A recent detailed investigation into the practice of recommending additional imaging (RAI) in head and neck radiology has unveiled a major gap in the realm of diagnostic healthcare. The study, now published in the Journal of the American College of Radiology, reports low levels of actionable recommendations, highlighting a critical area for improvement in medical imaging and patient care.
In medicine, the term “actionable” refers to information from a diagnostic test that directly informs patient management. The study in question measured the actionability of RAIs in head and neck CTs and MRIs. This field of radiology considerably lacks best practice guidelines, which is a concerning matter considering the central role of medical imaging in diagnosing and managing patients.
DOI: 10.1016/j.jacr.2024.01.005
The innovative research was conducted by an elite team from the Center for Evidence-Based Imaging at Brigham and Women’s Hospital, including experts such as Dr. Jeffrey P. Guenette, Dr. Elyse Lynch, Dr. Nooshin Abbasi, Dr. Kathryn Schulz, Dr. Shweta Kumar, Dr. Sebastien Haneuse, Dr. Neena Kapoor, Dr. Ronilda Lacson, and Dr. Ramin Khorasani. Over a span of one year, they retrospectively reviewed a massive pool of 60,543 radiology reports, focusing on head and neck CTs and MRIs generated across a multi-institutional, multi-practice healthcare system.
Out of the tens of thousands reports, 4,382 contained RAIs, representing a 7.2% occurrence rate. Alarmingly, a mere 3.9% of these RAIs were deemed actionable. This low rate raises concerns about the effectiveness of current practices in identifying clinically necessary additional imaging.
The study found that over 60% of RAIs pertained to only eight types of examinations. Leading the list was thyroid ultrasound, followed by neck CT, brain MRI, chest CT, neck CTA, temporal bone CT, temporal bone MRI, and pituitary MRI.
The expert team also looked into how radiologist factors affected the actionability of RAIs. Results showed that radiologists with more than 23 years of experience post-training, as well as those practicing in community settings, are less likely to make actionable recommendations compared to their less experienced counterparts and those in academic settings.
This research sheds light on an essential aspect of healthcare delivery—the importance of ensuring that diagnostic imaging yields actionable insights that can lead to effective patient care. While the paper does not delve into all potential factors influencing the low actionability rates, suggestions for improvement include implementing multi-faceted quality improvement initiatives. These initiatives could offer peer comparisons, incorporate clinical decision support at the time of reporting, and entail the development of evidence-based best practices.
References
1. Guenette JP, Lynch E, Abbasi N, et al. (2024). Actionability of Recommendations for Additional Imaging in Head and Neck Radiology. Journal of the American College of Radiology. https://doi.org/10.1016/j.jacr.2024.01.005
2. Lacson R, Prevedello LM, Andriole KP, et al. (2012). Information from searching content with an ontology-utilizing toolkit (iSCOUT): an information retrieval ontology to support automated radiology reporting quality assurance. J Digit Imaging. 25(4):512-9.
3. Khorasani R, Hentel K, Darer J, et al. (2013). Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 20(e1):e18-25.
4. Kapoor N, Lacson R, Wang A, et al. (2013). Automated detection of follow-up for findings of “uncertain malignant potential” in radiology reports over time. J Am Med Inform Assoc. 20(4):678-84.
5. Sistrom CL, Honeyman-Buck J. (2005). Free text in electronic health records. J Am Coll Radiol. 2(9): 713-728.
Keywords
1. Head and Neck Radiology
2. Additional Imaging Recommendations
3. Actionable Imaging Findings
4. Radiology Best Practices
5. Medical Imaging Quality Improvement
The need for evidence-based guidelines in head and neck radiology is unequivocal. The diligent exploration conducted by this team of researchers sparks a necessary scrutiny into current practices, calling for a substantial shift towards more actionable imaging recommendations. This study is poised to serve as a cornerstone for driving policy changes and ultimately improving patient outcomes in radiological care.