Supriya Gupta MBBS, 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

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 Medical Advisor, Merge Healthcare

We hypothesized that recommendations following high-cost cross sectional exams are more likely to be followed by the physicians. We determined the compliance rate among physicians for following radiologists’ recommendations for additional imaging following abdominal MRI exams.

IRB approved retrospective aggregated data collection was performed using Leximer to classify unstructured abdominal MRI reports into those with recommendations (R+) and those without recommendations (R-). We recorded consecutive 500 R+ reports with further recommendations for CT, another MRI and US abdomen and another 500 R- reports from 2008. The electronic medical record was followed for these 1000 exams. Compliance was considered to be positive (C+) if the recommended imaging exam was performed within one year of US abdomen. Utilization of recommendations was determined by dividing R+C+ exams with R-C+ exams. Values adjusted for overall imaging exams for the same time period.

Of 51,202 MRI abdomen reports in database, we selected 500 R+ reports with recommendations for CT (n=112), MRI (n=315) and US (n=75) abdomen. Average compliance rate (R+C+) for imaging recommendations was 79% following MRI abdomen. R+C+ rate was highest for another MRI abdomen (80%) followed by US abdomen (79%) and CT abdomen (76%). R-C+ rate for US abdomen in 500 R- exams was determined to be 32%. Utilization of recommendations (R+C+/R-C+) was found to be 2.47. This suggests that follow up of MRI abdomen is about 2.5 times more likely if a recommendation for additional imaging is found in the radiology report.

Compliance rate for recommendations for additional imaging are highest (80%) following MRI abdomen. The resons are unclear but high-cost MRI exams may predispose physicians to follow up radiologist’s recommendations.

Growth in imaging technologies has raised concerns for utilization of imaging resources. Recommendations for additional imaging need to be validated and ideally standardized guidelines set.

Gupta, S, Boland, G, Schultz, T, Saini, S, Dreyer, K, Do Physicians Comply with Radiologist Recommendations? Assessing Utilization of Recommendations Following MRI Abdomen Exams.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010572.html