RI-RADS would let radiologists grade physicians' imaging orders

When physicians place orders for imaging examinations, they often leave out key information that could help the radiologist provide better patient care. The authors of a new analysis published in the European Journal of Radiology have proposed a standardized grading system, the Reason for exam Imaging Reporting and Data System (RI-RADS), that could combat this issue.

“The purpose of this system is to standardize clinical information on imaging requisition, to enable radiologists to evaluate the usefulness of clinical information provided in imaging requisitions, and to communicate this assessment in the radiology report,” wrote Aidin Abedi, MD, Keck School of Medicine at the University of Southern California in Los Angeles, and colleagues.

Abedi et al. did note that other methods have been introduced that were designed to improve imaging orders. Success has been mixed, however, and even when one group of researchers found considerable success with their own intervention, “the rates of improvement gradually decayed over time.”

RI-RADS, the authors explained, would help ensure orders include enough information “to enable radiologists to recognize the precise intent of the study.”

“This pertinent clinical information should include: indication for the exam, working diagnosis, chronicity, and location of signs and symptoms, mechanism of ailment, pertinent positives and negatives, any pertinent lab values, pertinent past medical and surgical histories, and any other significant clinical information,” the authors wrote.

The proposed grading system would focus exclusively on information included in the requisition form. RI-RADS is not assessing direct communication, for instance, or information out of the electronic health records. The system then grades an order based on three areas: impression (a working diagnosis, differential diagnoses) clinical findings (signs, symptoms, history, other relevant information) and the main diagnostic question. If the order includes all the needed information, it would earn an “adequate” grade of RI-RADS A. RI-RADS B translates to “barely adequate,” RI-RADS C is “considerably limited” and RI-RADS D is “deficient.”

“Reports which are supplemented with RI-RADS will render regular feedback from radiologists and can be assembled into a provider ‘report card’ to inform the referring physicians about the sufficiency of their requisitions and how they compare to their peers,” the authors wrote. “With continuous feedback, clinicians may be encouraged to provide the best clinical information possible, leading to improved efficacy for the radiologists reviewing studies and better patient care.”

Implementation of such a system, the authors added, reduces the potential for medical errors and could even help limit the risk of malpractice litigation for all providers involved in the process. RI-RADS could also help radiologists keep unnecessary imaging orders to a minimum, working to “limit studies that are not indicated” and provide the best value possible.

“This simple and comprehensive system may increase the accuracy and efficiency of the interpretations, improve the interdisciplinary communications, and most importantly improve patient care,” the authors concluded.