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

Elkan F. Halpern PhD, Abstract Co-Author: Research Consultant, Hologic, Inc

Yonggang Chen, 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

To evaluate the trends in recommendations rates for recommending high cost vs. low cost modality exams from MRI abdomen.

A natural language processing program (Leximer) was used to classify unstructured abdominal radiology reports into those with recommendations (R+) and those without recommendations (R-). We took all R+ abdominal MRI reports which were then analyzed from 1993 till 2009 and the rate and type of recommended modality (ROR) was noted for each of them. The values were adjusted for the growth rate of overall imaging exams for the same time period and statistical significance was assessed.  

Out of 51,202 MRI abdomen exams from 1993 till 2010, recommendations were made in 6854 (13.38%) cases. From these, MRI was recommended in 35.8% followed by CT (15.15%), followed by biopsy (9.14%) and US (8.54%) whereas others were - repeat current exam – 35.5%,PET in 1.15% and plain radiographs 1.11% . There was a significant increase in ROR for MRI which has increased from 21.1% in 1993 to 43.2 % in 2009 ,but for the same time period , ROR for US decreased from 34.6% in 1993 to 4.6% in 2009 ,for biopsy decreased from 13.5% in 1993 to 7.5% in 2009 and for radiography decreased from 7.6% to 0.82% (p<0.0001). The ROR for CT however, remained almost the same –15.38% in 1993 to 14.02 % in 2009.

Rate for further imaging for an equivocal MRI has increased significantly following a primary MRI abdomen study whereas that for recommending an ultrasound has substantially fallen .

The increase in recommendation for further MRI may reflect the greater likelihood of highest test specificity, as compared to ultrasound for abdomen.

Gupta, S, Boland, G, Schultz, T, Halpern, E, Chen, Y, Dreyer, K, Comparing the Growth in Recommendations for High-Cost Modality Exams versus Low-Cost Modality Exams in a Tertiary Care Center: A Pilot Study of MR Imaging Abdomen Reports from 1993 to 2009  .  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007566.html