Supriya Gupta MBBS, MD, Presenter: Nothing to Disclose

Giles W. Boland MD, Abstract Co-Author: Principal, RCG HealthCare Consulting

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

Markus Stout, Abstract Co-Author: Nothing to Disclose

Joseph Wang, 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

Increasingly there is a focus on cost containment and gauging appropriateness for further imaging recommendations made by radiologists from a concurrent imaging study. This study therefore evaluates the frequency of further imaging recommendations made from abdominal MRI by sub-specialty radiologists according to their level of experience.

A natural language processing program, Leximer, was used to classify unstructured abdominal radiology reports into those with (R+) and without (R-) recommendations. The radiologist names, imaging modality, subspecialty, recommended modality and date of exam were combined to create a comprehensive radiology database. We analyzed all abdominal MRI exams (n=96931) performed in 2008, read by abdominal attending radiologists (n=23). They were further categorized into duration (years) of experience– (a) new attending (NA), <5 years (b) junior attending (JA), 5-10 years (c) intermediate attending (IA), 10-20 years and (d) senior attending (SA), >20 years experience. The R+ rates for different radiologist experience categories were assessed. The R+ rates and rate of type of recommended modality (ROR) in all R+ exams for each category was determined.

For MRI abdomen, we observed a decrease in ROR for MRI, biopsy and CT with an increase in radiologists’ sub-speciality experience ( MRI- A=42.69%, B=37.1%, C=34.94%,D=28.26%; Biopsy- A=8.99%, B=7.89%, C=6.29%, D=1.17%; CT- A=9.01%, B=9.16%,C=4.21%,D=3.38%). ROR for plain radiograph and ultrasound was variable ( radiograph-A=0.17%,B=0.89,C=0.11,D=0.62%; ultrasound- A=6%,B=2.27%,C=17.1%, D=2.25%). Among each category, the most common recommended modality was MRI (36.43%) . The values were adjusted for the total number of exams read by each radiologist and statistically significant results were achieved (p<0.0001).

With increase in experience, less high cost modalities (MRI, CT, Biopsy) were recommended following MRI of the abdomen by radiologists with more sub-specialty experience.   

Imaging recommendations is under scrutiny (cost, radiation, resource utilization).We found that junior radiologists are recommending more higher cost exams; appropriateness criteria needs revision.

Gupta, S, Boland, G, Schultz, T, Stout, M, Wang, J, Dreyer, K, Further Imaging Recommendations from Abdominal MRI Examinations: Variability with Duration of Subspecialty Radiologist’s Experience.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007469.html