Radiology experts advocate against purging decade-old imaging data
It’s a question many imaging leaders likely have asked: Can I get rid of previous imaging data that’s over a decade old?
Researchers with the University of Virginia recently aimed to answer this query, sharing their findings Oct. 16 in the Journal of Imaging Informatics in Medicine. To do so, they searched the academic system’s PACS (picture archiving and communication system) database, determining whether clinicians had used decade-old studies in the past 10 years.
“We found evidence, some of it definitive, validating that many of these were viewed for clinical purposes,” radiologist Cree M. Gaskin, MD, with the University of Virginia Health System, Charlottesville, and co-authors reported. “We conclude that if imaging studies > 10 years of age are readily available, they are commonly called upon to potentially contribute to medical decision-making. This potential value to the patient should be considered when determining whether to prune older archived imaging studies.”
Researchers analyzed archived studies by modality, body part and subspecialty reading division. They also performed a chart review of a random sample of 100 of the identified studies to validate the assumption many were likely viewed for clinical purposes. Over a two-year interval, UVA providers accessed about 201,000 of 4 million imaging studies (5%) that were over 10 years of age at the time.
The academic health system had long deferred a decision on how many years to store digital medical images prior to deletion, the authors noted. This was largely due to a lack of guidelines, the “manual nature of careful deletion,” and the “complexity of retention requirements.” Plus, more recently, state records disposition policy forced UVA leadership to confront the potential deletion of 10-year-old imaging tests to achieve compliance.
“Our providers expressed significant concern with this proposition but could only cite anecdotal experience that these older imaging tests might still be of clinical benefit to our patients,” the authors wrote. “Given the lack of evidence-based guidelines in the medical literature, we needed to determine if our old exams might still have value in the care of our patients.”
Studies accessed during the two-year period spanned all modalities, anatomical regions and subspeciality reading divisions, the analysis found. Gaskin and colleagues believe many were loaded by radiologists for comparison purposes when interpreting fresh exams. The authors also found anecdotal evidence that UVA radiologists sometimes compare very old studies to their new work, but often do not document this query, instead reporting comparisons to more recent intervening studies. This is due to “system issues,” along with the additional effort required.
“Given the potential for lost clinical benefit to patients when purging old studies, we find our results potentially at odds with our state’s current records disposition policy,” the authors noted. “This policy, intended to improve efficiency and prevent unauthorized disclosure, does not cite medical evidence about the lack of clinical impact to patients when directing our state academic healthcare institution to destroy digital medical images greater than 10 years of age. Meanwhile, in our study, nearly 1 in 20 similarly old exams were potentially called upon for likely clinical use in a practical recent time period. Over the much longer window that we commonly care for our longitudinal patients, this access would likely be even greater and more impactful.”
Based on the results, UVA leaders have decided to continue retaining old exams “for the sake of our patients, in spite of the state policy.” They also have lobbied Virginia, pushing to soften or extend the disposition requirements related to old imaging tests.
Read much more in the official journal of the Society for Imaging Informatics in Medicine here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.