Neuroimaging Wisely

Abstract

SUMMARY: Diagnostic imaging is the most rapidly growing physician service in the Medicare and privately insured population. The growing share of medical costs devoted to imaging procedures has led to increasing concerns among the key federal agencies and private payers. In an attempt to educate health care providers, patients, and families on the importance of making optimal clinical decisions, the American Board of Internal Medicine Foundation organized the Choosing Wisely initiative with strong collaboration from specialty societies representing nearly all medical disciplines. Among 45 tests and treatments listed on the Choosing Wisely Web site, 24 are directly related to imaging. Eleven of the 24 are associated with neuroimaging. The listing of imaging tests in the Choosing Wisely program by multiple medical societies other than the radiology societies acknowledges that appropriate use of medical imaging is a shared responsibility between radiologists and referring physicians. In this article, we highlight why radiologists are uniquely positioned to support the appropriate use of imaging. We review some of the strategies that radiologists can use to help their referring physicians with appropriate ordering of neuroimaging in real-world practice and address some the challenges and pitfalls in implementing patient-centered imaging decision-making and shifting to a value-based focus in radiology. ABBREVIATIONS: AAFP

Factors Associated with Incidental Neuroimaging Abnormalities in New Primary Headache Patients

“…es and the lack of radiation exposure. 35,36 Our study showed a disparity in capturing intracranial abnormalities between MRI and CT: 29.6% vs. 4.9% for overall neuroimaging abnormalities, and 4.9% vs. 1.1% for serious intracranial abnormalities. These findings suggest that using MRI rather than CT will increase the probability of capturing both overall and serious neuroimaging abnormalities in patients with primary headache disorder, which is consistent with the neuroimaging recommendation made in the Choosing Wisely campaign.…”

Connectome mapping with edge density imaging differentiates pediatric mild traumatic brain injury from typically developing controls: proof of concept

“…Use of edge density imaging in our study yielded 40% improvement in diagnostic AUC over the FA scalar. Added value of edge density imaging over neurocognitive testing is also important given concerns regarding the cost of neuroimaging [52] and the current barriers to adoption of DTI for mild TBI in routine clinical practice and in medicolegal settings [53]. Lack of correlation between edge density imaging and neurocognitive testing potentially suggests an underlying level of damage to the brain from mild TBI that might precede identifiable neuropsychological deficits, although the small sample size of our study limits its statistical power for determining such correlations.…”

Comparison of Clinical Guidelines for Authorization of MRI in the Evaluation of Neck Pain and Cervical Radiculopathy in the United States

“…14 In the follow-up review authored by Buethe et al, the authors described critical elements of appropriate-use criteria as defined by the Centers for Medicare and Medicaid services. These imaging criteria must “be developed or endorsed by national professional medical specialty societies or provider-led entities, be scientifically valid and evidence-based, and must be based on published studies that are reviewable by stakeholders.” 15 These concerted efforts are vital in shifting the onus of responsible utilization of advanced imaging toward providers and away from proprietary guidelines companies.…”