JACR: Algorithm slashes unnecessary ER cervical spine x-rays
The number of unnecessary cervical spine radiographs in the emergency department can be decreased with the addition of an imaging algorithm, according to a study published in the July edition of the Journal of the American College of Radiology.
“In view of the recent increasing awareness of over-utilization and concern of the risks from medical radiation, we looked for opportunities to eliminate what we believed were unnecessary or inappropriate examinations,” wrote Mark J. Adams, MD, MBA, from the department of imaging sciences at the University of Rochester Medical Center in Rochester, N.Y., and Jamie Lynn Adams, BA, of the University of Rochester School of Medicine and Dentistry in Rochester, N.Y.
Researchers started with routine trauma cervical spine radiography after negative results on CT after observing a large number of requests for routine trauma x-rays of the cervical spine after a CT scan of the cervical spine showed no significant findings.
“Not only are these radiographic exams unwarranted, they consume valuable resources, burden the emergency department and radiology staff members and subject patients to unnecessary radiation,” the researchers offered.
An initial attempt at reducing the number of cervical spine x-rays consisted of discussing the issue of unnecessary exams ordering with the physician in question, which yielded no significant improvement in the ordering patterns of the physicians at the university medical center, noted the investigators.
The two researchers then partnered with a multi-disciplinary trauma council to develop an algorithm for x-ray evaluation of post-CT cervical spines. The algorithm was distributed through the medical director’s office in a top-down fashion to care providers through their respective departments, as opposed to being implemented by the imaging department, the authors explained.
From January 2008 to January 2009, the authors noted “a significant decrease in the number of unnecessary or inappropriate studies being performed,” and cited a decrease of 83 percent in cervical spine x-ray examinations following negative CT results.
The authors credited the success of the algorithm and behavioral changes among physicians to the formal process and top-down approach through various departments and divisions with reinforcement from the radiology department, noting that providing awareness of the lack of utility and the unnecessary radiation risks of radiography after normal results on CT was not enough to change practice patterns of emergency department physicians.
Continued monitoring of the process will be necessary to ensure compliance with best practices, concluded the study.
“In view of the recent increasing awareness of over-utilization and concern of the risks from medical radiation, we looked for opportunities to eliminate what we believed were unnecessary or inappropriate examinations,” wrote Mark J. Adams, MD, MBA, from the department of imaging sciences at the University of Rochester Medical Center in Rochester, N.Y., and Jamie Lynn Adams, BA, of the University of Rochester School of Medicine and Dentistry in Rochester, N.Y.
Researchers started with routine trauma cervical spine radiography after negative results on CT after observing a large number of requests for routine trauma x-rays of the cervical spine after a CT scan of the cervical spine showed no significant findings.
“Not only are these radiographic exams unwarranted, they consume valuable resources, burden the emergency department and radiology staff members and subject patients to unnecessary radiation,” the researchers offered.
An initial attempt at reducing the number of cervical spine x-rays consisted of discussing the issue of unnecessary exams ordering with the physician in question, which yielded no significant improvement in the ordering patterns of the physicians at the university medical center, noted the investigators.
The two researchers then partnered with a multi-disciplinary trauma council to develop an algorithm for x-ray evaluation of post-CT cervical spines. The algorithm was distributed through the medical director’s office in a top-down fashion to care providers through their respective departments, as opposed to being implemented by the imaging department, the authors explained.
From January 2008 to January 2009, the authors noted “a significant decrease in the number of unnecessary or inappropriate studies being performed,” and cited a decrease of 83 percent in cervical spine x-ray examinations following negative CT results.
The authors credited the success of the algorithm and behavioral changes among physicians to the formal process and top-down approach through various departments and divisions with reinforcement from the radiology department, noting that providing awareness of the lack of utility and the unnecessary radiation risks of radiography after normal results on CT was not enough to change practice patterns of emergency department physicians.
Continued monitoring of the process will be necessary to ensure compliance with best practices, concluded the study.