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Reduction of unnecessary repeat knee radiographs during osteoarthrosis follow-up visits in a large teaching medical center

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Abstract

Background

Professional organizations recommend against repeat radiographs for routine follow-up of osteoarthrosis. However, clinics frequently obtain radiographs during or before the clinical visit. The purpose of our project was to determine the baseline frequency of unnecessary knee radiographs and whether educational interventions can reduce this frequency.

Methods

This QI project was exempt from IRB review. Radiology reports of knee radiographs were searched in our database filtered by presence of the words “severe”, “degenerative”, “osteoarthritis”, and similar variants. We reviewed 500 consecutive corresponding medical records to confirm the presence of severe osteoarthritis, and presence of a repeat radiograph within 6 months. Indications for repeat radiographs were determined. Repeat radiographs were counted as “non-indicated” when medical records revealed no new symptoms. A focused educational intervention was provided to the orthopedic and family practice departments. An additional 500 radiology reports were evaluated 9 months after intervention in the same manner and the rate of non-indicated radiographs was calculated. Follow-up review of additional 500 radiology reports at 1-year time point was performed.

Results

Our initial search returned 1517 reports. Upon evaluation of 500 studies, there were 112/500 repeat radiographs (22%); 77/500 (15%) of knee radiographs were not indicated. Upon initial follow-up evaluation of 500 studies, there were 52/500 repeat radiographs (10%) and 40/500 (8%) radiographs were not indicated. The reduction of unnecessary repeat knee radiographs rate was sustained at 1 year.

Conclusions

Focused educational intervention results in a substantial (50%) reduction of the number of unnecessary repeat knee radiographs in patients with known severe OA.

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References

  1. Deshpande BR, Katz JN, Solomon DH, et al. Number of persons with symptomatic knee osteoarthritis in the US: impact of race and ethnicity, age, sex, and obesity. Arthritis Care Res (Hoboken). 2016;68:1743–50.

    Article  Google Scholar 

  2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2163–96.

    Article  Google Scholar 

  3. Lawrence RC, Hochberg MC, Kelsey JL, et al. Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheumatol. 1989;16:427–41.

    CAS  PubMed  Google Scholar 

  4. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.

    Article  CAS  Google Scholar 

  5. Kellgren JH, Lawrence JS. Rheumatism in miners. II. X-ray study. Br J Ind Med. 1952;9:197–207.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Muraki S, Oka H, Akune T, et al. Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts: the ROAD study. Osteoarthr Cartil. 2009;17:1137–43.

    Article  CAS  Google Scholar 

  7. Bennett DL, Nelson JW, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria® for Non-Traumatic Knee Pain 2012. Available at: https://acsearch.acr.org/docs/69432/Narrative/. Accessed March 17, 2018.

  8. Sakellariou G, Conaghan PG, Zhang W, et al. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis. 2017;76:1484–94.

    Article  Google Scholar 

  9. Centres for Medicare and Medicaid Services. Fee schedule. Available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html. Accessed March 17, 2018.

  10. National Research Council (US). Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2, National Academies Press (US), 2006.

  11. Tornow K, Chalian M, Zerr J, et al. A quality improvement project to reduce unnecessary knee MRI for chronic degenerative changes. JACR. 2019 (in press).

  12. Spence SC, McAlister W, Reed B, et al. A multispecialty collaboration to reduce unnecessary imaging for knee osteoarthritis. J Am Coll Radiol. 2016;13:1343–6.

    Article  Google Scholar 

  13. Eccles M, Steen N, Grimshaw J, Thomas L, McNamee P, Soutter J, et al. Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial. Lancet. 2001;357(9266):1406–9.

    Article  CAS  Google Scholar 

  14. McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne effect: a randomised, controlled trial. BMC Med Res Methodol. 2007;7:30.

    Article  Google Scholar 

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Acknowledgements

Family medicine department and orthopedic department coordinators.

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Authors and Affiliations

  1. Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA

    Oganes Ashikyan, P. Pezeshk & A. Chhabra

  2. Medical School, UT Southwestern, Dallas, TX, USA

    D. C. Buller

  3. Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    C. McCrum & A. Chhabra

Authors
  1. Oganes Ashikyan
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  2. D. C. Buller
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  3. P. Pezeshk
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  4. C. McCrum
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  5. A. Chhabra
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Correspondence to Oganes Ashikyan.

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Unrelated disclosures

O. Ashikyan, MD, contributes content to, and a family member owns a business that manages the following websites: www.mridoc.com; www.newagepub.com; www.solrevs.com.

A. Chhabra, MD, serves as a consultant with ICON Medical and Treace Medical Inc. A. Chhabra, MD, also receives book royalties from Jaypee and Wolters.

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None.

IRB approval

This quality improvement project was exempt from IRB review.

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Ashikyan, O., Buller, D.C., Pezeshk, P. et al. Reduction of unnecessary repeat knee radiographs during osteoarthrosis follow-up visits in a large teaching medical center. Skeletal Radiol 48, 1975–1980 (2019). https://doi.org/10.1007/s00256-019-03247-4

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  • DOI: https://doi.org/10.1007/s00256-019-03247-4

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