6880 MRI Brain – An ideal world vs reality from a DGH perspective

Objectives The 'HeadSmart: Be Brain Tumour Aware' accredited RCPCH guidance sought to reduce the total diagnostic interval (TDI) to a median target of 5 weeks.¹ As pressure on radiology services and waiting-lists increase, a robust radiological vetting process is vital to ensure 'urgent' and 'routine' slots are assigned appropriately.² We aimed to analyse the requests for MRI-brain, comparing differences between routine and urgent requests and to calculate the median TDI. Methods This is a retrospective review of all MRI-brain requests and results in a DGH over a 6-month period (May-October 23) using the electronic requesting systems. We assessed the quality of the requesting clinical information, dates of the request and scan and the subsequent results. Ex-premature children and young people (CYP) and those with previous abnormal head scans were excluded from analysis. Results There were 109 MRI-brain scans requested; 60% were 'urgent', of which 15% were abnormal requiring urgent action. 39% of urgent scans were requested for inpatients. For 'urgent' requests, the top three symptomatic themes were focal neurological signs and/or seizures (39%), headaches with red flags (29%) and developmental delay/regression (6%). 12% were requested as an 'urgent' MRI despite referral criteria being more appropriate for a 'routine' scan. 40% of MRI scans were requested as 'routine'. 7% of routine scans had an abnormal result. Of all routine requests, 47% cited persisting headache, and of those 10% of requests included a red flag symptom. Delayed development (12%) and suspected macro or microcephaly (14%) were the other symptom themes. The median TDI for 'urgent' scans was 2.5 (0–12, IQR) weeks. The median TDI for 'routine' scans was 8 (2.5–20, IQR) weeks. Conclusion The NICE and RCPCH accredited 'Brain Pathways Guideline' decision support tool advises on the management of CYP presenting with symptoms of a potential brain tumour. Our study has revealed areas of good practice that align with this. We also demonstrate a wide interquartile range of time from request to scan at our centre. This could be attributed to clarity of the request and scanning capacity. As radiology waiting-list pressure looks to only increase, paediatricians and radiologists need to work together to develop and improve the requesting and vetting protocols. It is vital they have effective procedures and open lines of communication to ensure appropriate and timely allocation of routine and urgent scans. References NICE.org, Children's Brain Tumour Research Centre, 2017. NHS England, Diagnostic waiting times and activity statistical report, 2023.