Effect of Radiologist-driven Imaging Utilization

Radiologist-driven imaging utilization, ordering physicians, and clinically relevant pathology, from a study at ACR 2016.

In-house radiologists for high-end imaging utilization is feasible, cost-effective, and preferred by ordering physicians, according to a presentation at the 2016 annual meeting of the American College of Radiology.

Researchers from Christiana Care Health Systems in Newark, DE, performed a study to determine the effectiveness of radiologist-driven imaging utilization and how it is perceived by clinicians.

In-house radiologists reviewed 1,778 orders for CT, MRI, and PET scans obtained from July 2014 to May 2015. They were designated as approved, rejected, or alternate suggested. For studies designated as 'rejected' or 'alternate suggested', a dialogue was initiated with the ordering physician and a mutual decision reached regarding the appropriateness of the exam. Initial recommendations, final decisions, and imaging results were reviewed. Ordering clinicians were surveyed regarding effectiveness.

The results showed that 1,537 (86%) were approved as ordered, while 169 cases designated as alternate suggested, the radiologist recommended a more appropriate examination for the patient. Of these cases, 90% of the studies were completed per the radiologist's alternate imaging recommendation, and in 10%, the clinician disagreed with the recommended alternative and insisted the study be performed as ordered.

The study was marked rejected in 72 cases, indicating an inappropriate or unnecessary imaging exam. Of this group, the ordering clinician agreed in 72% of cases and in 28% of cases insisted the study be performed as ordered. Of the 37 total studies in which the ordering physician disagreed with the radiologist's recommendation (alternate or rejected), only five demonstrated clinically relevant pathology.

The researchers concluded that using in-house radiologists as gatekeepers of high-end imaging utilization is feasible, cost-effective, and preferred by ordering physicians. In their study, consensus between the radiologist and ordering clinician was reached in 98% of cases.