Radiation Exposure and Cost Influence Physician Medical Image Decision Making

Gimbel, Ronald W.; Fontelo, Paul; Stephens, Mark B.; Olsen, Cara; Bunt, Christopher; Cook, Cynthia A. Loveland; Liu, Fang; Burke, Harry B.

doi:10.1097/mlr.0b013e3182928fd5

Cited by 29 publications

(26 citation statements)

References 11 publications

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“…This result is consistent with our previous findings in adult patients. 9 The ACR Appropriateness Criteria alone also seemed to influence the imaging modality selection. Both CT and ultrasound were rated as "usually appropriate," but CT had the highest ACR rating among the 7 options, and CT selection increased whenever this information was presented.…”

Section: Discussionmentioning

confidence: 99%

“…Building on our previous research, 9 this study examined how decision support, in the form of estimated radiation exposure coupled with current imaging guidelines, influenced family physician selection of pediatric imaging modalities. We hypothesized that decision support information, and the order in which data were presented, would impact physician choice of imaging modality.…”

mentioning

confidence: 99%

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Point-of-Care Estimated Radiation Exposure and Imaging Guidelines Can Reduce Pediatric Radiation Burden

Bunt

Burke

Towbin

et al. 2015

The Journal of the American Board of Family Medicine

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Introduction:The steady increase in the use of computed tomography (CT) has particular concerns for children. Family physicians must often select pediatric imaging without any decision support. We hypothesized that point-of-care decision support would lead to the selection of imaging that lowered radiation exposure and improved guideline congruence.Methods: Our double-blind, randomized simulation included family physicians in the Military Health System. Participants initially reviewed a pediatric hematuria scenario and selected imaging without decision support. Participants were subsequently randomized to either receive imaging-appropriateness guidelines and then estimated radiation exposure information or receive estimated radiation information then guidelines; imaging selections were required after each step. The primary outcome was the selected imaging modality with point-of-care decision support.Results: The first arm increased CT ordering after viewing the guidelines (P ‫؍‬ .008) but then decreased it after reviewing radiation exposure information (P ‫؍‬ .007). In the second arm radiation information decreased CT and plain film use (P ‫؍‬ not significant), with a subsequent increase in ultrasound and CT after the guideline presentation (P ‫؍‬ .05).Conclusions: Decision support during a simulated pediatric scenario helped family physicians select imaging that lowered radiation exposure and was aligned with current guidelines, especially when presented with radiation information after guideline review. This information could help inform electronic medical record design.(J Am Board Fam Med 2015;28:343-350.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Point-of-Care Estimated Radiation Exposure and Imaging Guidelines Can Reduce Pediatric Radiation Burden

Bunt

Burke

Towbin

et al. 2015

The Journal of the American Board of Family Medicine

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“…Many factors contribute to unnecessary imaging, including patient age and sex, underlying disease, health care delivery model, access to high-cost imaging modalities, hospital characteristics, styles of practice, lack of adequate interest of doctors, social/individual preferences, national medical education status, knowledge gap regarding the safety/cost of cross sectional imaging, and radiologist recommendations [1,14]. The repetitive use of CT and MR techniques is the main unnecessary imaging reason.…”

Section: Discussionmentioning

confidence: 99%

“…Obtaining the history of the patients appropriately and completely, performing optimal physical examination, and continuing education about radiation exposure risk and evidence-based principles of cross-sectional imaging to the doctors can be useful in preventing side effects which may be develop due to unnecessary or increased CT/MR imaging [9]. Gimbel et al [1] decreased the number of unnecessary imaging to 50% after the education regarding to safety and cost information.…”

Section: Discussionmentioning

confidence: 99%

“…Unnecessary radiologic examinations leads to increase in the health expenditure and those examinations may also lead to development of nephrogenic systemic fibrosis (NSF), contrast-induced nephropathy (CIN), malignancy, reduced patient compliance and prolongation of treatment time [1]. According to Gimbel et al [1], approximately 50% of advanced medical imaging in USA is unnecessary.…”

Section: Introductionmentioning

confidence: 99%

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Unnecessary computed tomography and magnetic resonance imaging rates in a tertiary care hospital

2016

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Objectives. The actual rate of unnecessary imaging is unknown in our country. In this study we aimed to detect unnecessary computed tomography (CT) and magnetic resonance imaging (MRI) rates and the radiological quality of these examinations in our hospital. Methods. CT/MRI request documents of 1,713 patients who had multidetector CT or MRI examination in a 2-month period at a single tertiary care hospital were obtained. We evaluated that whether the disorder that mentioned in request document was present or not in multidetector CT or MR images from the picture and archiving communicating system of our hospital. Scoring was done as follows; score 0 (there is no pathologic finding), score 1 (suspicious findings), and score 2 (presence of mentioned pathology). The radiological quality of the examinations was scored as follows; grade 0 (poor quality), grade 1 (moderate quality), and grade 2 (good quality). Results. There was not any pathologic finding in 35% of the patients included in the study (score 0, unnecessary imaging). There was/were finding(s) regarding to the disorder that mentioned in the request document in 43% of the patients (score 2). Suspicious findings were existed in the remaining patients (score 1). In the assessment of radiologic quality of the examinations that included in the study; 94% of the radiologic examinations had good quality and the remaining had moderate (0.2%) and poor (5.5%) quality. Conclusions. Unnecessary CT or MRI rate was detected as 35% in our hospital. Unnecessary imaging causes increased nephrogenic systemic fibrosis, contrast-induced nephropathy and/or radiation risks, and total cost. It may also cause reduced patient compliance and prolongation of therapy period.

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Direct physician reporting is associated with reductions in radiation exposure in pediatric cardiac catheterizations

Nicholson

Gao

Kim

et al. 2015

Cathet Cardio Intervent

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Radiation Exposure and Cost Influence Physician Medical Image Decision Making

Abstract: This study suggests that physician decision making can be influenced by safety and cost information and the order in which information is provided to physicians can affect their decisions.

Cited by 29 publications

References 11 publications

Point-of-Care Estimated Radiation Exposure and Imaging Guidelines Can Reduce Pediatric Radiation Burden

Point-of-Care Estimated Radiation Exposure and Imaging Guidelines Can Reduce Pediatric Radiation Burden

Unnecessary computed tomography and magnetic resonance imaging rates in a tertiary care hospital

Direct physician reporting is associated with reductions in radiation exposure in pediatric cardiac catheterizations

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