Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Abstract

Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

Low-value MRI of the knee in Norway: a register-based study to identify the proportion of potentially low-value MRIs and estimate the related costs

“…Accordingly, the findings fit with the documented discrepancy between imaging use and outcome 5–7. Extensive use of imaging with low direct outcomes may indicate that patients and clinicians acquire imaging without a plan for using the results on a nice-to-know basis 28.…”

“…Our most conservative estimate shows that more than 58% of MRI are potentially of low value, but the real number of low-value knee MRIs is likely higher. International studies show that less than 1% of knee MRI results yielded change in patient management 7. Thus, the potential for shifting resources from low-value MRIs to high-value MRIs in the Norwegian healthcare system in a safe manner is substantial.…”

Evaluating ChatGPT as an Adjunct for Radiologic Decision-Making

“…With an increasingly aging population and accessible imaging technologies, radiology imaging volumes are only expected to rise despite persisting concerns for low-value imaging 21 . Concomitant improvements in CDS infrastructure to enhance provider accuracy of appropriate imaging orders will emerge as a major priority and the involvement of ChatGPT-like AI is already being discussed 22 .…”

Drivers for low-value imaging: a qualitative study of stakeholders’ perspectives in Norway

“…Low-value imaging is estimated to account for 20‒50% of all imaging internationally [ 1 , 13 ]. Internationally, several low-value examinations have been identified, for example, imaging of lower back pain, brain imaging in minor head injury, and various types of routine imaging, as these examinations often do not improve patient outcomes, compared to if the examination were not performed [ 14 – 16 ].…”