While a new review of over 9,400 radiologist recommendations for follow-up imaging revealed greater than 88 percent agreement between radiologists and referring clinicians, researchers did note key trends that may have contributed to cases of disagreement on future imaging needs for patients.
For the retrospective study, recently published in the Journal of the American College of Radiology, researchers utilized a PACS-integrated tool to assess the level of agreement between radiologists and referring clinicians on follow-up imaging in 9,406 cases (mean patient age of 61.5).
Overall, 8,331 of the reviewed cases (88.6 percent) demonstrated agreement between radiologists and referring clinicians. However, the study authors found that surgeon referrers were 27 percent less likely to agree with follow-up imaging recommendations from radiologists. Referring clinicians were also 41 percent more likely to concur with follow-up imaging recommendations issued by thoracic radiologists, according to the researchers.
Citing the common nature of incidental pulmonary nodules and the association with repeat computed tomography (CT) exams, the study authors indicated that the higher agreement with thoracic radiologists wasn’t surprising.
“Given that lung cancer is one of the leading causes of cancer deaths in the United States, it is possible that referring providers may tend to agree with radiologists who deem that follow-up is necessary for a pulmonary nodule or other suspicious chest imaging finding, particularly when the follow-up exam typically requires no intravenous contrast and can be performed quickly,” wrote lead study author Moses Flash, M.D., who is affiliated with the Department of Radiology at the Hospital of the University of Pennsylvania, and colleagues.
Follow-up magnetic resonance imaging (MRI) was recommended in 38 percent of cases, followed by CT (33.7 percent) and ultrasound (18 percent), according to the researchers.
Three Key Takeaways
1. High agreement overall. Radiologists and referring clinicians agreed on follow-up imaging recommendations in 88.6 percent of cases, demonstrating strong overall concordance.
2. Greater agreement on recommendation from thoracic radiologists. Referring clinicians were 41 percent more likely to agree with thoracic radiologists, likely due to the importance of follow-up for pulmonary nodules and other suspicious findings on chest imaging that may be suggestive of lung cancer.
3. Lower agreement with recommendations for follow-up nuclear medicine imaging. Recommendations for follow-up nuclear medicine imaging had 36 percent lower agreement, possibly due to factors such as cost, exam duration, and limited access to radiopharmaceuticals.
The study authors also noted that agreement between radiologists and referring clinicians was 36 percent less likely with recommendations for follow-up nuclear medicine.
“ … Decreased rates of agreement for nuclear medicine follow-up imaging may be related to cost, length of exam, and availability of radiopharmaceuticals,” posited Flash and colleagues. “When analyzed globally, significant variation exists in the availability in access to nuclear medicine studies, including PET-CT. If referring providers have experienced prior access challenges, they may prefer lower cost and easier-to-acquire follow-up imaging.”
(Editor’s note: For related content, see “Improving Adherence to Best Practices for Incidental Abdominal Aortic Aneurysms on CT and MRI,” “Ultrasound Study: O-RADS Scoring May Prevent Surgery for Over 40 Percent of Ovarian and Adnexal Lesions” and “Reassessing Recommendations in Radiology Reports.”)
While the researchers found no significant impact of race, ethnicity, language, or socioeconomic status upon agreement between radiologists and referring clinicians on follow-up imaging, they emphasized that further research with respect to social determinants of health is necessary.
Beyond the inherent limitations of a retrospective single-center study, the authors conceded that the majority of the cohort was comprised of non-Hispanic White patients. They also cautioned against extrapolation of the study findings to a broader population, noting that the recommendations for follow-up imaging were provided by subspecialty-trained radiologists.
