Radiology experts call for stricter rules around self-interpretation of imaging orders
Experts are calling for stricter rules around instances where other medical specialists order imaging exams, which they then interpret themselves, rather than relying on a radiologist.
Neiman Health Policy Institute researchers make their case in a new analysis published Tuesday by JACR. Based on an analysis of over 24 million office visits, Medicare patients appeared more likely to receive additional imaging when the ordering specialist handled the scan interpretation, rather than a radiologist.
Experts estimate that office-based imaging could potentially be reduced by about 17%, in the absence of self-interpretation.
“Our results point to the importance of radiologists as part of the care team to ensure that imaging is necessary, appropriate and aligned with clinical need,” lead author Eric Christensen, PhD, research director at the American College of Radiology-backed Neiman Institute, said in a statement Sept. 1. “Policy that establishes more stringent standards for nonradiologist interpretation may reduce inappropriate imaging that increases economic burdens and poses patient-safety risks,” he added.
The study utilized a 5%, nationally representative sample of Medicare claims spanning 2021 to 2023, extrapolating the results for the full picture across the U.S. Researchers pinpointed patients who visited a provider for evaluation and management and analyzed the 30 days afterward to see if they received any medical imaging.
Of the study sample, about 13.6% of patients had imaging within a month after an office visit, and the ordering provider’s self-interpretation rate was 33.2%. Practices where 100% of scans were interpreted by radiologists had lower adjusted odds for 30-day imaging across all modalities except for CT. Conversely, ordering providers who self-interpreted 100% of their own scans had nearly 3 times higher odds of visit-associated imaging (odds ratio = 2.88).
This persisted across different modalities, ranging from about 1.54 higher odds for MRI up to 3.51 higher odds for ultrasound. Study co-author Vijay M. Rao, MD, believes the magnitude and consistency of the association across modalities suggests that “who interprets imaging may influence clinical decision-making in important ways.” Self-interpretation can serve as a “potent predictor” of imaging utilization after an office visit, she contends. However, Rao emphasized that ACR and the policy institute are not advocating for banning imaging interpretations among other specialties.
“Concerns about self-interpretation are not about returning interpretation to radiologists. The concern is ensuring that imaging is performed for clinically appropriate reasons and are interpreted by physicians with the training and expertise to provide high-quality care,” Rao, former professor and radiology chair at Thomas Jefferson University, Philadelphia, said in the announcement. “Who interprets imaging is consequential for patient outcomes and healthcare spending.”
ACR said in the announcement that it believes the new study is further proof of the need for the Radiology Outpatient Ordering Transmission (ROOT) Act. Recently incorporated into the larger Patients First Act, the measure would require referring docs to consult decision-support aids before ordering scans. ACR previously estimated the legislation would save Medicare $2 billion over the next decade.
“The American College of Radiology is committed to reducing inappropriate imaging,” CEO Dana Smetherman, MD, said in the announcement. “This study identifies self-interpretation as an important factor associated with higher imaging utilization and underscores the need for evidence-based tools that help ensure imaging is ordered for the right patient, at the right time, for the right clinical indication.”
Read more, including potential study limitations, in the Journal of the American College of Radiology.
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.