Sarah Russell, Presenter: Nothing to Disclose

Alison Wilcox MD, Abstract Co-Author: Speaker, Toshiba Corporation

Cameron Hassani MD, Abstract Co-Author: Nothing to Disclose

Christopher Lee MD, Abstract Co-Author: Nothing to Disclose

Ana Maliglig MD, MPH, Abstract Co-Author: Nothing to Disclose

Suzanne L. Palmer MD, Abstract Co-Author: Research Consultant, Halt Medical, Inc

Though a CT request may be initiated by a physician, nurse practitioner, or physician's assistant with a sound knowledge of the question asked, there is variable understanding of the complexities of CT scanning protocols. Institutions may have several protocols for evaluation of the same body part, each answering a different clinical question. These complexities lead to both confusion and inaccurate ordering of CT scans. The review of CT requests is both time consuming and under-appreciated by the requesting physician. However, there is clearly a benefit for both the patient and the institution when this review occurs. If the provided information is sufficient, studies are approved without further review.

CT scans are frequently ordered inaccurately or with inadequate justification. In this era of managed health, limited financial resources, and increasing concerns regarding ionizing radiation exposure, a review process may become a necessity. The purpose of this review was to assess the clinical impact of a radiologist overseen imaging approval process at a large academic medical center.

All CT imaging orders are placed into a radiology information system system by nonradiologists. A radiologist reviews all CT requests (excluding trauma) and either approves without changes, approves with changes, or deems the study inappropriate. Records for all CT studies ordered between March 1, 2012 and September 1, 2012 were collected and analyzed. CT studies that were approved with changes were categorized as a clarification to the order, intravenous (IV) contrast change, or protocol change.

During this 6 month period, a total of 23,337 CT studies were ordered. 9049 exams were ordered from the ER. Of the non-ER studies, 2571 (14.2%) were approved with changes by a radiologist. 719 (27.9%)of these studies required a change in the IV contrast protocol, 860 (33.4%) required a clarification of the order, and 436 (16.9%)required a change in the protocol. In the ER, 5073 (56.1%) studies were not reviewed by a radiologist, as they were related to trauma. Additionally, 1795 (9.9%) of all studies and 228 (2.5%) of all ER studies were deemed not appropriate by a radiologist reviewer.

Russell, S, Wilcox, A, Hassani, C, Lee, C, Maliglig, A, Palmer, S, Under Scrutiny: The Role of Radiology in Imaging Approval.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13024567.html