Ankur Doshi MD, Presenter: Nothing to Disclose

Michael Kiritsy, Abstract Co-Author: Nothing to Disclose

Andrew B. Rosenkrantz MD, Abstract Co-Author: Nothing to Disclose

Abdomen and pelvic CT and MRI reports frequently contain recommendations for additional imaging (RAI) to evaluate an indeterminate finding, generating increased utilization and cost. The purpose of this study was to determine the frequency and characteristics of RAI that could be avoided by thoroughly reviewing all available prior studies.

This IRB-approved, retrospective evaluation of abdominopelvic CT and MRI reports included 1,015 RAI. An abdominal imaging fellow comprehensively reviewed the reports and images from each patient’s prior imaging studies, including all relevant body parts and modalities. The RAI was considered avoidable if the prior imaging demonstrated ≥2 years of stability of the finding, complete characterization of the finding, or if the recommended study was already recently performed. The fraction and characteristics of such “avoidable” RAI were computed/assessed using summary statistics. 

Of the 1,015 RAI, 41 were avoidable (4%). The involved organs were as follows: 22% kidney, 15% adrenal, 15% uterus, 12% liver, 7% bone, 7% biliary, 5% chest, 5% adnexa, 2% spleen, 2% peritoneum, 2% pancreas, 2% bowel, 2% abdominal wall. The RAI was considered avoidable on the basis of prior full characterization in 61%, ≥2 year stability in 29% and recent completion of the recommended study in 10%. The key prior study was a different modality from the study containing the RAI in 54% and was not mentioned as a comparison study in 83%. The key prior study modality comprised CT (44%), MRI (32%), ultrasound (17%), PET-CT (2%) and radiographs/fluoroscopy (5%). The key prior body imaging area included the abdomen/pelvis (59%), spine (10%) and chest (32%). The key finding was noted in the impression of the prior study in 22%, noted only in the report body in 17%, present on the prior images but not described in the report in 54%, and present in an outside study uploaded to our system in 7%.

A small fraction of RAI (4%) can be avoided by a thorough evaluation of all prior imaging studies, including studies of other body parts and modalities. More that half (54%) of the key prior studies did not report the finding, highlighting the importance of directly reviewing all relevant prior images.

Direct review of all prior relevant imaging, including different body parts and modalities, can help avoid recommendations for additional imaging.

Doshi, A, Kiritsy, M, Rosenkrantz, A, Dare to Compare! Analysis of Recommendations for Additional Imaging in Abdominopelvic Studies that can be Avoided by a Thorough Comparison with Prior Examinations.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004711.html