Strategies for Managing Imaging Utilization

Bernardy, Mark; Ullrich, Christopher G.; Rawson, James V.; Allen, Bibb; Thrall, James H.; Keysor, Kathryn J.; James, Christie; Boyes, John A.; Saunders, Worth M.; Lomers, Wendy; Mollura, Daniel J.; Pyatt, Robert S.; Taxin, Richard N.; Mabry, Michael R.

doi:10.1016/j.jacr.2009.08.003

Cited by 57 publications

(37 citation statements)

References 15 publications

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“…Additional adherence to appropriate imaging recommendations through collaborative efforts among radiologists and ordering physicians is needed. Physician education, standardization of order entry, and establishment of decision support systems have emerged as management strategies [29] demonstrating reduction in imaging overutilization and costs [30][31][32]. Evidence-based imaging is also promoted by the Protecting Access to Medicare Act of 2014 [33], which calls for the establishment and frequent review of appropriate use criteria.…”

Section: Discussionmentioning

confidence: 99%

MRI of the Knee and Shoulder Performed Before Radiography

George

Tsipas

Wozniak

et al. 2014

Journal of the American College of Radiology

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Section: Discussionmentioning

confidence: 99%

MRI of the Knee and Shoulder Performed Before Radiography

George

Tsipas

Wozniak

et al. 2014

Journal of the American College of Radiology

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“…Conventional CT examinations may be performed that do not represent the most appropriate imaging test for the clinical question being asked. Multiple strategies have been developed to address unnecessary use of imaging overall (Bernardy et al, 2009). Guidelines on appropriate use of CBCT need to be widely adopted.…”

mentioning

confidence: 99%

ICRP Publication 129: Radiological Protection in Cone Beam Computed Tomography (CBCT)

Rehani¹,

Gupta²,

Bartling³

et al. 2015

Ann ICRP

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The objective of this publication is to provide guidance on radiological protection in the new technology of cone beam computed tomography (CBCT). Publications 87 and 102 dealt with patient dose management in computed tomography (CT) and multi-detector CT. The new applications of CBCT and the associated radiological protection issues are substantially different from those of conventional CT. The perception that CBCT involves lower doses was only true in initial applications. CBCT is now used widely by specialists who have little or no training in radiological protection. This publication provides recommendations on radiation dose management directed at different stakeholders, and covers principles of radiological protection, training, and quality assurance aspects. Advice on appropriate use of CBCT needs to be made widely available. Advice on optimisation of protection when using CBCT equipment needs to be strengthened, particularly with respect to the use of newer features of the equipment. Manufacturers should standardise radiation dose displays on CBCT equipment to assist users in optimisation of protection and comparisons of performance. Additional challenges to radiological protection are introduced when CBCT-capable equipment is used for both fluoroscopy and tomography during the same procedure. Standardised methods need to be established for tracking and reporting of patient radiation doses from these procedures. The recommendations provided in this publication may evolve in the future as CBCT equipment and applications evolve. As with previous ICRP publications, the Commission hopes that imaging professionals, medical physicists, and manufacturers will use the guidelines and recommendations provided in this publication for implementation of the Commission's principle of optimisation of protection of patients and medical workers, with the objective of keeping exposures as low as reasonably achievable, taking into account economic and societal factors, and consistent with achieving the necessary medical outcomes.

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“…But until recently, conventional cardiac imaging UM programs did not include echocardiography tests. In the early 2000s, large health insurers such as UnitedHealth and Humana had operated without imaging UM programs that contained a prior authorization component (Bernardy et al 2009). However, the current industry trend indicates a shift back to reinstating imaging UM programs wherever they had been dropped and the expansion of existing UM programs to incorporate less invasive tests, such as echocardiography (Allen et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Examining the Association between Utilization Management and Downstream Cardiovascular Imaging

Agiro

Sylwestrzak

Shah

et al. 2014

Health Services Research

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Objectives. To examine the association of echocardiography utilization management (EUM) program with downstream cardiac imaging utilization. Data Sources/Study Setting. Administrative claims data from commercial health plans in Indiana, Ohio, Kentucky, Wisconsin, and Georgia. Study Design. Patients undergoing index cardiovascular imaging with no imaging in the preceding year were identified (N = 112,308). Claims-derived cardiac risk scores were used for one-to-one propensity score matching of patients subject to EUM to patients without EUM (n = 96,906). Downstream cardiac imaging utilization for 12-24 months postindex imaging was analyzed using generalized linear models and Cox proportional hazards model. Principal Findings. Downstream cardiac imaging tests were performed for 10,630 (21.9 percent) and 12,012 (24.8 percent) patients in the EUM and non-EUM groups, respectively. At 12-month follow-up, adjusted utilization was 15.2 (95 percent CI, 7.6-22.5) tests per 1,000 initially tested patients lower in the EUM group (p < .001). The likelihood of obtaining downstream cardiac imaging in the EUM group was 7.0 percent lower than the non-EUM group (hazard ratio: 0.930; 95 percent CI, 0.897-0.964, p < .001). Conclusions. Downstream cardiac imaging is relatively common among commercially insured patients. Every 10 initial diagnostic tests yielded two downstream imaging tests in first 24 months. EUM program was associated with lower volumes of downstream imaging.

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Strategies for Managing Imaging Utilization

Cited by 57 publications

References 15 publications

MRI of the Knee and Shoulder Performed Before Radiography

MRI of the Knee and Shoulder Performed Before Radiography

ICRP Publication 129: Radiological Protection in Cone Beam Computed Tomography (CBCT)

Examining the Association between Utilization Management and Downstream Cardiovascular Imaging

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