Advanced imaging has been identified as one factor that contributes to the overall rising cost of healthcare in the US. Unnecessary or inappropriate imaging utilization magnifies the cost burden associated with advanced imaging studies like MRIs and PET/CT scans. Though these studies often provide the best clinical information for making a diagnosis or planning treatment, experts suspect that a significant number of unnecessary studies are performed. Determining the rate of unnecessary imaging can help guide both policy-makers and physicians to develop guidelines that would ultimately reduce costs associated with advanced medical imaging.
A recent study by researchers from Brigham and Women's Hospital Department of Radiology adds new data about unnecessary imaging among cancer patients. Atul Shinagare, MD and attending radiologist, Paul B. Shyn, MD reviewed the reports attached to the PET/CT scans of 250 cancer patients and found that 84 of the reports contained a nuclear medicine physician or radiologist's recommendation for additional imaging tests. Further analysis led the researchers to conclude that 43 (approximately half) of those recommendations were unnecessary.
"Our research indicates that imaging specialists can substantially reduce the frequency of recommendations for additional imaging tests in oncologic PET/CT reports without adversely impacting patient outcomes," said Dr. Shinagare.
Other key findings from the study, which will be presented at the American Roentgen Ray Society Annual Meeting, May 4th in Vancouver, Canada, include:
- Eighty-four, or approximately 30 percent of the total number of PET/CT reports contained a recommendation for additional imaging.
- Additionally, referring physician did not follow through on 70 percent of the recommendations for additional imaging.
The study's protocols did not call for the authors to specifically investigate the reader motivations behind the additional imaging recommendations, but Dr. Shinagare offered some possible explanations. "Some of the factors prompting unnecessary recommendations include reluctance of physicians to accept uncertainty regarding diagnosis, partly driven by legal liability concerns, combined with a failure to fully consider the patients' clinical circumstances and the likely cost-effectiveness of additional imaging tests," he said.
Dr. Shinagare postulated that aspects of the routine clinical workflow for radiologists may have contributed to the 70 percent of additional imaging recommendations that referring physicians did not follow up on. "Radiologists and nuclear medicine physicians may not have access to the complete medical history of patients referred for PET/CT imaging. On the other hand, ordering clinicians usually know the patient record and history, which may put them in a better position to judge the necessity of some recommended imaging tests" said Dr. Shinagare.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research, BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org