Magnetic resonance imaging associated with higher rate of repeat ambulatory examinations

1. In a retrospective review of 100 patient recall requests for diagnostic imaging, over 90% of all recalls were for magnetic resonance imaging (MRI) requests.

2. Most recalls were due to an incomplete examination, but other causes included inadequate coverage of the area of interest, protocoling errors, poor image quality or contrast visualization, or additional images to clarify a finding on initial examination.

Evidence Rating Level: 3 (Average)       

Study Rundown: Radiology utilization has consistently increased in the United States, with estimates of over 400 million radiology examinations annually. However, there has been a paucity of information regarding the appropriateness and value of such imaging volume, and in particular, how many studies occur as a result of repeat examinations. The purpose of this study was to analyze the frequency and etiology of repeat outpatient imaging examinations at a single large academic institution. The study retrospectively reviewed all outpatient repeat examination over a span of three years in a large, academic hospital in the United States. At the conclusion of the study, there were 100 total patient recall requests, producing a recall rate of 1 in 8046 ambulatory studies. MRI was the most common modality to require a repeat examination, accounting for 95% of all recall requests. The most common reason for patient recall was for an incomplete examination, followed by inadequate coverage of the area of interest, poor image quality, errors in protocoling, or a necessity for additional images to clarify a finding on initial examination. This study is limited by a small sample size and a study population that is restricted to in the ambulatory and outpatient setting. However, the results of this study support the hypothesis that although patient recall for imaging is overall rare, the large majority occur due to errors associated with MRI examinations that may be amenable to quality improvement initiatives, including improved communication between ordering physicians, radiologists and MR-technologists. Additional large prospective studies are needed to determine whether quality improvement initiatives can reduce patient imaging recall rates, and to determine if these findings are applicable to patient recall from the inpatient or emergency setting.

Click to read the study in AJR

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In-Depth [retrospective cohort]: This study retrospectively reviewed all patient imaging recall requests from a single academic institution in the United States from 2012 to 2015. Each request was categorized by imaging modality and one of eight categories of imaging error (image quality, protocol error, anatomic coverage, insufficient contrast, incomplete examination, more imaging required, post-processing error, and patient information error). At the conclusion of the trial, there were a total of 100 patient recall requests during the study period, with a recall rate of 1 in 8046 ambulatory studies. The distribution of modalities for these recall requests were 95%, 2%, 2%, and 1% for MRI, CT, x-ray, and ultrasound, respectively. The most common reason for a patient recall was due to incomplete examination (24%), incorrect anatomic coverage (22%), incorrect protocol (20%), poor image quality (15%), additional imaging necessary (11%) or poor contrast visualization (7%).

Image: PD

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