health

Medical imaging tests can be cut with clinical support systems

Real-time feedback can stop a physician from ordering CT and MRI scans when accepted criteria for the tests aren't present, a new study says.

By Tanya Albert Henry — Posted Jan. 24, 2011

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Physicians may want to think twice about whether an imaging test is necessary before ordering it and talk to patients about radiation risks, two new studies suggest.

A third study shows that clinical decision support systems can help doctors reduce the number of inappropriate medical imaging tests.

Clinical decision support systems, mandated under some new government health care initiatives, are one way to decrease inappropriate medical imaging, including CT and MRI scans, according to a study in the January Journal of the American College of Radiology.

These systems -- decision aids usually involving a computerized order entry system when a doctor is ordering the test -- provide real-time feedback to the physician. The feedback can be purely educational or can stop the physician from ordering an imaging test when accepted criteria for the test aren't present.

Researchers from the Virginia Mason Medical Center in Seattle looked at imaging utilization rates before and after an evidence-based clinical decision support system was built into ordering systems for lumbar and brain MRIs, as well as sinus CT scans. The system required doctors ordering studies to check boxes corresponding to approved imaging indications. If the criteria weren't met, the test couldn't be ordered.

The study found that after the system was in place, low back pain lumbar MRI was 23.4% lower, headache head MRI was 23.2% lower and sinusitis sinus CT was 26.8% lower.

"Clinical decision support systems have the desired properties of being educational, transparent, efficient, practical and consistent," said C. Craig Blackmore, MD, MPH, the study's lead author. "As our study suggests, the use of such systems can aid the elimination of unnecessary imaging, increasing both patient safety and quality and decreasing health care costs."

Radiation exposure

Other new studies point to the potential need for these systems.

An article published online Jan. 3 in the Archives of Pediatrics & Adolescent Medicine found that among 355,088 children in five large U.S. health care markets, exposure to diagnostic imaging procedures with low-dose ionizing radiation was "frequent." Researchers looked at exposure to low-dose x-rays as well as more advanced tests, such as CT scans.

During the three-year study period, 42.5% of children underwent at least one of these procedures, and many children had more than one. One in four children experienced two or more of the procedures during that time, and 16% had three or more tests.

Based on the study's data, on average, children would receive seven imaging procedures using radiation by age 18.

Among the tests researchers examined, CT scans were the area of biggest concern of radiation exposure. Nearly 8% of the children studied had a CT scan in the three-year period, and 3.5% got more than one.

"We need to make sure [these procedures] are only done when they are needed and that they are done in a way to minimize radiation exposure," said Adam L. Dorfman, MD, a study author and clinical assistant professor of pediatrics, communicable diseases and radiology at the University of Michigan Medical School.

For pediatricians and family physicians, that means making sure there is a clear reason for a referral, Dr. Dorfman said. For radiologists, it means making sure they do what they can to limit radiation exposure, he added.

That includes using the least amount of radiation possible when performing a CT scan. Another recent study suggests that physicians need to discuss radiation exposure risks with patients more often.

In an article published online in December 2010 in the Annals of Emergency Medicine, researchers found that 20% of emergency department patients with acute abdominal pain felt confident in a medical evaluation that included a patient history and physical exam. That number jumped to 90% when blood work and a CT scan were added.

Researchers also found that more than 70% of the 1,168 patients in the study underestimated the radiation risk of a CT scan. Only 3% understood that CT scans increased a person's lifetime cancer risk.

"As physicians, we can underestimate what our patients know and what they don't know. Patients may think they need to have something done, but don't need it," said study lead author Brigitte M. Baumann, MD, an associate professor of emergency medicine at the University of Medicine and Dentistry of New Jersey in Camden.

Dr. Baumann has had some success talking to patients about the risk of an unnecessary test.

For example, she had an ED patient with kidney stones who was intent on getting a CT scan. She discussed radiation exposure risks, and taking medication and waiting 24 hours to see what happens. The patient chose to wait.

Back to top


External links

"Effectiveness of Clinical Decision Support in Controlling Inappropriate Imaging," Journal of the American College of Radiology, January (link)

"Use of Medical Imaging Procedures With Ionizing Radiation in Children," Archives of Pediatrics & Adolescent Medicine, published online Jan. 3 (link)

"Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure," Annals of Emergency Medicine, published online Dec. 14, 2010 (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn