Mekonnen, Abebe(MD, Consultant Neuroradiologist)Demeke, Etsehiwot2020-02-032023-11-052020-02-032023-11-052019-09http://etd.aau.edu.et/handle/123456789/20547Background: The use of advanced diagnostic imaging modalities is significantly increasing throughout the world. Overutilization of these modalities is straining the health care system and exposing patients to medical and economical sequel. There are various evidence-based guidelines to determine the appropriateness of a certain imaging modality. One such guideline is the American College of Radiology Appropriateness Criteria (ACR –AC). In our institution, there is no clear data showing how many of these investigations are truly indicated. Objective: The main aim of this study is to objectively determine the magnitude of inappropriate head CT scans done at Tikur Anbessa Specialized Hospital (TASH), Radiology Department and to assess the factors associated with inappropriate scans. Methodology: A hospital-based retrospective cross-sectional study was conducted at Tikur Anbessa Specialized Hospital (TASH) among patients getting head CT examinations at the department of radiology in the period of August 2018- November 2018. All head CT scans done in the study duration, with complete requests and available medical records were included in this study. Data was collected from the CT requests and the Medical records as well as the radiology reports. Appropriateness of each scan was assessed using the ACR-AC and finally, data was analyzed using SPSS version 25.0 software and results were displayed using descriptive, univariate, bivariate and multivariate regression models. Results: Of the 443 Head CT scans assessed, the majority were done for male patients (61.6%) and the mean age of patients scanned is 35.185 with minimum age 1 month and a maximum of 90years and standard deviation of 20.84. 17.2% were done for children younger than 14yrs of age. 63.9% of the scans were non-contrast head CTs and 64.3% were initial imagings with no prior study for similar indication. This study showed that there is a significantly large number of inappropriate head CT scans being done (11.7%). The most frequent indications for requesting inappropriate head CT included Headache, seizure and head trauma. The Central triage, EOPD sand pediatric departments requested the largest number of inappropriate head CT scans. Residents requested the majority of inappropriate scans. Inappropriate head CT scans were associated with young age, use of IV contrast agent, qualification of requesting physician and an incidental outcome. Scans done for cerebrovascular diseases were more likely to be appropriate. Conclusion: This study showed a high magnitude of inappropriate head CT scans and it should serve as a gateway for future studies to evaluate the appropriateness of all other imaging modalities in the department and motivate implementation of control mechanisms aimed at appropriate utilization of medical imaging. One such mechanism we recommend is preauthorization by radiologists. Medical students, physicians as well as radiology residents and radiologists need to be aware of the ACR appropriateness criteria and incorporate it into their daily practice to provide better quality care for patients. It should also be planned to prepare a local customized imaging appropriateness guideline taking the financial status of the country into consideration; as the ACR-AC assumes an ideal setup and moreover, doesn’t address most clinical indications.en-USappropriateness, overutilization, head CT, TASH, ACR-AC, preauthorizationThesis