Abstract
Objective
The aim of our study was to measure the rate of radiologists’ additional recommended imaging examinations (RAI) at a hospital-based inpatient setting and to estimate the influence on RAI of clinical variables.
Materials and methods
This retrospective study was approved by the institutional review board. Inpatients CT and US examinations interpreted by fifteen radiologists between October and December 2016 were studied. Information about RAI from radiology report texts was extracted manually. The analytic data set included the interpreting radiologists’ years of experience, patient age, patient gender, radiologist gender, ordering service and “clinical question to be answered” as collected from the radiology request forms.
Results
Of the 1996 US and CT examinations performed between October and December 2016 in the inpatient setting, 34% (683 examinations) had a radiologists’ RAI. The largest proportion of RAI was for chest CT, followed by PET-CT, abdominal CT and abdominal MRI. Patient age and gender had no impact on RAI. Radiologists’ years of experience were inversely correlated to RAI. “Pneumonia” showed the highest rate of RAI due to follow-up of lung nodules.
Conclusion
A high percentage of RAI resulted from CT and US radiologists’ reports. The largest proportion of RAI was for chest CT, followed by PET-CT, abdominal CT, and abdominal MRI. Radiologists’ years of experience play an important role in the number of the requested RAI. Further studies with a larger cohort of radiologists are needed to confirm the role of radiologists’ experience in RAI. Also, follow-up studies are warranted to assess the number of RAI that are actually acted upon by the referring physicians.
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References
Iglehart JK (2006) The new era of medical imaging: progress and pitfalls. N Engl J Med 354(26):2822–2828
Levin DC, Rao VM (2008) Turf wars in radiology: updated evidence on the relationship between self-referral and the overutilization of imaging. J Am Coll Radiol. 5:806–810
Hendee WR, Becker GJ, Borgstede JP, Bosma J, Casarella WJ, Erickson BA, Maynard CD, Thrall JH, Wallner PE (2010) Addressing overutilization in medical imaging. Radiology 257(1):240–245. https://doi.org/10.1148/radiol.10100063
Sistrom CL, Dreyer KJ, Dang PP et al (2009) Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations. Radiology 253(2):453–461
Blaivas M, Lyon M (2007) Frequency of radiology self-referral in abdominal computed tomographic scans and the implied cost. Am J Emerg Med 25(4):396–399
Baumgarten DA, Nelson RC (1997) Outcome of examinations self-referred as a result of spiral CT of the abdomen. Acad Radiol 4(12):802–805
Margolis NE, Rosenkrantz AB, Babb JS, Macari MJ (2015) Frequency of recommendations for additional imaging in diagnostic ultrasound examinations: evaluation of radiologist, technologist, and other examination-related factors. Clin Ultrasound 43(8):463–468
MacMaho H, Naidich DP, Mo Goo J, Soo Lee K, Leung ANC, Mayo JR et al (2017) Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society. Radiology 284(1):228–243
Rayamajhi SJ, Mittal BR, Maturu VN, Agarwal R, Bal A, Dey P, Shukla J, Gupta D (2016) (18)F-FDG and (18)F-FLT PET/CT imaging in the characterization of mediastinal lymph nodes. Ann Nucl Med 30(3):207–216
Mills P, Joseph AE, Adam EJ (1989) Total abdominal and pelvic ultrasound: incidental findings and a comparison between outpatient and general practice referrals in 1000 cases. Br J Radiol 62(743):974–976
West J, Fox JC, Richardson AG, Lopez S, Solley M, Lotfipour S (2011) Implications and approach to incidental findings in liver ultrasound models. Emerg Med 12(4):472–474. https://doi.org/10.5811/westjem.2011.2.2054
Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7(10):754–773. https://doi.org/10.1016/j.jacr.2010.06.013
Plebani M (2014) Defensive medicine and diagnostic testing. Diagnosis 1(2):151–154
U.S. Congress, Office of Technology Assessment, Defensive Medicine and Medical Malpractice (1994) OTA-H–6O2. U.S. Government Printing Office, Washington
Tsugawa I, Jena AB, Figueroa JF et al (2017) Comparison of hospital mortality and readmission rates for medicare patients treated by male vs female physicians: a recently study. JAMA Intern Med 177(2):206–213. https://doi.org/10.1001/jamainternmed.2016.7875
Pinto A, Brunese L (2010) Spectrum of diagnostic errors in radiology. World J Radiol 2(10):377–383
Sistrom CL, Dang PA, Weilburg JB, Dreyer KJ, Rosenthal DI, Thrall JH (2009) Effect of computerized order entry with integrated decision support on the growth of outpatient procedure volumes: seven-year time series analysis. Radiology 251(1):147–155
Lee SI, Krishnaraj A, Chatterji M, Dreyer KJ, Thrall JH, Hahn PF (2012) When does a radiologist’s recommendation for follow-up result in high-cost imaging? Radiology 262(2):544–549. https://doi.org/10.1148/radiol.11111091
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This study was approved and waived for patients’ consents by the institutional review board (IRB). The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Details that might disclose the identity of the subjects under study were omitted.
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Squillaci, E., Bolacchi, F., Ricci, F. et al. Radiologists’ recommendations for additional imaging (RAI) in the inpatient setting. Radiol med 124, 432–437 (2019). https://doi.org/10.1007/s11547-018-0982-4
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DOI: https://doi.org/10.1007/s11547-018-0982-4