Table 3 Overview of low-value imaging of the head and brain with reported outcome and suggested practice

Head CT

Minor head injury

2–7.4% relevant findings

[20,21,22,23,24,25,26,27]

Delirium

3–11% relevant findings

[28, 29]

Headache

2–8% relevant findings

Examine patients after trauma or when life-threatening conditions are expected only

[30,31,32,33]

Hepatic encephalopathy

4% relevant findings

Examine patients with history of head trauma or focal neurologic findings only

[34]

Meningitis

12–14% relevant findings

[35]

Hip fracture (geriatric)

 < 1–6% relevant findings

[36, 37]

Medical patients

4% relevant finings

[38]

Lamotrigine toxicity

No impact on patient management

The condition is clinically misinterpreted as stroke

[39]

Repeat head CT

Minor head injury

0–6.5% had change in management

Examine patients with neurological decline only

[33, 40,41,42,43,44,45,46,47,48,49,50]

Traumatic brain injury

5.2–11.4% had change in management

[48]

Delayed intracranial hemorrhage

1% relevant findings

Do not repeat routinely for patients on anticoagulation treatment

[51, 52]

Traumatic epidural hematomas

7% relevant findings

[53]

Follow-up head CT

Shunt surgery

2.3% reoperated

[54]

Chronic subdural hematoma

No change in treatment

Do not routinely do an early post-op CT

[55]

Anterior skull base surgery

12% relevant findings

Examine patients with neurological decline only

[56]

Brain MRI

Multiple sclerosis patients in the emergency department

27.8% relevant findings

[57]

Pure ground glass nodular adenocarcinomas

No relevant findings

[58]

Follow-up brain MRI

Macroprolactinoma

1.7% relevant findings

[59]

Head CT/Brain MRI

Syncope

0–3.8% relevant findings

[60, 61]

Migraine

Not recommended in guidelines

Clinical examination and patient history should be enough to refer patient to a specialist

[62]

Head XR

Shunt malfunction

Did not change patient management

CT should be used instead

[63]

Head CTA

In stroke patients after brain MRI

50% relevant findings

Examine patients with neurological decline only

[64)

Carotid ultrasound

Syncope

2.2–2.8% relevant findings

[65, 66]