Vetting imaging orders for appropriateness represents a 'substantial hidden workload,' new data show
Vetting imaging orders for appropriateness is a routine part of radiology staff duties, but new data suggest this act represents a “substantial hidden workload” for departments.
Radiologists, residents and radiographers are all typically involved in some form of image requisition vetting. This ensures patients undergo imaging that is appropriate for their clinical indication and reduces the likelihood that unnecessary exams are completed, thus improving resource utilization.
The loss of time is compounded at large centers where hundreds of imaging exams are performed daily. Experts recently sought to quantify how time spent reviewing imaging orders adds up long-term to determine whether process improvements could be made.
“Consultant radiologists’ job plans typically emphasize reporting output, procedural output, and participation in clinico-radiological meetings, with vetting activity rarely explicitly recognized. Similarly, the contribution of radiographers and sonographers remains poorly characterized,” Jafari M., with the department of radiology at South Tees Hospitals NHS Trust in Middlesbrough, North Yorkshire, and colleagues noted in Clinical Radiology. “A clearer understanding of the time demands of vetting could support more efficient patient pathways, enhance patient care and inform future workforce planning.”
The team analyzed image vetting processes that occurred between April and August of 2025 for more than 300 exams chosen at random, paying close attention to the amount of time spent on each requisition. The professional role of the vetter, outcome, referral source and modality also were compared. Vetters consisted of residents, consultant radiologists and radiographer/sonographers.
Of all 344 exams included in the analysis, the mean vetting time was recorded at 31 seconds. Review times were similar between radiographers/sonographers and consultant radiologists, while residents recorded the longest vetting times, averaging 61 seconds per request. Exam modality also showed correlation with vetting times, with CT requests taking the longest (42 seconds), followed by nuclear medicine studies (39 seconds); ultrasound requisitions came in with the shortest times, at an average vetting time of 11 seconds per exam.
Vetting outcomes differed based on who was reviewing the request, with residents approving the most exams. Referral source also played a role in request approvals; all exams ordered from emergency providers were approved, while general practitioners recorded the lowest approval rate, at 62%.
While the vetting times might not seem especially high, the group estimated that providers at their hospital, which handle tens of thousands of imaging requests throughout the year, spend over 344 hours reviewing orders each month.
The team touched on the significance of their findings, suggesting that the data both highlights the benefits of expanded roles for techs and the utility of EHR-embedded criteria for decreasing the likelihood that inappropriate imaging requests will be placed.
“This study is the first to quantify real-world vetting time in U.K. radiology departments, revealing a substantial hidden workload that is largely unaccounted for in job planning,” the group noted. “Comparable performance between consultants and radiographers/sonographers supports extended roles. Embedding evidence-based guidance, providing targeted training and recognizing vetting in workforce planning are crucial to optimize workflows and patient care.”
The group added that the emerging reliability of some artificial intelligence applications could further improve these processes.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.