High-Cost Imaging Follow-Ups? Don’t Blame the Radiologist

Radiologists order just 5.3 percent of high-cost imaging examinations, according to a study published online this week in the journal Radiology.

Susanna I. Lee, MD, PhD, of Massachusetts General Hospital, and colleagues sought to quantify the source of high-cost scans and understand what sort of examinations these scans involved. They considered chest and abdominal CT, brain and lumbar spine magnetic resonance imaging, and body positron emission tomography from a database of all radiology examinations (approximately 200,000) at Mass General over a six-month period.

Just 1,558 of 29,232 (5.3 percent) of high-cost examinations followed a radiologist’s recommendation, Lee and colleagues found. Chest CT was the high-cost examination most often resulting from a radiologist’s recommendation (9.4 percent), followed by abdominal CT (3.8 percent) and brain MR imaging (3.4 percent).

The examination types with the highest numbers of follow-up examinations were chest radiography, chest CT, abdominal CT, and abdominal ultrasonography. The most common findings resulting in follow-up were pulmonary nodules or masses (found in 35.9 percent of recommended high-cost examinations), other pulmonary abnormalities (9.6 percent), enlarged lymph nodes (6.6 percent), renal lesions (6.5 percent), and negative examination findings (6.5 percent).