Worth another look: Avoid unnecessary imaging by optimizing PACS to display priors

A certain number of radiology follow-up procedures could be avoided by conducting a comprehensive comparison with patients’ previous imaging studies, meaning PACS systems should be optimized to streamline review of priors for radiologists, according to a study published online in the Journal of the American College of Radiology.

The rising cost of healthcare is estimated to account for nearly 18 percent of the gross domestic product in the U.S. As government and medical industry initiatives continue to emphasize efficiency and reduced waste—particularly with regard to medical imaging—every treatment, test and scan is being evaluated for appropriateness.

Recommendations from radiologists for additional imaging or intervention (RAIs) are an especially scrutinized area of potential excessive procedures, according to lead author Ankur M. Doshi, MD, and his colleagues at NYU Langone Medical Center in New York City. “Estimates indicate that the interpretations of 10.5 percent of all radiologic examinations and 31 percent of abdominal CT examinations contain RAIs,” wrote Doshi et al. “Although the majority of incidental findings are benign, such recommendations result in patient anxiety, higher health care costs, and risk of complication from the potential chain of additional diagnostic procedures.”

Doshi’s team set out to determine how many additional imaging studies could be avoided by comparing patients’ prior imaging studies and evaluating the need for further testing. To do so, the reseachers performed a retroactive analysis of a total of 1,006 RAIs contained within abdominopelvic CT and MRI reports from their medical facility. Examinations of all relevant modalities and body parts from patients’ previous imaging studies were reviewed to assess whether or not the RAIs could have been avoided.

Their research found that 41 of the 1,006 of the recommendations for further imaging or intervention (4 percent) could have been avoided by comparing pre-existing imaging results, with the key factor of avoiding unnecessary additional imaging being examinations conducted in a different modality than the current RAI. “This overall low rate of avoidable RAIs is reassuring, indicating that, in general, radiologists effectively utilize prior imaging in crafting their interpretations and recommendations,” the authors wrote. “Nonetheless, given the increasing focus on delivering high-quality health care efficiently and with minimal cost, factors contributing to increased RAIs, even if infrequent, are important to acknowledge.”

Doshi and his colleagues believe accurate and timely evaluation of previous study images, as well as updates to PACS to enhance radiologists’ ability to review prior examinations, can help avoid unnecessary procedures. “To reduce avoidable RAIs, radiologists should directly review the actual images of prior relevant examinations, including those of different modalities and body parts but still image the area of interest,” wrote Doshi and colleagues. “The infrastructures of PACS should be optimized to correctly identify relevant prior imaging examinations and make such images immediately available and efficiently accessible by interpreting radiologists."