Patients frequently fail to obtain follow-up imaging. Could radiologist-referrer disagreements be to blame?

Patients frequently fail to obtain necessary follow-up imaging, as recommended by a radiologist. Could disagreements between rads and referrers be at the root of this problem? 

Harvard researchers recently set out to answer this question, sharing their results Friday in the Journal of the American College of Radiology [1]. As few as 30% of patients receive this crucial follow-up care, which can lead to delayed cancer diagnoses and death.

Neena Kapoor, MD, and co-authors retrospectively analyzed data from a single institution spanning over 9,400 recommendations for more imaging after the initial exam. Of those, almost 89% resulted in the two key parties seeing eye-to-eye.  

“Referring providers typically agree with follow-up imaging recommendations made by radiologists. Given high levels of agreement, radiologists should aim to make actionable and specific recommendations, knowing that most of these recommendations will be followed,” corresponding author Kapoor, an assistant professor of radiology, and colleagues wrote Nov. 15. 

Of the 11% (or 1,075) of instances that resulted in disagreement, “not clinically relevant” was the most common reason, occurring nearly 45% of the time. The odds of radiologists and referrers disagreeing were higher if the latter was a surgeon (odds ratio 0.73), or if the former requested a nuclear imaging exam (OR 0.64). Meanwhile, agreement was likelier when it was a thoracic radiologist recommending follow-up imaging (OR 1.41), or when the rad gave a larger timeframe for patients to receive the extra imaging work (OR 1.03). Patients’ race, ethnicity, insurance type and socioeconomic status had no noteworthy impact on radiologist-referrer agreement, the study found. 

Kapoor et al. believe further research is needed to better understand how social determinants of health can impact imaging, along with what quality improvements would be most effective in improving outcomes. They speculated about possible reasons why the involvement of nuclear medicine or surgeons might lead to greater rates of disagreement with radiologists.

“Decreased rates of agreement for nuclear medicine follow-up imaging may be related to cost, length of exam and availability of radiopharmaceuticals,” the authors wrote. “When analyzed globally, significant variation exists in the availability in access to nuclear medicine studies, including PET-CT. If referring providers have experienced prior access challenges, they may prefer lower cost and easier-to-acquire follow-up imaging.

“With regards to lower agreement rates between referring surgeons and radiologists, the causes are likely multifactorial. Prior analysis using a smaller study sample showed lower rates of completion of follow-up imaging for patients whose referring provider was a surgeon. Surgeons may be less likely to agree with follow-up imaging that is not related to the specific clinical indication being treated by the surgeon. Alternatively, surgeons may be more likely to use additional therapies or procedures, such as excisional biopsy, than use long-term follow-up imaging.”

Read more about the results, including potential study limitations, at the link below.