Pragya Ahuja Dang MBBS, Presenter: Nothing to Disclose

Mannudeep Karanvirsingh Kalra MD, Abstract Co-Author: Nothing to Disclose

Keith J. Dreyer DO, PhD, Abstract Co-Author: Clinical Trials Reader, Perceptics, LLC Medical Advisor, Agfa-Gevaert Group Medical Advisor, Fuji Photo Film Co, Ltd Medical Advisor, General Electric Company Medical Advisor, McKesson Corporation Medical Advisor, AuntMinnie.com Medical Advisor, AMICAS, Inc Medical Advisor, Dynamic Imaging, LLC Medical Advisor, Ascom Holding AG Medical Advisor, Bracco Group Medical Advisor, Merge Healthcare Medical Advisor, Emageon Inc Medical Advisor, RCG HealthCare Consulting Consultant, The Elizabeth Wende Breast Clinic Consultant, Valley Radiology Medical Associates, Inc Medical Advisor, Information Systems Consultants, Inc Medical Advisor, Siemens AG Medical Advisor, Barco nv Medical Advisor, Hue AS Medical Advisor, Planar Systems, Inc Medical Advisor, Vital Images, Inc Medical Advisor, Commissure, Inc Medical Advisor, TeraRecon, Inc Medical Advisor, Mercury Computer Systems, Inc Medical Advisor, IBM Corporation Medical Advisor, Hewlett-Packard Company Medical Advisor, EMC Corp Medical Advisor, Phase Forward Incorporated Medical Advisor, Winchester Systems, Inc Medical Advisor, Dell Inc Medical Advisor, Eastman Kodak Company Medical Advisor, Amirsys, Inc Medical Advisor, Reed Elsevier Editorial Board, Diagnostic Imaging Editorial Board, AuntMinnie.com Editorial Board, Imaging Economics Author, Springer Science+Business Media Deutschland GmbH

Thomas Schultz, Abstract Co-Author: Nothing to Disclose

Daniel Ira Rosenthal MD, Abstract Co-Author: Nothing to Disclose

James Hunter Thrall MD, Abstract Co-Author: Medical Advisory Board, Bracco Group Board of Directors, E-Z-EM, Inc

Overutilization of high cost imaging has raised concerns about increased health expenditure. We developed a Web-Based ROE System (WBRS) to assist ordering of high cost imaging tests (CT and MRI) based on appropriateness zones (low, intermediate, and high utility) for given clinical presentations. Subsequently, we performed this study to assess the effect of radiology exam ordering practice on the yield and volume of these imaging examinations.

An IRB approval was obtained for this HIPAA compliant study. All CT (n=69389) and MR (n=41170) exams ordered with WBRS from last quarter of 2004 (Q4, 2004) to first quarter of 2007 (Q1, 2007) were included in the study protocol (total n= 110559). Data mining and analytical software, RadCube, were used to assess the trend of Specified Radiological Findings (SRF) in the reports of CT and MRI examinations performed in 2005-06. Statistical analysis was performed to assess the trends in the appropriateness zones for CT and MRI as well as rates of SRF in the same exam cohort. In addition, temporal trend in CT and MR exam volume over this period was recorded.

WBRS implementation was associated with a significant decrease in low utility exams from Q4, 04 (CT, 3.5%, 85/2436; MR, 11%, 207/1846) to Q1, 07 (CT, 0.8%, 30/3865; MR, 2%, 35/1996) (p<0.0001). A significant increase in high utility exams was also noted during this period (CT, 86% to 95%; MR, 71 to 85%) (p<0.0001). During this period, the volume of CT and MR studies decreased by 44.3% (Q4, 04, n= 21869; Q1, 07, n=12188) and by 31.0% (Q4, 04, n=11645; Q1, 07, n=8031) respectively. Additionally, the rate of SRF in the radiology reports increased substantially for both CT (74% to 84%) and MR (73 to 85%) (p<0.0001).

The implementation of the web-based ROE system improved the utility patterns for both CT and MRI. Additionally, it increased the yield of CT and MRI exams and led to a substantial decrease in the volume of the high cost imaging tests, presumably at the cost of low yield exams.

Appropriate radiology exam ordering practice helps in decreasing the number of low yield, high cost exams and enhancing the yield of imaging examinations for relevant clinical findings.

Dang, P, Kalra, M, Dreyer, K, Schultz, T, Rosenthal, D, Thrall, J, Does Radiology Exam Ordering Practice Affect the Volume of High Cost radiology Exams?.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5011199.html