Supriya Gupta MBBS, Presenter: Nothing to Disclose

Vartan Vartanians MD, Abstract Co-Author: Nothing to Disclose

Thomas J. Schultz BS, Abstract Co-Author: Nothing to Disclose

Markus Stout, Abstract Co-Author: Nothing to Disclose

Steven A. Graham MBA, Abstract Co-Author: Nothing to Disclose

Keith J. Dreyer DO, PhD, Abstract Co-Author: Medical Advisor, General Electric Company Medical Advisor, Siemens AG Medical Advisor, Nuance Communications, Inc Medical Advisor, Carestream Health, Inc Medical Advisor, Vital Images, Inc Medical Advisor, Amirsys, Inc Medical Advisor, Life Image Inc Medical Advisor, McKesson Corporation Medical Advisor, Merge Healthcare

According to a study by National Imaging Associates, patient use of imaging technology actually triples after age of 65 increasing the use of diagnostic imaging. We wanted to analyze the frequency and type of imaging exams performed following patient’s demand. We also determined the utility of performing these exams by analyzing radiology reports for presence of significant clinical findings.

Radiology database was queried using SQL-based server to mine Radiology Order Entry (ROE) system for retrieving outpatient reports with a low utility score (red score- 0-3) on decision support from March 2007 to March 2011. Red exams which were demanded by a patient were recorded and analyzed for exam modality, patient demographics, medical history and radiology report findings. All reports were divided into 3 groups - Presence of a clinically significant finding (F+), absence of any finding (F-) and with findings which are not clinically significant (F0). Utilization was calculated by dividing F+ reports with the total number of exams for each modality.

Of 12,615 outpatient exams with red score in ROE, 738 (5.85%) were due to patient demand. Of these, 59.2% (437/738) exams were performed and finalized. Our study found that cardiac stress testing was highest in demand by patients (47.2%) in 206/437 cases followed by spine CT or MRI for lower back pain in 26.1% cases (114/437), head CT or MRI exams in 16.5% cases (72/437) and evaluation for aortic aneurysm in 5.7% cases (25/437). F+ rate was highest in extremity MRI cases (66.7%) followed by sinus CT (27.2%), head CT/MRI (20.8%), cardiac stress testing (14.56%) and spine CT/MRI (10.5%). Lowest utilization was found in exams performed for abdominal aortic aneurysm evaluation (4%).  

Patients commonly demand cardiac stress testing and spine CT or MRI exams for back pain. MRI performed for extremity evaluation and sinus CT exams have highest utility among such exams. This provides an insight for assessing utilization of performing patient demanded imaging and emphasizes utility of decision support systems. Results of such studies can be used to provide feedback to the patient to help understand the utility of performing an exam.

Cost and radiation dose concerns have driven radiologists and;physicians to tailor imaging exams according to medical needs of;patient necessitating balance between patient demand and exam utilization

Gupta, S, Vartanians, V, Schultz, T, Stout, M, Graham, S, Dreyer, K, Addressing Consumers Concerns: Utilization of Patient-demanded Imaging Exams by Performing a Four-Year Analysis of Outpatient Imaging Exams.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034310.html