Experts share recipe to reduce radiologist recommendations for unnecessary extra imaging
Experts are sharing guidance on how to encourage radiologists to reduce recommendations for unnecessary follow-up imaging.
About 1 in 10 radiology reports contain advice for additional imaging, suggested to assess unexpected, unexplained, or uncertain findings in the initial study. However, up to two-thirds of referring providers may ignore these recommendations, potentially leading to diagnostic errors and patient harm, researchers wrote Tuesday in RSNA’s Radiology.
A Boston-based, Harvard-affiliated hospital tested a series of interventions to improve the clarity of radiologist recommendations for imaging, among other goals. Updates included radiologist education, electronic tools for tracking follow-up imaging, and performance reports to track progress.
Changes reduced the rate of radiologist recommendations for additional imaging by 44% compared to a control site that did not implement them.
“We found that technology-enabled interventions to optimize recommendations for additional imaging (RAIs) in radiology reports may reduce the rates of clinically unnecessary RAIs and improve recommendation clarity and actionability, leading to higher RAI resolution rates,” lead author Nooshin Abbasi, MD, MPH, with Brigham and Women’s, and colleagues wrote June 3. “Such changes have the potential to improve patient safety, decrease healthcare costs, yield fewer diagnostic errors, and reduce low-value imaging follow-up.”
Researchers conducted the study between 2015 to 2022 at two academic medical centers in the same health system. They used diagnostic radiology reports generated during this time span across several subspecialties, with a total of over 7.5 million. Their interventions were implemented in January 2017, including meetings to educate radiologists about variation among their peers in ordering follow-up imaging. Abbasi and colleagues used AI to assess old reports on whether they contained these recommendations.
Interventions helped cut the recommendation rate for additional imaging over an eight-year period, the authors found. In addition, changes produced a nearly eightfold increase in the actionability of recommendations for additional imaging, along with a 30% higher resolution rate of actionable RAIs. Meanwhile, the same quality metrics remained unaffected at the control site that did not implement changes.
“These findings demonstrate the impact of interventions across multiple radiologic subspecialties and modalities and suggest the potential to increase follow-through on actionable RAIs to improve patient safety by reducing diagnostic errors,” the authors wrote. “Furthermore, this initiative may help streamline imaging practices and contribute to more judicious use of imaging resources.”
In a corresponding editorial, radiologist Eric J. Russell, MD, noted that recommendations for additional imaging may result in overuse of diagnostic services, driving up healthcare costs. While practices that fail to control unnecessary RAIs may benefit from further payment, “patient care should always take precedence over financial considerations.” He lauded the results of the investigation, believing they’ll address a problem the magnitude of which prompted the American College of Radiology to form a collaborative to address it.
“Abbasi et al. not only highlighted an important issue for patient care and safety, they went to considerable lengths to close the loop and, importantly, educate practitioners to improve upfront actionability and appropriateness of follow-up recommendations,” wrote Russell, a professor in the Department of Radiology at Northwestern University in Illinois. “Their efforts yielded impressive results, improved patient care, and helped optimize appropriate use of finite patient and societal resources.”
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.