Inconsistent imaging: Radiologists letting personal preferences influence decision-making
There is significant variation from one radiologist to the next in suggesting follow-up imaging, and the differences trace more to personal preferences than to measurable, systemic factors.
That’s according to a new analysis from Brigham and Women's Hospital, published Wednesday in the American Journal of Roentgenology [1]. Relatively few guidelines exist on how to handle incidental findings and follow-up exams for head and neck concerns. Jeffrey P. Guenette, MD, and colleagues aimed to better understand how radiologists address this issue, analyzing data from more than 39,000 patients who underwent the same number of head and neck CTs or MRIs.
They found nearly 30-fold variation within a study cohort of 61 radiologists. Some suggested more scans as infrequently as 0.8% of the time up to as often as 22%.
“Quality improvement initiatives, incorporating best practices for incidental findings management, may help reduce radiologist preference-sensitive decision-making in issuing [recommendations for additional] head and neck imaging and associated care variation,” Guenette, with the Center for Evidence-Based Imaging, and co-authors advised.
The researchers used a natural language processing tool to pinpoint radiologists’ recommendations for additional imaging, contained in about 7.5% (or 2,946) of reports. Rads were likelier to suggest more imaging after CTA scans than regular CT (odds ratio 0:32). The same went for examinations that included a trainee in the report generation (OR: 1.23). Radiologists also were more likely to recommend additional tests for Black patients versus white (OR: 1.25) and less likely for men compared to women (OR: 0.90). Increasing years of experience also appeared to reduce rads’ likelihood of suggesting more exams (OR: 0.90 per 5 years of experience).
Of instances where the model could explain the likelihood of a patient requiring additional head and neck imaging, 25.7% was tied to examination, patient and radiologist factors. Meanwhile, the other 74.3% stemmed from radiologist-specific behaviors.
“In conclusion, interradiologist variation in RAI rates for head and neck imaging may be larger than such variation for other areas of radiology,” the authors wrote. “Individual radiologist-specific behavior appeared to be the major cause of such variation, whereas examination, patient and radiologist factors had an overall relatively small association.”
Read more, including potential study limitations, in AJR at the link below.
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.