Supriya Gupta MBBS, MD, Presenter: Nothing to Disclose

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

Pradheep Vemula, Abstract Co-Author: Nothing to Disclose

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

Sanjay Saini MD, 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 rate for recommending high cost vs. low cost modality exams from ultrasound 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 ultrasound 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 measured using student t-test.

Out of 1,011,052 USG abdomen exams from 1993 till 2010, recommendations were made in 202,948 (20.07%) cases. Out of those recommendations, US was recommended in 14% followed by biopsy (11.12%), followed by MRI (7.9%) and CT 5.83% whereas others were - repeat current exam – 12.36%, endoscopy-0.18 %, PET in 0.02% and x-ray 0.87% ). The ROR for MRI has increased from 4.55% in 1993 to 10.11 % in 2009 ,but for the same time period , ROR for CT decreased from 16.36% in 1993 to 3.75% in 2009 ,for biopsy decreased from 11.1% in 1993 to 5.8% in 2009 and for radiography decreased from 2.07% to 0.65% (p<0.0001). ROR for ultrasound however, remained almost the same –14.2 % in 1993 to 12.62% in 2009.

Rates for further imaging with MRI have increased significantly following a primary ultrasound abdomen study that is equivocal, while those for CT, biopsy and radiography have substantially fallen.

The increase in recommendation for further MRI imaging following ultrasound of the abdomen may reflect the greater likelihood of higher test specificity for MRI as compared to CT.

Gupta, S, Boland, G, Vemula, P, Schultz, T, Saini, S, 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 Ultrasound 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/2010/9007621.html