Clinicians follow musculoskeletal MRI reports less often when further imaging is recommended

Clinicians often follow recommendations in musculoskeletal MRI reports, but compliance is lowest when additional imaging is requested. More can be done to change this trend, however, argued authors of a recent study published in the American Journal of Roentgenology.

Researchers from New York Presbyterian Hospital’s Department of Radiology looked at hundreds of radiology reports to reach their conclusions. Compliance was nearly perfect when clinical intervention was suggested, but dipped to 67% when a report recommended further imaging.

Adherence to reports varies by subspecialty, but brushing off guidance from these documents, the team warned, could have real-world consequences for patients and clinicians alike.

“The lack of compliance with recommendations can lead to incorrect patient management, poor clinical outcomes and an increase in medical malpractice risk,” John S. Nemer, with Presbyterian Hospital, and colleagues wrote in the study, published Dec. 30. “Despite this, compliance rates for recommendations made by radiologists remain variable.”

According to recent literature, those rates can range anywhere from 30% to 77%. And such data is not even readily available for a number of specialties, the researchers noted.

To gain a more accurate picture, Nemer et al. retrospectively analyzed 790 musculoskeletal MRI reports completed from January 2016 through 2018.

Overall, clinicians acknowledged recommendations 83% of the time and followed them in 73% of cases, with additional imaging coming in as the most frequently suggested guidance.

Subspecialists acknowledged and abided by reports at various rates, with internists notching the highest percentages (92% and 85%, respectively) and orthopedists coming in at the lowest (76% and 64%, respectively).

Simply improving communication bolstered these figures, the team explained. When radiologists spoke directly to clinicians, compliance rates jumped from 71% to 93%.

“Radiologists have room to improve on the quality and clarity of recommendations, particularly for referrers who may not be familiar with current imaging guidelines,” they wrote. “One way this can be done successfully is through simple direct communication with the clinician.”

The approach can also work for patients who may refuse to comply simply because extra imaging requires more time and money. And if they don’t adequately understand the benefit of another exam, they’ll likely pass.

Nemer and co-authors noted that automated tracking, score-based recommendations and evidence-based follow-up guidelines managed by algorithms may also help narrow the adherence gap between subspecialties.

“Such algorithmic systems are highly desired by providers and if created for musculoskeletal radiology could help address the differences in compliance rates observed between provider specialties,” they concluded.