TY - JOUR
T1 - Inappropriate CT examinations
T2 - how much, who and where? Insights from a clinical decision support system (CDSS) analysis
AU - Rosen, Shani
AU - Singer, Clara
AU - Vaknin, Sharona
AU - Kaim, Arielle
AU - Luxenburg, Osnat
AU - Makori, Arnon
AU - Goldberg, Natalia
AU - Rad, Moran
AU - Gitman, Shani
AU - Saban, Mor
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to European Society of Radiology.
PY - 2023/8/30
Y1 - 2023/8/30
N2 - Objective: To assess the appropriateness of Computed Tomography (CT) examinations, using the ESR-iGuide. Material and methods: A retrospective study was conducted in 2022 in a medium-sized acute care teaching hospital. A total of 278 consecutive cases of CT referral were included. For each imaging referral, the ESR-iGuide provided an appropriateness score using a scale of 1–9 and the Relative Radiation Level using a scale of 0–5. These were then compared with the appropriateness score and the radiation level of the recommended ESR-iGuide exam. Data analysis: Pearson’s chi-square test or Fisher exact test was used to explore the correlation between ESR-iGuide appropriateness level and physician, patients, and shift characteristics. A stepwise logistic regression model was used to capture the contribution of each of these factors. Results: Most of exams performed were CT head (63.67%) or CT abdominal pelvis (23.74%). Seventy percent of the actual imaging referrals resulted in an ESR-iGuide score corresponding to “usually appropriate.” The mean radiation level for actual exam was 3.2 ± 0.45 compared with 2.16 ± 1.56 for the recommended exam. When using a stepwise logistic regression for modeling the probability of non-appropriate score, both physician specialty and status were significant (p = 0.0011, p = 0.0192 respectively). Non-surgical and specialist physicians were more likely to order inappropriate exams than surgical physicians. Conclusions: ESR-iGuide software indicates a substantial rate of inappropriate exams of CT head and CT abdominal-pelvis and unnecessary radiation exposure mainly in the ED department. Inappropriate exams were found to be related to physicians' specialty and seniority. Clinical relevance statement: These findings underscore the urgent need for improved imaging referral practices to ensure appropriate healthcare delivery and effective resource management. Additionally, they highlight the potential benefits and necessity of integrating CDSS as a standard medical practice. By implementing CDSS, healthcare providers can make more informed decisions, leading to enhanced patient care, optimized resource allocation, and improved overall healthcare outcomes. Key Points: • The overall mean of appropriateness for the actual exam according to the ESR-iGuide was 6.62 ± 2.69 on a scale of 0–9. • Seventy percent of the actual imaging referrals resulted in an ESR-iGuide score corresponding to “usually appropriate.” • Inappropriate examination is related to both the specialty of the physician who requested the exam and the seniority status of the physician.
AB - Objective: To assess the appropriateness of Computed Tomography (CT) examinations, using the ESR-iGuide. Material and methods: A retrospective study was conducted in 2022 in a medium-sized acute care teaching hospital. A total of 278 consecutive cases of CT referral were included. For each imaging referral, the ESR-iGuide provided an appropriateness score using a scale of 1–9 and the Relative Radiation Level using a scale of 0–5. These were then compared with the appropriateness score and the radiation level of the recommended ESR-iGuide exam. Data analysis: Pearson’s chi-square test or Fisher exact test was used to explore the correlation between ESR-iGuide appropriateness level and physician, patients, and shift characteristics. A stepwise logistic regression model was used to capture the contribution of each of these factors. Results: Most of exams performed were CT head (63.67%) or CT abdominal pelvis (23.74%). Seventy percent of the actual imaging referrals resulted in an ESR-iGuide score corresponding to “usually appropriate.” The mean radiation level for actual exam was 3.2 ± 0.45 compared with 2.16 ± 1.56 for the recommended exam. When using a stepwise logistic regression for modeling the probability of non-appropriate score, both physician specialty and status were significant (p = 0.0011, p = 0.0192 respectively). Non-surgical and specialist physicians were more likely to order inappropriate exams than surgical physicians. Conclusions: ESR-iGuide software indicates a substantial rate of inappropriate exams of CT head and CT abdominal-pelvis and unnecessary radiation exposure mainly in the ED department. Inappropriate exams were found to be related to physicians' specialty and seniority. Clinical relevance statement: These findings underscore the urgent need for improved imaging referral practices to ensure appropriate healthcare delivery and effective resource management. Additionally, they highlight the potential benefits and necessity of integrating CDSS as a standard medical practice. By implementing CDSS, healthcare providers can make more informed decisions, leading to enhanced patient care, optimized resource allocation, and improved overall healthcare outcomes. Key Points: • The overall mean of appropriateness for the actual exam according to the ESR-iGuide was 6.62 ± 2.69 on a scale of 0–9. • Seventy percent of the actual imaging referrals resulted in an ESR-iGuide score corresponding to “usually appropriate.” • Inappropriate examination is related to both the specialty of the physician who requested the exam and the seniority status of the physician.
KW - Appropriate imaging
KW - Appropriateness criteria
KW - Clinical decision support systems
KW - CT exam
KW - European Society of Radiology
UR - http://www.scopus.com/inward/record.url?scp=85169155874&partnerID=8YFLogxK
U2 - 10.1007/s00330-023-10136-x
DO - 10.1007/s00330-023-10136-x
M3 - Article
C2 - 37646812
AN - SCOPUS:85169155874
SN - 0938-7994
VL - 33
SP - 7796
EP - 7804
JO - European Radiology
JF - European Radiology
IS - 11
ER -