Imaging specialists can substantially reduce the frequency of recommendations they make for additional imaging tests in oncologic positron emission tomography (PET)/computed tomography (CT) reports without adversely affecting patient outcomes, indicate the findings of a recent study.
A blinded retrospective review of reports attached to the PET/CT scans of 250 consecutive cancer patients at Brigham and Women’s Hospital in Boston, Massachusetts, revealed that nuclear medicine physicians or radiologists made 84 recommendations for additional imaging in 88 PET/CT findings involving 29.6% (74) of 250 patients. Further analysis led the investigators—a team headed by Brigham and Women’s Hospital radiologists Atul Shinagare, MD, and Paul B. Shyn, MD—to conclude that approximately half (43 of 84, or 51.2%) of those recommendations were unnecessary. A total of 26 of the 84 (31%) recommendations prompted further imaging, and 10 of 88 (11.4%) of the findings proved to be clinically significant.
Although the study was not designed to determine the motivations behind the recommendations for additional imaging, Shinagare noted in a statement issued by the hospital that one factor prompting unnecessary recommendations is physician reluctance to accept an uncertain diagnosis, partly due to legal liability concerns. Nevertheless, the investigators also learned that the referring clinicians did not follow through on 69% (58 of 84) of the recommendations for additional imaging.
Only 4.7% (two of 43) recommendations deemed inappropriate and 5.2% (three of 58) recommendations not pursued by clinicians were found to be clinically significant. However, PET/CT was sufficient for diagnosis or management in each of those cases.
The investigators concluded that no adverse patient outcome would have occurred by not recommending additional imaging tests in the 51.2% of recommendations deemed unnecessary or in the 69% of recommendations not pursued by the referring clinicians. In the statement issued by the hospital, Shinagare postulated that aspects of the routine clinical workflow for radiologists may have contributed to that 69%, pointing out that radiologists and nuclear medicine physicians might not have access to the complete medical history of patients referred to PET/CT imaging.
“Ordering clinicians usually know the patient record and history, which may put them in a better position to judge the necessity of some recommended imaging tests,” commented Shinagare.
The study results were presented at the American Roentgen Ray Society Annual Meeting held April 29 through May 4, 2012, in Vancouver, British Columbia, Canada.