19.80

4.1.1 How patient’s names were filled on the request forms

How name field was Frequency Degree (out of 360)

filled

All names 198 328.48

Only one name with 11 18.25

abbreviations

Labelled unknown 04 6.64

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

abbreviations of patient initials.

4.1.2 Table showing frequency distribution of how patient age was filled on the XRF

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N = 217

How age was filled Frequency Percentage %

Properly filled indicating 155 71.43

years, months or days

Filled without indicating 06 2.77

years, months or days

Filled as adults 15 6.91

Not filled at all 41 18.89

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

Sex Frequency Relative frequency

Indicated 181

Not indicated 36

4.1.4 how patient’s ward field was filled on the XRF

Only 87 (40.1%) the request forms had the patient’s hospital ward indicated while the rest

(59.9%) did not show the ward.

4.1.5 patients address and telephone contact

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12 (5.53%) of the request forms had patient’s address indicated and only 2 (0.92%) had the

telephone numbers filled on the request forms.

4.1.6 Mobility (physical) status of the patient

Only 19.8% (43) of the request forms indicated whether the patient was ambulant or not.

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4.2 Table 5: the distribution frequency of how patient’s clinical information was given on

the request forms. N = 217

Field Frequency Percentage

Clinical history with

investigation indicated only

Clinical questions and

investigations

Investigations only

Clinical history only 02

Clinical history, questions

and investigations filled

Date of the investigation is 141 64.98

indicated

Date of investigation not 76 35.02

indicated

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4.3 Distribution of referrer’s information on the request forms N = 217

Frequency Relative frequency (%)

Consultant’s & clinician’s

name given

Consultant’s name not given 208 95.85

Only clinicians name given

Only signature given

Clinicians name and signature

REFERENCES

Abubakar, M.G., C.N. Ivor, A. Waziri, D.Z. Joseph, G. Luntsi, A. Obotiba, and E. Mathew.

2015. “Evaluation of the Adequacy of Completion of Radiology Request Forms in a Tertiary

Hospital Northeast, Nigeria”. Pacific Journal of Science and Technology. 16(2):219-224.

Akinola R, Akinkunmi M , Wright K, Orogbemi O. Radiology request forms are they adequately

filled by clinicians? The internet Journal of Radiology.2012; 12(1):

Alexander G Pitman: Quality of referral: What information should be included in a

request for diagnostic imaging when a patient is referred to a clinical radiologist?

Journal of Medical Imaging and Radiation Oncology 61 (2017) 299–303

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Asare HK (2018) Audit of X-Ray Requisition form at Tamale Central Hospital, Ghana. J Radiol

Radiat Ther 6(1): 1078.

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

Intervention. Cureus 13(2): e13335. DOI 10.7759/cureus.13335

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.

ICRP, 2013. Radiological protection in paediatric diagnostic and interventional radiology.

ICRP Publication 121. Ann. ICRP 42(2).’

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

Medical Radiation Sciences / Volume 64, Issue 3 / p. 212-219

Journal of Radiation Medicine in the Tropics | Volume | Issue | January-June 2021.

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

Mohamed O. Yousef1 *, Caroline .E .Ayad 1, Amin A. E. Elzaki 2 and Abdelmoneim Sulieman

Evaluation of radiology request forms, SMM 2011; 6 (3):201 – 210

Mung’omba, B. 2011. “Factors Influencing Patient’s Demand for X-Ray Examinations in Rural

Kwazulu-Nata”l. Unisa institutional Repository.

Onwuchekwa RC, Obinna .C Maduforo. Analysis of adequacy of radiological request form

completion: a multicenter evaluation. Pakistan journal of radiology, vol 27,no 3;2017.

Robinson ED, Ijeruh OY, Wonodi W, Abam R. Clinical governance in radiologic practice:

Evaluating the appropriateness of radiologic investigation considering patient clinical

information using the radiology request form. Biomed Res J 2021;8:20-4.

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

Documentation Better Reflect Severity of Illness in Neurosurgical Patients? Clinical

Neurosurgery,58. First published: 11 February 2011

https://doi.org/10.1002/jmrs.211

Vom J, Williams I. Justification of radiographic examinations: what are the key issues? J Med

Radiat Sci. 2017; 64: 212-219.

Appendices

Appendix i: Data collection checklist

Patient information Clinical information Referrer’s Other

information info.
Consultant
Investigati
Telephone

Telephone
Questions

signature

Remarks
Clinician
Address

number
’s name

Xray
Date
on

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Key

H/o = clinical history, Qn = clinical question, Dx = provisional diagnosis

Re = remarks by radiographer

Appendix ii: Workplan

ACTIVITY PERIOD LOCATION PERSON

RESPONSIBLE

1. Literature review and September 2021 UIAHMS-Mulago Investigator

topic identification Supervisor

2. Writing the research Sept -Oct 2021 UIAHMS-Mulago Investigator

proposal Supervisor

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3. Handing in research October 2021 UIAHMS-Mulago Investigator

proposal for approval

4. Pre-testing of January 2022 Murchison bay Investigator

research tools hospital, luzira

prisons

5. Data collection January 2022 MNRH Investigator

6. Data analysis and February 2022 UIAHMS-Mulago Investigator

compiling

7. Report writing March 2022 UIAHMS-Mulago Investigator

Supervisor

8. Handing in of March 2022 UIAHMS-Mulago Investigator

research report

Appendix iii: proposed budget

S Services Items Quantity Unit cost Total Remarks

No. Needed required (Ug.Shillings) (Ug.Shillings)

1 Stationary Ream of 1 15,000 15,000 Student

papers researcher
File folders 3 5,000 15,000 As above

Markers 4 1,000 4,000

Pens 6 500 3000

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 Note book 2 5000 10,000

2 Secretarial Binding of 3 copies of 4000@ 36,000

proposal and proposal and
dissertation 6 copies
dissertation
Proposal 40pages 100@ 4,000
printing 5copies 4,000@ 20,000

Dissertation 6 copies 20,000@ 120,000

printing
Printing of 25 copies 100@ 2,500
checklist
3 Welfare Breakfast 15 days 3,000 45,000

Lunch 15days 7,000 105,000

Field transport 15 trips 2,000 30,000

Air time/ data 50,000 50,000

GRAND TOTAL 459,500

Appendix iv: Letter of permission

UGANDA INSTITUTE OF ALLIED HEALTH

AND MANAGEMENT SCIENCES- MULAGO
P.O BOX 34025,
KAMPALA- UGANDA.
Date …./……./2021.
TO:
THE CHAIRPERSON RESEARCH AND ETHICS COMMITTEE,
MULAGO NATIONAL REFERRAL HOSPITAL
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THROUGH:
THE PRINCIPAL TUTOR,
SCHOOL OF RADIOGRAPHY- UIAHMS-MULAGO
Dear Sir,
RE: PERMISSION TO CARRY OUT A STUDY AT MULAGO NATIONAL REFERRAL
HOSPITAL RADIOLOGY DEPARTMENT.
I am Kidima Robert a third year student of Medical Radiography at Uganda Institute of Allied
Health and Management Sciences – Mulago.
I am kindly requesting for permission to conduct a study on ASSESSMENT OF THE LEVEL
OF COMPLETION OF X RAY REQUEST FORMS RECEIVED AT THE RADIOLOGY
DEPARTMENT, MNRH for the partial fulfillment of the award of a Diploma in Medical
Radiography.
I will be grateful when my request is put under parental consideration.
Yours faith fully,
……………………………
KIDIMA ROBERT
Student Radiographer (Tel-0778620852/0751247670)

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