Pandemic provides priority-setting opportunity to scrutinize low-value imaging, experts say

The COVID-19 pandemic may provide an opportunity to reset priorities in radiology and focus on exams that are essential to patient care while shedding others that fell by the wayside.

Norwegian imaging experts recently used the public health crisis as an opportunity to explore the necessity of specific services. They discovered that after COVID-related imaging slowdowns let up, the use of certain imaging exams did not return at the same rate as prior to 2020.

“We found a substantial reduction of the number of outpatient examinations, indicating how specific radiological examinations are valued in practice,” Bjørn Hofmann, PhD, a noted author and researcher with the Center of Medical Ethics at the University of Oslo, Norway, and colleagues wrote Oct. 26 in BMC Health Services Research. “As such, it can help us identify potential low-value radiological services.”

For the study, Hofmann et al. retrospectively analyzed data from the Norwegian Health Economics Administration covering 2015-2020. They separated 2020 into three segments for their review: (1) the “shut-down period,” from March 12 to April 11, when only extraordinarily important cases were examined; (2) from April 12 to May 12, when there was a slight let up in restrictions for additional important cases; and (3) May 13 to June 12, with further let up and departments returning to “almost normal” outpatient activities.

They found a 45% reduction in outpatient radiology exams during the shut-down when compared to historical trends from the same period in 2015-2019. By Period 2, the reduction was 25%, and during Period 3 as things let up further, imaging numbers were down only about 6%.

Exams with the greatest continuing reductions during the pandemic included abdominal kidney, ureters and bladder views; CT enterography (using contrast to view the small intestine); MRI of the pelvis and lower limbs; along with axillary ultrasound, or sonographic scans of the liver, gall bladder and pancreas. Several more saw declines—such as throat and neck ultrasound and MRI of the thoracic spine, sacroiliac joints and face—which are specifically called out by the Choosing Wisely campaign as low-value healthcare services.

Meanwhile, bone density examinations did not see the same slowdowns, actually increasing during Period 3 as restrictions lifted. And only five CT examinations fell more than 20% amid Period 2, despite a 57% reduction in the first period, the authors noted. This may be because Norwegian providers prioritized cancer pathways and follow up, because CT exams are inherently high value, or it is difficult to curb computed tomography use. Hofmann et al. noted that no clear pattern was found indicating that providers cut low-value care on purpose, and the investigation did not assess how these reductions affected patient outcomes.

“Further research should focus on in-depth analyses of examination codes, clinical indications, and long-term effects to verify specific radiological examinations as low value,” the authors concluded. “Nonetheless, the SARS-COV-2 pandemic provides a natural intervention for identifying potential low-value services and for quality improvement.”

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