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Magnetic resonance imaging for vestibular schwannoma: cost-effective protocol for referrals

  • B A D Mettias (a1) and M Lyons (a2)



Vestibular schwannoma is the most common neoplasm in the cerebellopontine angle, and fast spin-echo T2-weighted magnetic resonance imaging is the most sensitive test for diagnosing it. This study evaluated the financial and time costs of unnecessary magnetic resonance imaging referrals before and after the application of a magnetic resonance imaging protocol.


A full audit cycle was used for the assessment. The first cycle in January 2012 was retrospective and evaluated the financial impact of current selection criteria for magnetic resonance imaging referral against standard guidelines. The second cycle in January 2014 was prospective after implementation of the protocol.


There were 46 and 112 patients who had magnetic resonance imaging during first and second cycle, respectively. Of the referrals for magnetic resonance imaging, 65 per cent versus 81 per cent of the referrals were appropriate in the first and second cycles, respectively. The relative risk was reduced from 0.5 to 0.2. The waiting times for magnetic resonance imaging scans improved.


Selection criteria for magnetic resonance imaging referral are important in reducing waiting times for scans, patient anxiety and conserving trust resources.


Corresponding author

Author for correspondence: Dr Bassem A D Mettias, ENT Department, Lister Hospital, Corey's Mill Lane, Stevenage SG1 4AB, UK E-mail:


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Dr B A D Mettias takes responsibility for the integrity of the content of the paper

Presented at the British Academic Conference in Otolaryngology, 8–10 July 2015, Liverpool, UK and at the National ENT Audit day, 23 November 2018, Nottingham, UK.



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Magnetic resonance imaging for vestibular schwannoma: cost-effective protocol for referrals

  • B A D Mettias (a1) and M Lyons (a2)


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