Radiologists must embrace imaging appropriateness early

Another big issue facing radiology as we head into 2014 is one seemingly left over from 2013: imaging appropriateness, ie, ensuring that every patient who needs imaging gets the right exam at the right time for the right indication, while avoiding care that they don't need.

During a session on the "threats to radiology" at the 2013 meeting of the Radiological Society of North America in Chicago, Vijay Rao talked about the necessity of radiologists taking on the role of imaging utilization gatekeepers in order to reduce unnecessary imaging. "This is where radiologists have to take a leadership role in reducing unnecessary imaging," she said.

In an interview with Diagnostic Imaging, Rao expanded on the subject, arguing that radiology residents should be taking on the role of "change agents" when it comes to imaging appropriateness. "You have to be at the front line making sure that only appropriate tests are being performed," she said.

Unfortunately, in some cases this is easier said than done. In a study presented at RSNA a year earlier, researchers at Tufts Medical Center in Boston determined that imaging appropriateness isn't exactly a priority in medical school training.

The study, which involved surveying medical school radiology directors, found that imaging appropriateness ranks behind interpretation when it comes to med school priorities, and that limited faculty time and short radiology clerkships are the biggest barriers to implementing imaging utilization curriculum.

So what can be done to make sure that aspiring radiologists are getting exposed to this kind of training? The obvious answer is that teaching hospitals should be making it part of their curriculum.

But, there are other ways in which medical residents can start taking a leadership role when it comes to imaging appropriateness. For example, research published last summer in the Journal of the American College of Radiology found that having radiology residents participate in rounds with clinical teams could reinforce their role as consultants to clinicians on issues like imaging appropriateness.

Rao also pointed out that radiology residents can be proactive when it comes to this issue by taking advantage of resources available from organizations like ACR, or at annual meetings of the RSNA.

A recently published European Society of Cardiology position paper urges cardiologists to take efforts to reduce inappropriate radiation exposure. While I think such a position is a noble one, radiologists, more so, need to be the ones to embrace such efforts.

Significant changes are taking place in the specialty--particularly with regard to imaging appropriateness. Those just entering the field shouldn't be bashful about taking a leadership role in effecting such changes. - Mike (@FierceHealthIT)

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