Andrew Kent Moriarity MD, Presenter: Nothing to Disclose

Matthew O'Brien MD, Abstract Co-Author: Nothing to Disclose

Chad Klochko MS, MD, Abstract Co-Author: Nothing to Disclose

Safwan Halabi MD, Abstract Co-Author: Nothing to Disclose

To measure how often radiologists alter the initial advanced imaging request using an electronic protocolling system and analyze how the implementation of clinical decision support for inpatient requests impacted the need for protocolling by radiologists.

An IRB approved retrospective review was performed of 218,904 requests for computed tomography (CT), magnetic resonance (MR) and nuclear medicine (NM) examinations over a 29-month period. Information collected for each request included the patient setting, the body part to be imaged, the imaging protocol requested, the requested use of contrast media and the responsible physician. Point of care generated clinical decision support (CDS) appropriateness scores were examined for inpatient requests.

During request protocolling, radiologists changed the modality or examination type of 86,122 requests (39.3%) and the use of contrast for 18,796 requests (8.5%). The overall rate of change for emergency department (ED), inpatient (IP) and outpatient (OP) patients was 18.3%, 35.7% and 42.9% respectively. Rates are also compared across the 43 distinct clinical specialties of the requesting physician. There were 13,568 and 12,881 IP requests examined in the 7-months prior to and following implementation of CDS. There was no significant difference in the percentage requests changed during protocolling after implementation of CDS for CT protocol, NM protocol or the use of CT contrast. The rate of change for MR protocol increased after CDS from 38.0% to 40.0% while the rate of change for MR contrast decreased from 19.3% to 16.1%.

More than one-third of inpatient and outpatient imaging requests are altered by radiologist protocolling with the type of examination performed changed four times more often compared to the addition or removal of contrast material. Implementation of clinical decision support at the time of inpatient request entry did not significantly reduce the rate of changes made during protocolling.

Protocolling imaging requests by radiologists is an important value added activity that ensures the right patient receives the correct examination for the appropriate clinical indication.

Moriarity, A, O'Brien, M, Klochko, C, Halabi, S, Patient-centered Imaging: The Effect of Radiologists’ Protocolling Imaging Requests.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016581.html