Collin Michael Torok MD, Abstract Co-Author: Nothing to Disclose

Cindy Lee MD, Presenter: Nothing to Disclose

Paul G. Nagy PhD, Abstract Co-Author: Nothing to Disclose

David M. Yousem MD, Abstract Co-Author: Author, CMEInfo Author, Reed Elsevier

Jonathan S. Lewin MD, Abstract Co-Author: Stockholder, Interventional Imaging, Inc Founder, Interventional Imaging, Inc

To analyze second opinion reports of the neuroradiology outside films service (OSF) in an academic hospital in order to determine the duplicative imaging rate, as well as the underlying factors driving the perceived need for repeat imaging.

11757 complete reports of all neuroradiology OSF studies reviewed in calendar year 2010 were imported into an Excel spreadsheet database. The database was queried with the keyword ‘repeat,’ yielding a total of 287 results. Each of the associated 287 results was then individually reviewed and a total of 133 events were identified in which repeat imaging was recommended due to a variety of study limitations. Limitations were broadly categorized into poor image quality, missing or inadequate standard magnetic resonance imaging sequences, and a lack of intravenous contrast where otherwise deemed appropriate. The available electronic medical records were reviewed to assess whether or not the repeat recommendation was actually performed. 

Duplicate imaging studies were recommended by neuroradiologists in 1.1% of cases (133/11757) based on our search parameters. Recommendations for repeat studies were completed in correlation with available information from the electronic medical record in 21.8% of cases (29/133). The estimated actual duplicative imaging was 0.25% taking into consideration the electronic medical record correlation. Of the 133 repeat imaging recommendations identified, poor image quality was the most commonly cited (n=88) as a contributing study limitation warranting a repeat examination, primarily due to the hard copy scanned nature of the electronic images (n=69) and motion artifact (n=23). Missing or inadequate sequences was the second most commonly cited (n=38) study limitation. A lack of intravenous contrast where otherwise appropriate was the third most commonly cited (n=22) study limitation.

OSF studies are infrequently limited by technical factors, occasionally mandating the need for repeat imaging in order to provide optimal patient care. Our experience in 2010 demonstrates both a low rate of repeat study recommendations (1.1%) as well as a low rate of actual duplicative imaging (0.25%) based on available electronic medical records. 

Identification of the duplicative imaging rate and factors driving examination limitations may create opportunities to further reduce duplicative imaging and optimize patient care.

Torok, C, Lee, C, Nagy, P, Yousem, D, Lewin, J, Neuroradiology Outside Films Service: Assessment of Duplicative Imaging.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11007155.html