JACR: high percentage of imaging exams found to be unnecessary, inappropriate
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The study, performed at Harborview Medical Center in Seattle, Wash., noted that in the current cost-containment and comparative effectiveness environment, a reasonable compromise should be found for clinical decision support systems and traditional radiology benefit management tools.
Lead author of the study Robert L. Bree, MD, and colleagues retrospectively analyzed a large group of CT and MRI examinations conducted at the medical center for appropriateness using evidence-based guidelines developed by a radiology benefits management company.
The researchers included the records of 459 elective outpatient CT and MR examinations referred from primary care physicians for review. The evidence-based appropriateness criteria was employed to establish whether or not the exam would have met the standards for approval, and recorded clinical history, clinic notes and laboratory results prior to the date of the imaging exam were observed by the authors in order to better understand the decision of the referring physician. The radiology reports and all clinic visits following the imaging exam were analyzed for outcomes.
MR examinations consisted of 175 of the 459 studies (38 percent), while CT accounted for 284 of the 459 exams (62 percent). Of the 459 reviewed examinations, Bree and colleagues determined 341 (74 percent) to be appropriate, with the remaining 118 (26 percent) deemed inappropriate.
In addition, the authors wrote: “Fifty-eight percent of the appropriate studies had positive results and affected subsequent management, whereas only 24 percent of inappropriate studies had positive results and affected management.”
Inappropriate CT exams included brain scans for chronic headache and scans for hematuria during a urinary tract infection. Improper MR exams included imaging of the lumbar spine for acute back pain and knee or shoulder imaging in patients with osteoarthritis, said the researchers.
“Our study shows that CT and MRI examinations ordered in the outpatient primary care setting are frequently not appropriate based on the application of a national radiology benefit management company’s evidence-based guidelines,” said Bree.
Aside from 26 percent of these imaging exams being classified as inappropriate, the researchers said that these studies offered a significantly greater chance of a negative finding, estimating the rate to be 3.5 times higher than that of an appropriate exam.
“This is important information for policymakers as they struggle with physicians and patients, who are unhappy with restrictive utilization management programs and payers and the public, who are looking for ways to decrease health care costs and increase the quality and safety of examinations in an era of higher awareness of effects of excess radiation,” the authors concluded.