Reducing the Rate of Repeat Imaging: Import of Outside Images to PACS

Lu, Michael T.; Tellis, Wyatt M.; Fidelman, Nicholas; Qayyum, Aliya; Avrin, David E.

doi:10.2214/ajr.11.6890

Cited by 31 publications

(24 citation statements)

References 17 publications

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“…In addition, searching for studies from other sources wastes provider time [9–12] and delays treatment [13]. Finally, imaging has high utility in the diagnosis and treatment of disease, but inaccessible studies cannot support clinical decision making [11,14]. …”

Section: Introductionmentioning

confidence: 99%

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Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

Vest

Jung

Ostrovsky

et al. 2015

Journal of the American College of Radiology

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Introduction Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization. Methods Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004–2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models. Results A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = −0.17; 95% confidence interval [CI] = [−0.25, −0.09]; P < .001). However, image sharing technology was associated with a significant increase in any imaging utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias. Conclusions Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings.

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Section: Introductionmentioning

confidence: 99%

“…Several quantitative evaluations indicate that use of image sharing technologies reduces imaging utilization, particularly that for repeat and unnecessary imaging [14,22–25]. However, other studies show inconsistent results, or no effect at all [26–28].…”

Section: Introductionmentioning

confidence: 99%

Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

Vest

Jung

Ostrovsky

et al. 2015

Journal of the American College of Radiology

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“…24 We found that the type of practice women attend for mammography screening may influence their ability to readily access additional breast imaging required to complete diagnostic work-ups after abnormal screening. Specifically, women attending multi-specialty breast centers and full diagnostic radiology practices for screening are more likely to have advanced breast imaging services readily available compared to women attending non-radiology or breast imaging only practices.…”

Section: Discussionmentioning

confidence: 88%

Advanced Breast Imaging Availability by Screening Facility Characteristics

et al. 2015

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Rationale and Objective To determine the relationship between screening mammography facility characteristics and on-site availability of advanced breast imaging services required for supplemental screening and the diagnostic evaluation of abnormal screening findings. Materials and Methods We analyzed data from all active imaging facilities across six regional registries of the National Cancer Institute-funded Breast Cancer Surveillance Consortium offering screening mammography in calendar years 2011–2012 (n=105). We used generalized estimating equations regression models to identify associations between facility characteristics (e.g., academic affiliation, practice type) and availability of on-site advanced breast imaging (e.g., ultrasound, magnetic resonance imaging (MRI)) and image-guided biopsy services. Results Breast MRI was not available at any non-radiology or breast imaging only facilities. A combination of breast US, breast MRI, and imaging-guided breast biopsy services was available at 76.0% of multi-specialty breast centers compared to 22.2% of full diagnostic radiology practices (p=0.0047) and 75.0% of facilities with academic affiliations compared to 29.0% of those without academic affiliations (p=0.04). Both supplemental screening breast ultrasound and screening breast MRI were available at 28.0% of multi-specialty breast centers compared to 4.7% of full diagnostic radiology practices (p<0.01) and 25.0% of academic facilities compared to 8.5% of non-academic facilities (p=0.02). Conclusion Screening facility characteristics are strongly associated with the availability of on-site advanced breast imaging and image-guided biopsy service. Therefore, the type of imaging facility a woman attends for screening may have important implications on her timely access to supplemental screening and diagnostic breast imaging services.

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“…Much of the interest in containing escalating imaging costs has focused on curbing overutilization by reducing inappropriate tests [2, 4, 10–16]. In view of prior studies pointing to low likelihood of finding significant abnormality on imaging in uncomplicated headache [5, 9, 17, 18], both the American College of Radiology (ACR) and the American Association of Neurology have recommended limited use of neuroimaging in patients with headache [5, 6].…”

Section: Discussionmentioning

confidence: 99%

Two-Tiered Approach to MRI for Headache: A Cost-Effective Way to Use an Expensive Technology

Sharma

Reis

Parsons

et al. 2013

American Journal of Roentgenology

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OBJECTIVE The purpose of this study was to compare the diagnostic efficacy and cost implications of a proposed two-tiered approach to MRI in patients with headache. MATERIALS AND METHODS We identified 245 consecutive patients with headache using MRI studies performed at a tertiary care facility between October 2009 and July 2011. Three radiologists prospectively used FLAIR sequences from these MR studies to diagnose underlying abnormality or to identify the need for a comprehensive MRI study. We compared the diagnostic efficacy and the cost implications of such a two-tiered approach with those of conventional MRI from the perspectives of the payer, the patient, and the imaging facility. RESULTS The sensitivity and specificity for two-tiered (83.3% and 100%, respectively) and conventional (91% and 97.8%, respectively) MRI approaches were not significantly different. Assuming a 50% reduction in the payment for the initial limited MRI performed as a first step of the two-tiered approach, this approach would have resulted in 44.8% savings to the payer. A substantial reduction in the scanner utilization time from 4168 minutes to 1249 minutes for the two-tiered approach would have enabled increased throughput at the imaging facility. Although 27 (11%) patients would have been recalled for a comprehensive MRI study in the two-tiered approach, the average time spent in the scanner by each patient would have been less for the two-tiered approach (5.1 minutes vs 17.0 minutes). CONCLUSION A two-tiered approach to MRI can serve as a viable cost-effective alternative to the conventional approach.

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Reducing the Rate of Repeat Imaging: Import of Outside Images to PACS

Abstract: Importing outside images to PACS reduces the rate of repeat imaging.

Cited by 31 publications

References 17 publications

Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

Advanced Breast Imaging Availability by Screening Facility Characteristics

Two-Tiered Approach to MRI for Headache: A Cost-Effective Way to Use an Expensive Technology

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