There is considerable variation among radiologists when choosing whether to include follow-up imaging recommendations in radiology reports, according to new findings published in Radiology. What can be done address this issue?
“A better understanding of follow-up recommendations in radiology reports is needed, as are clear identification of factors that might account for variation in rates of follow-up recommendations,” wrote author Laila R. Cochon, MD, Brigham and Women’s Hospital in Boston, and colleagues. “Previous studies performed at single institutions and in single subspecialty divisions have suggested that radiologist experience may be associated with fewer follow-up recommendations. However, it remains poorly understood how much radiologists vary when recommending additional imaging and what additional radiologists and other factors influence the likelihood of additional imaging.”
The authors explored data from 318,000 radiology reports at a single urban hospital and its tertiary care centers. All reports were written from Jan. 1 to Dec. 31, 2016, and 57% of the 65 radiologists responsible for those reports were men.
A machine learning tool found that more than 38,000 (12.2%) of the radiology reports included follow-up imaging recommendations. Overall, interradiologist variation in the likelihood of including follow-up recommendations ranged from 2.8- to 6.7-fold, depending on the radiologist’s subspecialty.
Examining potential patient factors, the team found that each additional year of a patient’s age was associated with higher rates of follow-up recommendations. Also, male patients had lower overall rates of follow-up recommendations.
Cochon et al. shared some ways imaging providers can work to get their radiologists on the same page.
“Whereas radiologist sex, trainee involvement, and experience did not contribute to unwarranted variation in follow-up recommendations, there was substantial variation in follow-up recommendations between radiologists within the same division,” the authors wrote. “Therefore, interventions to reduce unwarranted variation in follow-up recommendations may be most effective if targeted to individual radiologists. Interventions could include feedback reports that show follow-up recommendation rates for individual radiologists, educational efforts to improve awareness and acceptance of evidence-based imaging guidelines, and improved decision support tools.”
Future research, the authors added, should explore how different interventions may impact interradiologist variation and overall patient care.