# A Neuroimaging Audit of Patients Referred to an Old-Age Community Mental Health Team From Memory Assessment Service: Compliance With the Royal College of Radiologists Guidance

## TL;DR

This audit evaluated how well local neuroimaging reports for dementia patients followed Royal College of Radiologists guidelines, finding good recognition of brain changes but inconsistent use of standardized scoring and diagnostic conclusions.

## Contribution

The study provides a detailed audit of neuroimaging report compliance with RCR standards in a specific clinical setting.

## Key findings

- Cerebral atrophy was described in 85% of reports, but standardized scoring systems were rarely used.
- Reversible causes were more thoroughly documented in scans for non-cognitive impairment indications.
- Only 68% of cognitive impairment reports included a diagnostic conclusion.

## Abstract

Background

Neuroimaging is a crucial component in the assessment of patients with suspected dementia, aiding in diagnostic confirmation, subtype differentiation, and the exclusion of reversible causes. The Royal College of Radiologists (RCR) provides standards to guide the structured and comprehensive reporting of imaging scans, aiding in diagnostic accuracy and clinical decision-making. Local compliance with RCR standards may vary, which could influence the clinical utility of the scans. This audit was undertaken to evaluate local compliance with RCR reporting standards and identify areas for improvement.

Methodology

A total of 50 referrals from the Memory Assessment Service to the Old Age Community Mental Health Team (April 2024-September 2025) were reviewed. Radiology reports were analyzed for compliance with RCR standards, focusing on documentation of atrophy pattern, vascular pathology, reversible causes, use of rating scales, and inclusion of diagnostic conclusions. Data were also organized by imaging modality and indication to assess reporting consistency and completeness.

Results

Of the 50 referrals, nine (18%) patients were diagnosed with dementia without neuroimaging, consistent with clinical guidelines. Among 41 imaged patients, 33 had CT and four had MRI scans. Cerebral atrophy was described in 85% of reports, increasing to 100% for cognitive impairment cases; however, standardized scoring systems were infrequently used (Medial Temporal Atrophy score 7/22). Vascular pathology was mentioned in most reports with severity markers, but Fazekas scoring was used in 3/22 scans. Reversible causes were more comprehensively covered in scans done for indications other than cognitive impairment. Overall, 15/22 (68%) cognitive impairment reports included a diagnostic conclusion.

Conclusions

Local neuroimaging reports for dementia patients showed comprehensive recognition of atrophy and vascular changes but inconsistent use of standardized scoring, documentation of reversible causes, and diagnostic conclusions. Structured reporting templates and multidisciplinary feedback could improve adherence to RCR standards and enhance clinical utility.