Radiographers' concerns that no referral criteria for radiological examinations are in place could soon be alleviated as meetings are underway to lay down the relevant guidelines.

The criteria could help so that patients do not get unnecessary X-rays, the president of the Society of Medical Radiographers, Etienne Grech said.

It is estimated that one-third of the Maltese population undergoes an X-ray annually, he said.

Mr Grech voiced his colleagues' concern that no referral criteria or guidelines had been put in place in any Department of Health institution, although they have been mandatory since 2003 under a legal notice.

He told The Times the guidelines would help physicians pick the ideal radiological investigation according to particular clinical symptoms.

When contacted the spokesman for St Luke's, Boffa and Mater Dei hospitals, Tonio Bonello, said the professionals involved were holding meetings to lay down guidelines for the referral of patients who need to undergo radiological examinations.

He said representatives from the International Atomic Energy Agency were assisting with the planning and discussions at these meetings in order to facilitate the necessary work.

Mr Bonello said an average of 150,000 X-ray and Gamma ray examinations are carried out annually.

He pointed out that radiology facilities are equipped with the most conventional imaging modalities and the medical staff consider the risks and benefits of radiological examinations for their patients.

"Radiologists themselves are also consulted and they vet referrals for examinations where the radiation dose involved requires further evaluations, such as CT-scan and fluoroscopy examinations," he said.

The spokesman said the concept in Malta of defensive medicine was starting to set in and this would result in more investigations being requested.

However, he pointed out that if an investigation did not yield any abnormal results it was not necessarily a waste of time since the information was incorporated in the patient's file, which enables the referring physician to reach an early and timely diagnosis.

The radiographers are also concerned that an increase in the number of doctors at St Luke's accident and emergency department might lead to added pressure on their service.

"As things stand at the moment we already have our hands full and have to work faster than we would like. A radiographer sees on average a patient every six minutes and in this time he has to do a multitude of things, including ensuring that female patients are not pregnant, explain the procedure, register the patient on a radiology information system, wait for the patient to change, position the patient, optimise the radiation dose, evaluate the radiographs and consider the necessity of further views," he said.

However, Mr Bonello said increasing the number of doctors at the accident and emergency department would not lead to more requests for radiological examinations. He argued that the number of examinations requested was in proportion to the number of patients who go to the A&E department and not to the number of doctors seeing the patients.

"Furthermore, increasing the number of doctors means that each case may be thoroughly evaluated and this should actually result in a drop in the number of investigations requested," he said.

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