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More research needed to pinpoint cause

Follow-up imaging happens less when radiologists interpret initial exams

by Lauren Dubinsky , Senior Reporter
When ultrasound exams are interpreted by a radiologist, the rate of follow-up imaging is significantly lower.

These were the findings of a study presented at the American College of Radiology annual meeting this week in Washington, D.C.

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Researchers at the Harvey L. Neiman Health Policy Institute assessed Medicare data from 2009 to 2014 to identify emergency department patients who underwent initial ultrasound exams. They determined whether each exam was interpreted by a radiologist or non-radiologist.

The team then added all of the follow-up imaging events that were performed seven, 14 and 30 days after each initial ultrasound exam. The differences in the mean number of imaging procedures for radiologists and non-radiologists were calculated.

They found that radiologists still interpret the vast majority of ED ultrasound exams — 200,357 were interpreted by radiologists and 36,788 by non-radiologists.

They also uncovered that the rate of follow-up imaging was 34 percent less when a radiologist interpreted the initial exam. ED patients whose ultrasounds were interpreted by non-radiologists underwent 1.08 more imaging studies within seven days, 1.22 more within 14 days and 1.34 more within 30 days of the initial exam.

Dr. Bibb Allen Jr., co-author of the study and chair of the institute's advisory board, speculated that the higher use of limited ultrasound exams among non-radiologists or their lack of confidence in the interpretations may explain these findings. However, he cautions that more research is needed to pinpoint the exact cause.

That research will be critical since cost and resource use will be a vital metric in federal health care reform as part of the Medicare Quality Payment Program.

"Efforts toward ensuring appropriate selection of the initial examination, improving documentation of findings and archiving of images, and development of institutional quality assurance programs to ensure accuracy of interpretations may all help reduce this discrepancy in the future," the researchers concluded.

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